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Hospices Must Report Their Medical Director to Medicare Now

The Health Group

The 2024 Home Health Prospective Payment System (“HH PPS”) Rate Update final rule included a provision clarifying that the definition of a Managing Employee in 42 CFR §424.502 includes the administrator and medical director of a hospice.  This change was incorporated into CMS Pub 100-08 Medicare Program Integrity effective January 1, 2024.  Most hospices have always reported the administrator; however, many have not previously reported their medical director as part of their Medicare Enrollment Record.

Pursuant to CFR 42 §418.102, the hospice must designate a physician to serve as medical director.  This individual can be employed by the hospice or under contract with the hospice.  Accordingly, all hospices should include a medical director in their enrollment record.

With the change in regulations, hospices have been updating their Medicare Enrollment Record to include the medical director when the Medicare Enrollment Record needed to be updated for another reason.  Most hospices have updated this information when initially enrolling, revalidating enrollment, or at the time of changing other information currently on file.

Recently, the Centers for Medicare & Medicaid Services (“CMS”), Center for Program Integrity, issued a letter to hospice providers that included the following:

“Every Medicare provider and supplier must report all current managing employees.  If you have not reported a medical director or administrator to CMS as a managing employee, you must do so now.

If any updates are needed, submit an 855A enrollment application online via http://pecos.cms.hhs.gov or a paper CMS-855-A enrollment application via mail to your jurisdiction’s Medicare Administrative Contractor (MAC).  You will need to update the enrollment record of each individual Hospice enrollment.”

Furthermore, the letter includes, “A failure to comply with this requirement may result in the revocation or deactivation of your Medicare enrollment in accordance with 42 CFR §424.535 and §424.540.”

The letter did not provide a specific date by which the update must be made; however, based on the letter, we recommend that all hospices address this reporting need at their earliest opportunity.  The CMS-855-A, as revised, includes information that may not have been previously reported.  Other modifications to the Medicare Enrollment Record may also be necessary.

 

MedPAC Report Slammed by Insurers and Docs over Medicare Advantage and Physician Reimbursement

Fierce Healthcare | By Noah Tong
 
Health plans and providers alike are disgruntled with a new report (PDF) to Congress released by the Medicare Payment Advisory Commission (MedPAC) Friday.
 
The American Medical Association (AMA) and the Medical Group Management Association (MGMA) said the recommendations it gives for physician payments are flawed, while America's Health Insurance Plans (AHIP) defended Medicare Advantage (MA).
 
"On the heels of Congress allowing a 1.69% cut to Medicare physician reimbursement to stand for the remainder of 2024, today's MedPAC recommendation to provide a 50% inflationary update for physician servics in 2025 is woefully inadequate," said Anders Gilberg, senior vice president of government affairs for the MGMA, in a statement. "I am mystified why MedPAC even bothers to make an annual recommendation while it ignores the signficant Medicare cuts to physicians in 2024 and recent years."
 
AMA President Jesse Ehrenfeld, M.D., praised the commission's opinion to tie physician payments to the Medicare Economic Index but said its current proposal is lacking.
 
"MedPAC’s decision recognizes that physician pay is lagging far behind the cost of practicing medicine," said Ehrenfeld in a statement. "Yet, an update tied to 50% of MEI—as MedPAC recommended—will cause physician payment to fall even further behind increases in the cost of providing care."
 
The AMA has wanted Congress to pass legislation requires the MEI to better reflect inflation, a contrast from the current environment where rates have continued to fall and providers are dealing with rising costs across the board, particularly after the COVID-19 pandemic.
 
MedPAC's recommendation calls for updating the base payment rate "by the amount specified in current law plus 50% of the projected increase in the MEI." It also wants to establish safety-net add-on payments under the physician fee schedule for services delivered to low-income Medicare members…

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House Committee Hearing ‘Setting the Stage’ for Home Care Support, Policy Expert Says

McKnight’s Home Care | By Adam Healy
 
A House Ways and Means Committee hearing last week reinforced congressional support for home care, stakeholders said. Home-based kidney care and telehealth were two big topics of discussion.  
 
“Seemingly, the hearing was setting the stage for consideration of a number of pieces of legislation on these topics,” Mollie Gurian, vice president of home based and HCBS policy at LeadingAge, said during a policy update call on Wednesday. “A lot of the committee members on both sides of the aisle showed up and almost all of them were touting a bill that they were working on in one of these spaces.”
 
Such bills ranged from narrow regulatory fixes to broader policy change, she said, including legislation that could make permanent some waiver flexibilities implemented during the COVID-19 pandemic. Notably, telehealth and hospital-at-home programs received waiver extensions as a result of the pandemic. 
 
“It was a very interesting hearing and there was a lot of support for expanded care at home, generally, which we found to be very positive,” she said. 
 
Experts supporting home dialysis, hospital-at-home, telehealth and more testified last Tuesday. Among those testifying was Ateev Mehrotra, MD, a professor of health policy and medicine at Harvard Medical School, who recommended policy changes that could make virtual care services more accessible to Medicare beneficiaries.
 
“I believe it is critical to give Medicare as much flexibility as possible in adapting telehealth policy,” Mehrotra said in his testimony. “Telehealth use is rapidly changing, and policy must adapt accordingly.”
 
And Nathan Starr, medical director of home services and tele-hospitalist programs at Intermountain Health, advocated for the expansion of home-based services such as hospital-at-home during the Tuesday hearing.
 
“I have personally seen patient, family, community, and caregiver benefits of care at home,” Starr said. “Our positive experience has reinforced our commitment to increasing access to care at home. That is also why we are so pleased to be here today to advocate for the federal health policy changes needed to enable and support current and future hospital-at-home and patient needs.”

 

Ghostbots: AI Versions of Deceased Loved Ones Could be a Serious Threat to Mental Health

The Conversation | By Nigel Mulligan

We all experience loss and grief. Imagine, though, that you don't need to say goodbye to your loved ones, that you can recreate them virtually so you can have conversations and find out how they're feeling.

For Kim Kardashian's fortieth birthday, her then husband, Kanye West, gifted her with a hologram of her dead father, Robert Kardashian. Reportedly, Kim Kardashian reacted with disbelief and joy to the virtual appearance of her father at her birthday party. Being able to see a long-dead, much missed loved one, moving and talking again might offer comfort to those left behind.

After all, resurrecting a deceased loved one might seem miraculous—and possibly more than a little creepy—but what's the impact on our health? Are AI ghosts a help or hindrance to the grieving process?

As a psychotherapist researching how AI technology can be used to enhance therapeutic interventions, I'm intrigued by the advent of ghostbots. But I'm also more than a little concerned about the potential effects of this technology on the mental health of those using it, especially those who are grieving. Resurrecting dead people as avatars has the potential to cause more harm than good, perpetuating even more confusion, stress, depression, paranoia and, in some cases, psychosis.

Recent developments in artificial intelligence (AI) have led to the creation of ChatGPT and other chatbots that can allow users to have sophisticated human like conversations.

Using deep fake technology, AI software can create an interactive virtual representation of a deceased person by using their digital content such as photographs, emails, and videos.

Some of these creations were just themes in science fiction fantasy only a few years ago but now they are a scientific reality.

Digital ghosts could be a comfort to the bereaved by helping them to reconnect with lost loved ones. They could provide an opportunity for the user to say some things or ask questions they never got a chance to when the now deceased person was alive.

But the ghostbots' uncanny resemblance to a lost loved one may not be as positive as it sounds. Research suggests that deathbots should be used only as a temporary aid to mourning to avoid potentially harmful emotional dependence on the technology.

AI ghosts could be harmful for people's mental health by interfering with the grief process

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How CON Laws Influence Hospice Quality, Program Integrity [Featuring HHAC]

Hospice News / By Holly Vossel

Variations in hospice certificate of need (CON) state laws are raising program integrity concerns.

However, this coin has two sides. CONs have a big role to play when it comes to quality and utilization, according to Susan Ponder-Stansel, president and CEO of Florida-based Alivia Care.

“What ends up happening in states without CON is actually lower hospice utilization with way too many hospices in one service area, and often fragmented care without all four levels of hospice offered,” Ponder-Stansel told Hospice News. “In states with CON, we see much higher utilization rates and more scaling down on quality. You can’t create an unlimited demand or more demand without understanding consumer preferences and regulatory barriers. You have to walk in line with the [patient] demand and regulatory requirements.”…

If a state does not have a CON program in place, then local governing bodies are often unable to play a direct role in the hospice needs determination process, according to Matt Hansen, deputy director of the Home Care and Hospice Association of Colorado (HHAC). Hansen also serves as executive director of the Homecare & Hospice Association of Utah (HHAU).

“They may be aware of a need due to reports from referring parties that they aren’t able to find a provider. However, approving a new license is not based on how many providers are already in an area,” Hansen said.

Without having a role in the determination process, it can make it difficult to balance quality with supply and demand of hospice in a region, according to Hansen.

“Demand and supply of hospice resources is balanced by market conditions,” Hansen said. “If there are too many hospices in an area to meet current demand, those hospice agencies that do not have a large enough referral base and patient census will typically flounder until they sell to another provider or close.”

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