Woman wearing blue gown lies in bed with her hand resting on a blanket

Hospice providers could face anything from termination to a combination of remedies, including fines, under a new Special Focus Program being proposed by the Centers for Medicare and Medicaid Services. 

During a webinar Tuesday, the National Association for Home Care & Hospice (NAHC) outlined the program, which is included in sweeping hospice survey reforms under the Consolidated Appropriations Act of 2021.

“There is a lot of structure to this program, but there is also a lot of subjectivity,” Katie Wehri, NAHC director of home health and hospice regulatory affairs, told members.

Hospice providers that are determined by CMS to pose an immediate jeopardy would be terminated, face enforcement remedies or both. The remedies include civil penalties not to exceed $10,000 a day, payment suspension, temporary management, a directed plan of correction and directed in-service training. The remedies could not exceed six months.

“For all of the remedies, a provider would be notified of which enforcement remedy is going to be applied and they would have at least two calendar days notice on the enforcement remedy, if there is an immediate jeopardy citation as part of the survey,” Wehri explained.

OIG report fallout

The new survey reforms follow an Office of Inspector General (OIG) report in 2019 on the quality of hospice services. The OIG report found 80% of hospices surveyed during a five-year period had one deficiency and more than 300 hospice providers were identified as poor performers with one serious deficiency and a substantiated severe complaint about the process of services.

NAHC President William Dombi said the hospice industry took an aggressive approach to helping map out survey reforms, meeting with the OIG and CMS to develop better methods of oversight, transparency and enforcement.

“Internally we brought our advocacy council and the hospice advisory council into the mix, engaging them in a deep dive into what works and what shouldn’t work on that,” Dombi said.

Special Focus hospices

Under proposed changes to hospice surveys, CMS would work with state agencies to identify hospices for the Special Focus Program. Individual states would prioritize hospice providers for the program, but would not be required to submit a certain number or percentage of hospices to CMS.

Hospice providers would have the right to appeal any action taken by CMS.