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Volume 24.05

The 2024 Home Health Prospective Payment System (“HH PPS”) Rate Update final rule included a provision clarifying that the definition of a Managing Employee in 42 CFR §424.502 includes the administrator and medical director of a hospice.  This change was incorporated into CMS Pub 100-08 Medicare Program Integrity effective January 1, 2024.  Most hospices have always reported the administrator; however, many have not previously reported their medical director as part of their Medicare Enrollment Record.

Pursuant to CFR 42 §418.102, the hospice must designate a physician to serve as medical director.  This individual can be employed by the hospice or under contract with the hospice.  Accordingly, all hospices should include a medical director in their enrollment record.

With the change in regulations, hospices have been updating their Medicare Enrollment Record to include the medical director when the Medicare Enrollment Record needed to be updated for another reason.  Most hospices have updated this information when initially enrolling, revalidating enrollment, or at the time of changing other information currently on file.

Recently, the Centers for Medicare & Medicaid Services (“CMS”), Center for Program Integrity, issued a letter to hospice providers that included the following:

“Every Medicare provider and supplier must report all current managing employees.  If you have not reported a medical director or administrator to CMS as a managing employee, you must do so now.

If any updates are needed, submit an 855A enrollment application online via http://pecos.cms.hhs.gov or a paper CMS-855-A enrollment application via mail to your jurisdiction’s Medicare Administrative Contractor (MAC).  You will need to update the enrollment record of each individual Hospice enrollment.”

Furthermore, the letter includes, “A failure to comply with this requirement may result in the revocation or deactivation of your Medicare enrollment in accordance with 42 CFR §424.535 and §424.540.”

The letter did not provide a specific date by which the update must be made; however, based on the letter, we recommend that all hospices address this reporting need at their earliest opportunity.  The CMS-855-A, as revised, includes information that may not have been previously reported.  Other modifications to the Medicare Enrollment Record may also be necessary.


On March 15, 2024, the Medicare Payment Advisory Commission (“MedPAC”) released its Report to Congress.  

The report included the recommendation that Congress should eliminate the update to the 2024 Medicare base payment rate for hospice.  This recommendation was expected.

Additional information regarding the MedPAC report will be provided.