BriggsNetNews

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

CMS is placing newly enrolling hospices located in Arizona, California, Nevada, and Texas in a provisional period of enhanced oversight. Over the last 12 months, we’ve received numerous reports of hospice fraud, waste, and abuse. The number of enrolled hospices has also increased significantly in these states, raising serious concerns about market oversaturation.

The goal of enhanced oversight is to reduce hospice fraud, waste, and abuse.

For the period of enhanced oversight, new hospices include those:

            ● Newly enrolling in the Medicare Program (starting July 13, 2023)

            ● Submitting a change of ownership (CHOW) that meets all the regulatory requirements under    42 CFR 489.18

            ● Undergoing a 100% ownership change that doesn’t fall under 42 CFR 489.18

You may be affected if you:

            ● Got final approval for Medicare enrollment on or after July 13, 2023

            ● Started the enrollment or certification process before July 13, 2023, but haven’t received a       final approval letter from your Medicare Administrative Contractor (MAC)         

            ● Got approval on a change of ownership request on or after July 13, 2023

The above information is found on page 1 of the 3-page of the MLN Fact Sheet with the same title as this blog. If this information relates to your newly enrolling hospice in any of these 4 states, be sure to carefully review and share it with your team/colleagues. The remaining pages of the Fact Sheet address:

• What Type of Enhanced Oversight Will You Perform?
• How Will You Notify Me?
• When Does the Period of Enhanced Oversight Start? (Spoiler Alert: July 13, 2023)
• Will Every Hospice in the Period of Enhanced Oversight Have the Same Start Date?
• How Long Will a Hospice Stay in the Period of Enhanced Oversight?
• Can You Perform Medical Review on a Hospice That’s No Longer in the Period of Enhanced Oversight?
• Where Can I Get More Information?