Jim’s Notebook: Why CMS’ 2027 Home Health Rule Matters for Every Hospice Provider
I hope everybody enjoyed the July 4 holiday. We are a troubled nation these days but can still find reasons to celebrate. I had friends come to visit from Minneapolis, people I consider to be chosen family, and it was great to spend time with them and our mutual Chicago-based chums.
The government is an active 250-year-old, giving the hospice industry quite a bit of notable news to chew over right before the holiday weekend.
The U.S. Centers for Medicare & Medicaid Services (CMS) in its proposed home health rule for 2027 introduced new measures intended to combat fraud, waste and abuse. While they appeared in a home health proposal, these measures would also apply to hospice providers as well as other health care settings. The proposals, if finalized, are projected by CMS to generate approximately $82 million in annual savings.
CMS Administrator Dr. Mehmet Oz said the proposals would provide the agency with additional tools to protect Medicare beneficiaries and taxpayer funds by ensuring that only qualified providers and suppliers participate in the program.
Among the proposed changes, CMS would expand its authority to recover Medicare payments from providers and suppliers whose enrollment is revoked. Under current policy, the agency can recoup payments retroactively only for certain types of enrollment revocations. The proposal would extend that authority to all revocation categories, allowing CMS to seek repayment regardless of the reason for the revocation.
CMS is also proposing to broaden the circumstances under which it can deny or revoke Medicare enrollment. The proposed changes include allowing the agency to:
Revoke a provider’s or supplier’s Medicare enrollment if it determines the enrollment poses a high risk of fraud, waste or abuse because the provider or supplier is located in a geographic area with an unusually high concentration of Medicare providers and suppliers.
Deny or revoke Medicare enrollment for providers or suppliers convicted within the past 10 years of certain misdemeanor offenses related to sexual assault or financial misconduct.
On the surface, these aren’t bad ideas. Strengthening barriers to entry could help curb the proliferation of fraudulent providers entering certain markets. Though I am a little concerned about the agency’s language on revoking a providers’ enrollment simply because of where they are located. It makes a certain amount of sense to apply additional scrutiny to new providers in those regions, as well as a close examination of existing companies.
However, CMS has been somewhat undiscerning in its payment suspension and revocation practices to date, with legitimate providers swept up in enforcement dragnets. I think some safeguards to protect those legitimate hospices should also be in place. Fraud needs to be confirmed before enrollment is revoked or payments suspended, which could cause a hospice to shut down.
Another major provision in the proposed rule was to allow payments for community-based palliative care through the home health benefit. You will see more from me on this issue here as well as further coverage on Hospice News after we gather some more information.
In the meantime, what do you think about these new proposed program integrity provisions from CMS? Drop a comment.