Eli's Hospice Insider

Published on Wed Sep 22, 2010 PDF

CMS has given state Medicaid programs their marching orders about furnishing hospice to children while still covering curative treatment, and the new requirements are likely to increase your hospice business.

In a Sept. 9 letter, CMS tells state Medicaid program directors that the health care reform law enacted earlier this year requires them to cover both hospice services and curative treatment for kids.

Medicaid programs are not required to offer the hospice benefit at all, the letter points out. But if they do, states now must cover hospice in addition to other medically necessary treatments for children. "We believe implementation of this new provision is vitally important for children and their families seeking a blended package of curative and palliative services,"  says the letter. "This provision will increase utilization of hospice services since parents and children will no longer be required to forego curative treatment." The letter is at www.cms.gov/smdl/downloads/SMD10018.pdf.

• Looking for new falls prevention education tools? The American Physical Therapy Association has a video in which PT Diane Nichols provides some fall-proofing tips for seniors. APTA issued the tool for the third annual Falls Prevention Awareness Day on Sept. 23. Links to the video and other falls prevention tools, such as a walking aid tips sheet, are at www.moveforwardpt.com/tips.

One tip: A "walker or cane should be about the height of your wrists when your arms are at your sides," the tips sheet says.

• CMS has followed through on its proposal to update the ICD-9 code set one last time on Oct. 1, 2011. In 2012, no ICD-9 codes will be added to the set except for those updates required for new technologies and diseases.

That's the word from the ICD-9-CM Coordination and Maintenance Committee meeting, held Sept. 15 and 16. In 2013, there will be limited code updates to the ICD- 10 code set to capture new technologies and diagnoses, CMS's Pat Brooks explained at the meeting. ICD-9 will no longer be used for reporting purposes, so no updates to that code set will take place.

Starting Oct. 1, 2014, regular updates to ICD-10 will begin, Brooks said.

• Another Affordable Care Act provision may affect you if you run into trouble with your physician relationships. The measure, which the health care reform law refers to as the Medicare self-referral disclosure protocol (SDRP), provides a way for providers with actual or potential Stark (self-referral) violations to come clean. Providers can "confess their sins to the [HHS Office of Inspector General] and get special consideration," says attorney Michael Cassidy, in Pittsburgh, Pa. "It's almost like where you can self disclose to the Internal Revenue Service and therefore don't get the severe penalties," he adds.

"The SRDP requires health care providers ... to submit all information necessary for CMS ... to analyze the actual or potential violation" of the Stark law, CMS says in a message to providers. The provision "gives the Secretary of [the Department of Health and Human Services] the authority to reduce the amount due and owing for violations." The SRDP is located on the CMS website at www.cms.gov/PhysicianSelfReferral.