Hospice:
Brace for Background Checks To Hit Your Hospice
Published on Mon May 16, 2005
Proposed COP changes may throw your hospice a curve ball. Get ready to put all your employees through a criminal background check - before they do a single day's work for you.
The Centers for Medicare & Medicaid Services has proposed new hospice conditions of participation, and chief among the changes are those for patient assessments and quality improvement (see Eli's HCW, Vol. XIV, No. 21).
But a host of other regulatory changes could throw your hospice for a loop, if finalized, experts warn. One major shift might be in how you conduct criminal background checks for your employees.
In 2002, 39 states required some kind of criminal background check for hospice employees, CMS says in the proposed rule. But the new background check procedures CMS floats could be stricter than your current ones, if you have them.
Background checks are "an economic and administrative burden on hospices,"
notes attorney Deborah Randall with Arent Fox in Washington, DC.
CMS wants hospices to conduct checks on all employees, whether they furnish hands-on care or not. And the agency proposes requiring hospices to complete the check before the employee can start working. In places where checks can take weeks or even months, that can be a major hurdle to staffing.
And hospices would have to conduct checks for both directly employed staff and contracted staff, the proposed rule says. Currently, many hospices have the companies they contract with conduct the background checks on their contracted staff. Whether CMS would still allow those arrangements under the new COPs is unclear, Randall points out.
Other changes in the COPs include: SNF relationships. CMS proposes a new COP on hospice care for patients residing in skilled nursing or other facilities. But industry veterans found guidance sorely lacking in this area that is often a hot bed for compliance problems.
"There are important details of the regulations that need to be understood," says attorney Mary Michal with Reinhart Boerner Van Deuren in Madison, WI. "Specific issues surrounding hospice care in the nursing home setting" need clarification, Michal urges.
"I was disappointed that more attention was not given to inpatient care and patients in nursing homes," offers attorney Connie Raffa with Arent Fox in New York City. For instance, intermediaries are denying inpatient care for some hospice beneficiaries because the inpatient care benefit is described as "short-term," Raffa says. CMS needs to better explain criteria for inpatient care so that patients don't have to revoke hospice to receive such care, she maintains.
Raffa also wants to see better methodology for determining when a SNF versus a hospice is responsible for certain costs, such as medications, adult diapers, etc. "Sometimes these are a very gray area" when trying to figure out what's related to the terminal diagnosis and [...]
