CMS Updates Benefit Policy Manual to Provide Hospice Clarifications

WASHINGTON, D.C. (October 26, 2021)—The Centers for Medicare & Medicaid Services (CMS) has updated Chapter 9 of the Medicare Benefit Policy Manual to provide clarification for two hospice items:

1. Election statement addendum
2. Aggregate cap calculation methodology

The clarifications are welcome, especially for the election statement addendum. Since its implementation last year hospices have been asking for more information about certain aspects of the addendum. In the FY 2022 hospice final rule CMS provided the following related to the addendum:

• If the beneficiary dies, revokes, or is discharged within the required timeframe after requesting the addendum (i.e., within five days or three days of the request, depending on when the request was made), and before the hospice has furnished the addendum, the addendum is not required to be furnished and the condition for payment is considered satisfied.
• If the beneficiary requests the addendum and the hospice furnishes the addendum within three or five days (depending upon when the request for the addendum was made), but the beneficiary dies, revokes, or is discharged prior to signing the addendum, a signature from the individual (or representative) is no longer required in order for the condition for payment to be considered met.
• Hospices must include the “date furnished” on the addendum.
• The “date furnished” must be within the required timeframe (that is, three or five days of the beneficiary or representative request, depending on when such request was made), rather than the signature date.
• If a beneficiary requests the addendum within the first five days of the effective date of the election, the hospice has five days from the request date to furnish the addendum. If a beneficiary requests the addendum after the first five days of an election, the hospice has three days from the date of the beneficiary request to furnish the addendum.
• If a patient or representative refuses to sign a requested addendum, the hospice must document clearly on the addendum the reason the addendum itself is not signed in order to mitigate a claims denial for this condition for payment.
• The hospice has “three days” rather than “72 hours” to furnish the requested addendum when the request is made after the first 5 days of the hospice election date.
• If a non-hospice provider requests the election statement addendum, the non-hospice provider is not required to sign the addendum.

Change Request (CR) 12491/Transmittal 11056 updates the manual to reflect these changes and also updates the manual to reflect an extension of the hospice aggregate cap calculation methodology required by the IMPACT Act of 2014. Specifically, the IMPACT Act of 2014 requires that, for accounting years that end after Sept. 30, 2016, and before Oct. 1, 2025, the hospice cap be updated by the hospice payment update percentage rather than using the medical care expenditure category of the Consumer Price Index for Urban consumers (CPI–U).

The 2021 Consolidated Appropriations Act (CAA 2021) has extended the accounting years impacted by the adjustment made to the hospice cap calculation until 2030. Therefore, the hospice cap amount is updated by the hospice payment update percentage rather than using the CPI–U for accounting years that end after Sept. 30, 2016, and before Oct. 1, 2030, at which time the annual update to the cap amount will revert back to the original methodology.

—Via NAHC