Volume 25.04
The Full-Year Continuing Appropriations and Extension Act of 2025 (FY 2025) “ACT”), recently passed by Congress allows for the continuation of many programs. Telehealth flexibilities for hospice have been extended through September 30, 2025. Hospices may perform face-to-face recertifications through telehealth.
Additionally, the legislation extended the waivers allowing an expanded definition of practitioners who are eligible to provide telehealth services and expanded originating sites for telehealth services.
The extensions provided by the Act are critically important to telehealth providers because without them, Medicare coverage of telehealth services will once again be restricted by provisions in Section 1834(m) of the Social Security Act. This Section limits Medicare coverage of telehealth services to services furnished to patients in rural clinical sites by a specified list of providers with limited exceptions. The extension of these waivers through September 30, 2025, provides some temporary relief for health care providers with respect to Medicare payment for telehealth services. Telehealth providers and practitioners will be awaiting further action from the new Congress before the next impending termination of these important statutory waivers, which have allowed Medicare coverage of telehealth services that patients and providers have come to rely upon. The availability of telehealth has allowed hospices to serve more patients especially during a period with staffing shortages and increasing demand for hospice services.
HOSPICE INTEGRITY STILL CENTER STAGE
While the Trump administration has suspended the significantly flawed Special Focus Program (“SFP”), overall integrity of the hospice program, owners, Medical Directors, and services themselves remains forefront in the minds and efforts of CMS.
Many integrity initiatives, such as those included in previously proposed legislation, remain available for further action. However, it is obvious that claims driven audits continue in earnest. Many hospices have been subjected to multiple audits being conducted concurrently. Unfortunately, quality hospices are expending more and more resources defending claims which could be available for patient care. The increased audit activity is compounded by differing interpretations by differing auditors.
NUMBER OF CAP HOSPICES CONTINUES TO INCREASE
It is obvious that the number of hospices exceeding the Hospice Aggregate Payment Limitation (“CAP”) continues to increase based on self-filings for the 2024 CAP Year and hospices reaching out to us as they receive repayment demands that were not expected. Even hospices not currently experiencing a CAP liability should be self-monitoring their CAP liability or developing procedures to monitor both current and historical CAP liabilities that continue to grow as the Medicare Administrative Contractors (“MACs”) recalculate prior year CAP. The March 2025 MedPAC Report to Congress has hospices exceeding the CAP for 2022 at 22.6% compared to 18.9% for 2021.
The 2025 Hospice Financial Administration Conference sponsored by The Health Group, LLC will be offering some concurrent sessions allowing attendees to make certain program selections based on their unique needs. One concurrent session will be “Everything CAP”. The three (3) hour session will be the most comprehensive CAP session ever provided and address many issues and circumstances that can and do influence CAP liabilities.
MEDPAC RELEASES MARCH 2025 REPORT TO CONGRESS
The Medicare Payment Advisory Commission (“MedPAC”) has issued its 2025 Report to Congress. The Report makes only one (1) recommendation – “For fiscal year 2026, the Congress should eliminate the update to the 2025 Medicare base payment rates for hospice”. We will be reporting further on some of the detail contained in the MedPAC Report; however, the recommendation (previously made) to geographically adjust the Hospice CAP was glaringly missing when such a recommendation has been made in the past.
The entire report can be viewed here.