CMS Ruling May Put Long-Term Care And Hospice Providers At Odds
By Greg Bengel, contributing writer
Rule requires written agreements – previously optional – that clearly delineate which services each entity will provide to residents of nursing homes
On June 27, CMS passed a new rule requiring long-term care (LTC) facilities to enter into written agreements with hospice providers to clearly delineate which services each entity will provide to residents of nursing homes. Effective August 26, 2013, skilled nursing homes and nursing facilities will need to have these written agreements in place, which previously had been optional.
According to morganlewis.com, this new rule might complicate the relationship between LTC facilities and hospice providers and lead to confrontation. It reads, “An extensive list of comments and responses in the final rule examines many challenging operational issues, such as whether the LTC facility or hospice provider would assume the role of primary decision maker as well as how providers would handle disagreements between hospice staff and LTC facility staff due to hospice providers changing orders unrelated to palliative care for a patient’s terminal diagnosis. LTC facilities and hospices attempting to reconcile the final rule’s care coordination agreement and patient transfer notification requirements with those already in effect for hospices may want to examine whether the changes require them to reexamine and perhaps renegotiate their contracts.”
Despite these potentials for conflict, the rule aims to help the situation, not complicate it. This article on mondaq.com explains what CMS hopes to achieve with the rule. The agreement’s purpose, according to the article, is “to ensure that duplicative or conflicting services are not provided to the resident as part of the hospice benefit, and that there will be no missing hospice services.” The written agreements should “increase coordination of care for patients as well as foster communication between the two providers assisting patients and their families.” CMS also believes the new rule will “address situations where neither the LTC facility nor the hospice is providing a needed hospice service.”
Leading Age does a great job at breaking down the provisions of the final rule. Scanning the provisions provides insight on how the rule plans to increase communication between the two providers. For instance, the rule contains a provision that the LTC facility must immediately notify hospice about significant changes in status, clinical complications, a need to transfer the resident, or the resident’s death. Also, LTC facilities must designate an interdisciplinary team member who collaborates and works with hospice to coordinate care.
According to Home Health Care News, CMS does not believe its rule will significantly impact bottom lines. CMS also estimates the requirements will cost $437 per LTC facility in the first year and $232 in the following years. These figures, CMS notes, represent less than 1 percent of these companies’ revenues.