New Federal Rules for Hospice Providers

 Posted on April 05,2022 in Medical License Defense

The healthcare industry faces an ever-growing mountain of rules and regulations issued by the federal government that must be followed. Failure to adhere can result in fines, sanctions, and even a suspension or revocation of an individual’s professional license or the facility’s operating license. As new requirements issued for hospices as a result of the Consolidated Appropriations Act of 2021 go into effect in the fiscal year 2022, it is critical to understand what those requirements are.

Why the Change?

These new rules were created as a result of the findings of reports filed over the past several years that examined the results of hospice surveys by accreditors and regulators that found that at least 20 percent of these hospices had serious deficiencies. Some of the deficiencies cited in one report issued by the U.S. Department of Health and Human Services Office of the Inspector General (OIG) in 2019 included organizations that failed to manage patients’ pain, failure to make home visits, and even cited one incident where a patient’s feeding tube was infested with maggots.  

Special Focus Program

There are nine changes that U.S. Centers for Medicare & Medicaid Services (CMS) will be putting into effect. Each of these changes do have various effective dates. Some, such as the new requirement for each hospice program to set up a hotline, have already gone into effect. These changes have been made in the following sections:

• Patient’s rights (Section 418.52)

• Initial and comprehensive assessment of the patient (Section 418.54)

• Interdisciplinary group, care planning and coordination of care (Section 418.56)

• Quality assessment and performance improvement (Section 418.58)

Penalties for Noncompliance

In the past, the only option CMS could take against hospice providers that failed to comply with Medicare rules was termination. But these new rules allow CMS to issue a variety of significant penalties against a provider. Some of the forms of remedy CMS now includes are:

• Fines (from $500 to $10,000 per day for every day provider is not in compliance)

• Appointment of temporary management to bring provider back into compliance

• Suspension of all Medicare reimbursement

• Revocation of Medicare certification

In addition to the above remedies, all results from hospice surveys, which in the past had been confidential, will now be public.

Let an Illinois Professional License Defense Attorney Help

If you are a hospice provider and you have been notified of noncompliance, contact a seasoned Illinois CRM noncompliance attorney for help in defending against these allegations. Call The Law Offices of Joseph J. Bogdan, Inc. at 630-310-1267 to schedule a free consultation and find out what legal options you may have.

 Sources:

https://www.cms.gov/files/document/2021aug31hospice-final-rule-webinar.pdf

https://www.congress.gov/116/bills/hr133/BILLS-116hr133enr.pdf