Hospice Survey Reforms Updated in 2022 Home Health Final Rule

Based on 2019 reports about concerns stemming from hospice survey performance from the Department of Health and Human Services’ Office of the Inspector General regarding, Congress enacted broad reforms in the Consolidated Appropriations Act of 2021 (CAA 2021), which include expansion of enforcement remedies available to CMS for use in response to survey deficiencies, requirements to make hospice survey findings publicly available, and creation of a Hospice Special Focus Program.

Final rules were included in the recently-released CY 2022 Final Home Health Payment Rule. The following is from an article that constitutes the National Association for Home Care & Hospice’s (NAHC’s) summary of those rules based on an initial review.

“The CAA 2021 contains nine new survey and enforcement provisions for hospice programs. The law:

• Requires public reporting of hospice program surveys conducted by State agencies (SAs) and accrediting organizations (AOs), as well as enforcement actions taken as a result of these surveys, on CMS’s website in a manner that is prominent, easily accessible, searchable and readily understandable format.

• Removes the prohibition at section 1865(b) of the Act of public disclosure of hospice surveys performed by AOs, requiring that AOs use the same survey deficiency reports as SAs (Form CMS-2567, “Statement of Deficiencies” or a successor form) to report survey findings.

• Requires programs to measure and reduce inconsistency in the application of survey results among all surveyors.

• Requires the Secretary to provide comprehensive training and testing of SA and AO hospice program surveyors, including training with respect to review of written plans of care.

• Prohibits SA surveyors from surveying hospice programs for which they have worked in the last 2 years or in which they have a financial interest.

• Requires hospice program SAs and AO to use a multidisciplinary team of individuals for surveys conducted with more than one surveyor (to include at least one registered nurse (RN).

• Provides that each SA must establish a dedicated toll-free hotline to collect, maintain, and update information on hospice programs and to receive complaints.

• Directs the Secretary to create a Special Focus Program (SFP) for poor-performing hospice programs, sets out authority for imposing enforcement remedies for noncompliant hospice programs.

• Requires the development and implementation of a range of remedies as well as procedures for appealing determinations regarding these remedies. These enforcement remedies can be imposed instead of, or in addition to, termination of the hospice program’s participation in the Medicare program. These remedies include civil money penalties (CMPs), suspension of all or part of payments, and appointment of temporary management to oversee operations.

As a reminder, the survey reforms have various implementation dates, ranging from “upon enactment” to October 1, 2021, to future dates. Based on a memo released on October 20, 2021, CMS is prohibited from conducting compliance monitoring activities using these policy changes until sixty (60) days from the effective date of the new regulations contained in the CY 2022 Home Health Payment Rule, which is January 1, 2022.”