Federal Home Health and Hospice Updates
(March 25, 2025) Please see LeadingAge National's home health and hospice updates below:
CMS Releases Updated List of Unacceptable Hospice Principal Diagnosis Codes Effective April 1st. In a Change Request (CR 13882) released on March 13th, the Centers for Medicare and Medicaid Services (CMS) provided an updated list of unacceptable principal diagnosis codes under the hospice benefit. The Claims Processing Manual has also been updated to provide guidance on non-reportable principal diagnosis codes and provides clarification of liability for claims denials during a hospice election. Specifically, the CR discusses the responsibility and the liability related to missing GW, GV, or 07 modifiers for Medicare-certified providers. CMS states: “It is the responsibility of all Medicare-certified providers to check the Medicare status of each Medicare beneficiary when rendering and billing for services, a claim missing the GW or GV modifier or condition code 07 would be denied as provider liability.” The effective date of the CR is April 1, 2025; for claims received on or after April 1, 2025, unless otherwise specified, the effective date is the date of service. Any claims submitted with these codes will be returned to the provider with claims edits for non-reportable hospice diagnosis code. Providers will no longer receive edits with reason code 30727, but instead they will receive an Integrated Outpatient Code Editor (IOCE) edit.
Hospice Quality and Compliance Workgroup to Meet on March 26th. The LeadingAge National Hospice Quality and Compliance Workgroup will meet on Wed., March 26th at 1 p.m. ET. During the meeting, providers will break out into groups based on electronic health record (EHR) vendor to share what each provider has been told regarding the implementation of the Hospice Outcomes and Patient Evaluation (HOPE) tool and the consistencies and inconsistencies in information. Once the breakouts conclude, the group will come back together and discuss each vendor’s current timeline for complying with HOPE’s implementation and discuss follow-up and advocacy opportunities for LeadingAge National with individual vendors and the administration. LeadingAge National strongly encourages members to have anyone engaged with these vendors to join the call. Members can sign up here.
Register Now for Next LeadingAge National Medicare Advantage Webinar on April 23rd. Contracting with Medicare Advantage plans can be challenging. They often offer low reimbursement and require additional work from providers. LeadingAge National is offering a new webinar exclusively focused on “Mastering the Medicare Advantage Contract Lifecycle” on Wed., April 23rd from 2-3:30 p.m. ET. In this webinar, Strategic Healthcare’s Grant Swemba will dig deeper into how to initiate these contract discussions, what data providers will need to support better contract terms, and how to implement the contract provisions to get the payment deserved. To learn more and register, click here.
LeadingAge National Asks DEA to Exclude Hospice and Skilled Nursing Prescribers from Telehealth Rule. On March 18th, LeadingAge National submitted comments on a proposed rule from the Drug Enforcement Administration (DEA) which would establish special registration requirements for prescribing controlled substances via telehealth. In the letter, LeadingAge National urged the DEA to specifically exempt hospice and skilled nursing providers from this and any future similar rules under the authority given to the DEA Administrator and the Secretary of Health and Human Services to jointly establish exemptions in regulation under the Ryan Haight Act of 2008. LeadingAge National also strongly encouraged the DEA to revise these rules, in consultation with stakeholders, to further account for providers that serve equally vulnerable individuals outside of nursing homes and hospices, including providers serving palliative care patients and home health patients. Read the full comments here.
MedPAC Releases March 2025 Report. On March 13th, the Medicare Payment Advisory Commission (MedPAC) released their March 2025 report to Congress. LeadingAge National will review the findings in more detail in the coming days, but reminds members that MedPAC recommendations must be passed by Congress to become law – they are just recommendations, not mandates. The March report focuses on assessing payment adequacy and access across Medicare settings; the June report tends to include chapters with more long-term work that the Commissions is undertaking.
- Home health received a recommendation for a 7 percent fee-for-service (FFS) base payment cut, which LeadingAge National strongly disagrees with, and they have pushed MedPAC to look at various aspects of the program. LeadingAge National is pleased that MedPAC is doing a deep dive on Medicare Advantage and home health and looks forward to seeing that work published in June.
- Hospice received a recommendation of no increase – i.e., flat reimbursement – which LeadingAge National also disagrees with.
- Skilled nursing facilities (SNFs) received a recommendation for a 3 percent FFS base payment cut, which LeadingAge National also disagrees with. LeadingAge National will provide more details on aspects of the chapters on home health, hospice, SNFs, and Medicare Advantage and any other pertinent points next week.
Home Health, Hospice Dissertation Grant Opportunity. The Research Institute for Home Care (the Institute) announced a new round of dissertation grant funding for this year called the Home Care Research Grant. The Institute is seeking to sponsor one or more dissertation research projects to help advance the full spectrum of home care and may seek to improve care delivery at home through quality and innovation as part of their annual Home Care Research Grant. Last year, the LeadingAge Long-Term Services and Supports (LTSS) Center’s Molly Wylie was selected for funding to support researching health literacy among community-dwelling older adults who access home and community-based services (HCBS) and their caregivers. Funding will be awarded up to $10,000 maximum per project. Submissions will be accepted through Fri., May 9th at 5 p.m. ET. Projects must have focus in at least one of the following areas:
- Workforce
- Rural Health
- Patient Access to Home Care
- Virtual Care and Technology Utilization
- Disease-Specific Innovation
- Payment and Delivery Models
- Quality of Care
- Care Delivery Continuum
LeadingAge Win: AHRQ Releases Systematic Review of Interventions to Improve Care of Bereaved Persons. On March 13th, the Agency for Healthcare Quality and Research (AHRQ) released their systematic review of interventions to improve the care of bereaved persons. This is a systematic review of current literature on evidence-based practice related to grief and bereavement services. This is a continuation of the work that LeadingAge National has previously reported on by AHRQ and the Assistant Secretary for Planning and Evaluation (ASPE) as part of the Consolidated Appropriations Act of 2023, in which LeadingAge National advocated for funding on an evidence review and technical expert panel to establish consensus-based standards for grief and bereavement care based on feedback from members about the lack of standards for grief and bereavement care in hospice. Prior to the release of this review by AHRQ, on June 28, 2024, LeadingAge National submitted comments to AHRQ on the first phase of this systematic literature review for a research project on Interventions to Improve Care of Bereaved Persons; these comments spoke to LeadingAge National’s continuum of services. ASPE then reviews key points from that literature review and key contributor interviews, which can be read here. LeadingAge National thanks U.S. Senators Brown and Capito for partnering with them on this funding request in 2023 and will review the work in its entirety to inform next steps.
Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871