The Ohio Department of Health (ODH) convened a meeting on January 8 with hospice providers throughout the state who have a hospice inpatient facility to discuss the provisions in recently-passed HB 286, which will allow hospices who operate an inpatient facility or unit to serve palliative care patients in that facility. ODH will be writing rules for this new program, but first wanted to learn from industry experts how this new provision might impact services to palliative care patients.
ODH did stress the statute will only impact hospices with inpatient units, and this change will be addressed in the current hospice rule package. ODH also emphasized that a hospice did not have to accept palliative care patients in their inpatient units if they chose not to. However, if the hospices made the decision to admit palliative care patients they would have to ensure all hospice patients with general inpatient (GIP) level of care needs were able to receive the necessary care either in their facility or via contract with a Medicare/Medicaid certified facility and surveyors would expect to see policies supporting this.
Discussions regarding specific language in statute, such as short-term basis and medically necessary were also discussed at length. ODH stated because “short-term basis” was in statute they would have to define a specific time frame in rule. It was determined a subgroup of medical providers should be convened to craft guidance for rule development regarding criteria for medically necessity as well as for what will constitute as “short-term”. Selina Jackson, ODH asked that providers email her if they are interested in being on this subgroup.
Shannon Richey, ODH said she had reached out to the Centers for Medicare & Medicaid Services (CMS) previously to ask for guidance as to how this new program would affect the hospice survey and certification processes. CMS stated, a hospice program who is receiving federal dollars for hospice GIP level of care in their inpatient units would have to follow all the Conditions of Participation (CoPs) for their palliative care patients as well. Providers sought clarification of whether CMS was referring to ALL COP’s or only those pertaining to inpatient care. Lengthly discussion then ensued regarding the hospice CoP’s related to a patient’s prognosis of 6 months or less which would not necessarily be appropriate for a palliative care patient. ODH realized many palliative care patients have a longer prognosis than 6 months, but felt CMS was adamant regarding upholding the hospice CoP’s for palliative care patients. ODH asked the providers to submit comments to them regarding this issue as soon as possible and they will elevate the provider comments to CMS for additional guidance.
The hospice providers then answered ODH’s questions surrounding how hospices would accept referrals, attending physician involvement in inpatient care, whether hospice inpatient units would have staff dedicated to palliative care patients, pharmacy issues, family involvement with the palliative patient plan of care and education of hospice staff, patients and families about this new program.
ODH suggested it might be beneficial if the hospice providers convened a subgroup to discuss and create education and/or resources about this new program that can be housed on the ODH website and shared with staff and consumers. ODH also said they would plan to reconvene stakeholders to review the hospice rules that would be either updated to reflect the changes in the statute or developed for the palliative care program. There is no timeframe for the updating or developing these rules as ODH has asked for an extension of the 5-year rule review for the hospice rules.
If you have any questions regarding this discussion, or if you have specific feedback for ODH to inform its discussions with CMS regarding whether the entirety of the CoPs should be applied to palliative care patients, please contact Anne Shelley at ashelley@leadingageohio.org.