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Revised 2024 Medicare Physician Fee Schedules
These fees are based on the CY 2024 Medicare Physician Fee Schedule (MPFS) Final Rule and are effective January 1, 2024.
Centers for Medicare and Medicaid Services (CMS)
Hospice Providers, TNMHPO has shared this information with you via Community Mobilize and the Regulatory Update since Mid-November 2023. It is extremely important that you review all this information and share it with pertinent staff.
This will be the final notice on these 2024 rule changes.
(CY) 2024 Home Health Prospective Payment System Rate Update and Quality Reporting Program Requirements and CY 2024 Physician Fee Schedule Highlights
TNMHPO wants you to be aware that there will be changes for hospice providers on January 1, 2024. It is important to note that many changes took place under 42 CFR 424—CONDITIONS FOR MEDICARE PAYMENT under the CY 2024 HH Prospective Payment System Rate Update. The information provided is based on webinars and communication between national associations and CMS. We highly recommend that you share all the changes with pertinent staff. We shared the information daily via the TNMHO Mobilize Community during the week of November 13th, 2023.
CY 2024 Physician Fee Schedule Highlight: Marriage and Family Therapists & Mental Health Counselors
Beginning January 1, 2024, hospice providers may utilize Marriage and Family Therapist or Mental Health Counselors. Please note the following information from CMS! CMS confirmed that hospices may use one social worker, one MFT, or one MHC on the Hospice IDG. In other words, hospices can choose which of these disciplines to include, and do not need to include all three on the IDG. Conversely, in the proposed rule (42 CFR 418. 56), CMS indicated that a hospice’s decision on which discipline to include would depend “on the preferences and needs of the patient.” CMS indicated that hospices may choose this discipline. The CFR does require that you have a social worker as one of the four core services, BUT the SW doesn’t have to be in the IDG if the MFT or MHC will participate on the IDG.
While MFTs or MHC’s can provide services to the hospice patient, IF they provide these services, they CANNOT bill Medicare Part B.
Medicaid Hospice: Policy specialists have been contacted to ascertain the Medicaid hospice policy stance on this final rule. Will they follow the same stance as Medicare?
(CY) 2024 Home Health Prospective Payment System Rate Update and Quality Reporting Program Requirements
Special Focus Program (SFP)
The following information is based on webinars and communication between national associations and CMS. The SFP program is of concern to all. CMS’ algorithm for SFP could pull in good providers and omit those poor providers because they do not submit HCI and CAHPS data. TNMHPO is communicating with the national organization(s) to ensure they are aware of the two states’ concerns.
The federal government will implement the SFP on January 1, 2024. This new rule/program was adopted November 1, 2023. The selection of hospices for the SFP is not expected to likely begin until late 2024. The SFP is a program conducted by CMS to identify hospices as poor performers, based on defined quality indicators. CMS selects hospices for increased oversight to ensure that they meet Medicare requirements. Hospices in SFP will successfully complete the SFP program or be terminated from the Medicare program.
Any hospice that has submitted a claim in the past 12 months will be eligible for SFP enrollment. CMS will identify a subset of 10% of the programs based on the lowest performers.
CMS will utilize survey data for three consecutive years (condition level deficiencies and substantiated complaints), CAHPS and HCI data to determine what providers will be put into the SFP.
Survey data will be pulled for the years 2020-2023 to identify hospices eligible to be in the SFP beginning in 2024. CMS stated there might be some overlap given their use of consecutive 36-month period for hospices during these years.
CMS will use HCI and CAHPS data from November 2023 data refresh (most recent data available) to identify the eligible pool of hospices to be in SFP. This will include data from Quarter 1, 2021 to Quarter 4, 2022.
Hospices will be notified when it is posted publicly by CMS. Nothing official will be sent to the provider.
Hospices in SFP will be surveyed every six months and may be subject to one or more enforcement remedies at CMS’ discretion.
Resources:
- CMS Special Focus Program: https://www.cms.gov/medicare/health-safety-standards/certification-compliance/hospice-special-focus-program.
- For HCI and CAHPS data, CMS will pull the latest data from the Hospice Provider Data Catalog (PDC) at https://data.cms.gov/provider-data/topics/hospice-care.
- CMS HQRP source page that outlines the date ranges: https://www.cms.gov/medicare/quality/hospice/public-reporting-key-dates-providers.
Hospice Informal Dispute Resolution (IDR)
The IDR for hospice programs would allow hospice providers an informal opportunity to refute one or more condition-level deficiencies cited in the Statement of Deficiencies survey report and the Plan of Correction (Form 2567). This option is the same as the IDR now in place for home health agencies. It is important to remember that the standard level deficiencies alone do not begin enforcement action, so you don’t have appeal rights.
Hospice Enrollment Provisions
CMS finalized provider enrollment regulatory changes to prevent and address hospice fraud, waste, and abuse in the future. These provider enrollment provisions related to hospice ownership and management will strengthen protections against hospice fraud schemes and improve transparency. The hospice enrollment-related regulatory changes in the final rule include:
- Subjecting hospices to the highest level of provider enrollment application screening, which includes fingerprinting all 5 percent or greater owners of hospices;
- Expanding the HHA change in majority ownership provisions in 42 CFR § 424.550(b) to include hospice changes in majority ownership; and
- Clarifying that the definition of “Managing Employee” in 42 CFR § 424.502 includes the administrator and medical director of a hospice. Every hospice’s designated administrator and designated medical director will be considered “managing employees” for purposes of Medicare enrollment. This change will require the hospice to update their PECOS or 855A enrollment materials and further update these forms when personnel change.
Expanding the 36 Month Rule to Hospices
Any provider that undergoes a change in ownership must enroll in Medicare as a new hospice and obtain a state survey or an accreditation from its approved accreditation program. Home health providers have had this rule for a while. This WILL apply to hospice providers!!
The adopted rule reads:
42 CFR§ 424.502’s states: if there is a change in majority ownership of an HHA by sale (including asset sales, stock transfers, mergers, and consolidations) within 36 months after the effective date of the HHA’s initial enrollment in Medicare or within 36 months after the HHA’s most recent change in majority ownership, the provider agreement and Medicare billing privileges do not convey to the new owner. The prospective provider/owner of the HHA must instead:
- Enroll in the Medicare program as a new (initial) HHA under the provisions of §424.510; and
- Obtain a State survey or an accreditation from an approved accreditation organization.
For purposes of §424.550(b)(1), a “change in majority ownership” (as defined in 42 CFR §424.502) occurs when an individual or organization acquires more than a 50 percent direct ownership interest in an HHA during the 36 months following the HHA’s initial enrollment into the Medicare program or the 36 months following the HHA’s most recent change in majority ownership (including asset sales, stock transfers, mergers, or consolidations). This includes an individual or organization that acquires majority ownership in an HHA through the cumulative effect of asset sales, stock transfers, consolidations, or mergers during the 36-month period after Medicare billing privileges are conveyed or the 36-month period following the HHA’s most recent change in majority ownership.
Shortening the Non-Billing Deactivation Period
The final rule § 424.540(a)(1) shortens the deactivation period for hospice providers from the standard 12 to six months. This means that the providers billing privileges have stopped but they are still enrolled in Medicare. If a provider has not submitted a claim for six consecutive months, their ability to bill will be stopped. CMS believes that a 6-month time frame would keep businesses from having multiple billing numbers.
Enhanced Oversight Definition Changes
It should be noted that the new rules (CY) 2024 Home Health Prospective Payment System Rate Update and Quality Reporting Program Requirements expanded the definition of “new provider”. (The MLN below that was shared over the summer of 2023 addresses 100% CHOWs.) The definition in the new rule will read:
- A newly enrolling Medicare provider or supplier.
- A certified provider or certified supplier undergoing a change of ownership consistent with the principles of 42 CFR 489.18. (This includes providers that qualify under § 424.550(b)(2) for an exception from the change in majority ownership requirements in § 424.550(b)(1) but which are undergoing a change of ownership under 42 CFR 489.18).
- A provider or supplier (including an HHA or hospice) undergoing a 100 percent change of ownership via a change of information request under § 424.516.
As a reminder, CMS released the following article MLN Period of Enhanced Oversight for Arizona, California, Nevada, & Texas in July 2023. The goal was to reduce fraud, waste, and abuse. The enhanced oversight included medical reviews such as a prepayment review. You will note that the 100% review was addressed for hospice providers at that time. Access the MLN article.
Hospice: New Requirement for Physicians Who Certify Patient Eligibility
Effective May 1, 2024, for Medicare to pay for hospice services, the following physicians must enroll in Medicare or opt out:
- Hospice medical director or the physician member of the hospice interdisciplinary group who certifies the patient’s terminal condition.
- Patient-designated attending physician (if they have one) who certifies their terminal condition.
If you’re currently enrolled or opted out, you don’t need to do anything.
This new requirement:
- Only applies to Fee-for-Service Medicare
- Doesn’t prohibit the patient’s independent attending physician from treating them while in hospice and billing for these services under Part B
- Applies to all written or oral certifications under § 418.22(c)
Hospices can quickly verify a physician’s enrollment or opt-out status using the CMS ordering and referring data file (ORDF), which lists all Medicare-enrolled and opted-out physicians. We’ll modify the ORDF to create a separate column with this status.
More Information:
- FY 2024 Hospice final rule: https://www.cms.gov/medicare/medicare-fee-service-payment/hospice/hospice-regulations-and-notices/1041017703/cms-1787-f.
- New Requirement for Physicians Who Certify Patient Eligibility: https://www.cms.gov/training-education/medicare-learning-network/newsletter/2023-11-16-mlnc.
Medicaid Hospice: Policy specialists have been contacted to ascertain the Medicaid hospice policy stance on this final rule. Will they follow the same stance as Medicare?
Some Medicare Enrollees to Receive New Medicare Number Due to Data Breach
The Centers for Medicare & Medicaid Services (CMS) is notifying additional Medicare enrollees who may have been impacted by a data breach at a CMS contractor, Maximus Federal Services, Inc. CMS mailed a letter to all potentially affected Medicare enrollees to notify them of the data breach and what steps CMS is taking to protect them.
CMS is issuing potentially affected enrollees a new Medicare number and a new Medicare card. Legal assistance and aging and disability service providers may receive calls from clients or members of the community asking about this issue or about the letters.
If and when an enrollee receives a new Medicare card, the enrollee will receive a letter asking them to begin using the new Medicare number on December 29th and to update their Medicare information with all of their health care providers and destroy the old card. Plans will receive the related enrollment codes alerting them about the Medicare number changes and will be processing the changes internally.
It should be noted that this breach does not affect all Medicare enrollees—most are not affected. Nor does it mean that those enrollees who are affected will necessarily experience any harm. Affected enrollees should, however, monitor their bank accounts and other financial accounts, credit cards, and credit records, and report any suspicious activity to the relevant financial institution or credit agency immediately.
Texas News and Information
Health and Human Services Commission (HHSC)
Home and Community Support Services Agencies (HCSSA)
HHSC Publishes Updated HCSSA FAQs – Dec. 19
HHSC Long-term Care Regulation has published updated Frequently Asked Questions (PDF) for Home and Community Support Services Agency providers.
Electronic Visit Verification (EVV)
All home health providers, specifically those of you who provide supportive palliative care MUST sign up for EVV! This was effective January 1, 2024.
New EVV TAC Rules
The Texas Health and Human Services Commission (HHSC) has revised the Electronic Visit Verification (EVV) rules in Texas Administrative Code (TAC), Title 1, Chapter 354, Subchapter O. The new TAC rules are effective Jan. 1, 2024.
The EVV TAC rules §354.4001, §354.4003 have been amended, and §354.4005, §354.4007, §354.4009, §354.4011 have been repealed.
New TAC rules §354.4005, §354.4006, §354.4007, §354.4009, §354.4011, §354.4013, §354.4015, §354.4017, §354.4019, §354.4021, §354.4023, and §354.4025 have been adopted.
The new EVV TAC rules:
- Add the home health care services required by the 21st Century Cures Act, 1903(l) of the Social Security Act (42 U.S.C. §1396b(l)).
- Add the current policies regarding training, visit maintenance, and requests by program providers and FMSAs to become Proprietary System Operators (PSOs).
- Add definitions related to the addition of the new TAC rules.
- Reorganize the structure of the existing EVV required personal care services list for clarity.
Email HHSC EVV with any questions
Reminder: Prepare for EVV Cures Act Home Health Care Services Implementation
The Texas Health and Human Services Commission (HHSC) will require Electronic Visit Verification (EVV) for Medicaid home health care services (HHCS) beginning Jan. 1, 2024, as listed in the Home Health Care Services required to use EVV (PDF). The 21st Century Cures Act is the federal law that requires states to implement EVV.
HHCS Claims for EVV Required Services Must be Submitted to TMHP Starting December 1
- Program providers and financial management services agencies (FMSAs) must submit all HHCS EVV claims to Texas Medicaid & Healthcare Partnership (TMHP) using TexMedConnect, or through Electronic Data Interchange (EDI) using a Compass 21 (C21) Submitter ID starting with dates of service on or after Dec. 1, 2023.
- Managed care organizations (MCOs) will reject any HHCS managed care claims with EVV services and dates of service on or after Dec. 1, 2023, back to the program provider and FMSA, directing them to submit the claim to TMHP for EVV claims matching.
Register for TexMedConnect
- To access TexMedConnect through the TMHP website, you must already have an account.
- If you don’t have an account, set one up using the information provided in the TMHP Website Security Provider Training Manual.
- Program providers and FMSAs that need help setting up C21 or CMS Submitter IDs should call the EDI Help Desk at 888-863-3638, Option 4, or visit TexMedConnect for more information.
Request EVV Portal Access
- To access the EVV Portal, program providers and FMSAs must have a TMHP User Account.
- Program providers and FMSA staff must contact their TMHP Provider Administrator to request EVV Portal access.
- For full instructions, review the EVV Portal job aids on the EVV Learning Management System (LMS).
Complete Onboarding and EVV Portal Training by December 31
Program providers and FMSAs must complete the following before Dec. 31, 2023, to avoid impacts to EVV claims payment:
- Onboard with the state-funded EVV vendor system, HHAeXchange, by submitting the HHAeXchange Provider Onboarding Form.
- Complete the TMHP Learning Management System (LMS) to complete annual EVV Portal training requirements.
Visit the TMHP EVV Training web page for more information.
EVV Home Health Care Services Practice Period: Oct. 1–Dec. 31, 2023
The practice period allows program providers and FMSAs, to practice using the EVV system, using the EVV Portal and submitting EVV claims before the Jan. 1, 2024, implementation date. EVV claims will be paid by the payers (HHSC or MCO) even if the EVV visit transactions do not match the EVV claims.
- Consumer Directed Services (CDS) employers can practice using the EVV system selected by their FMSA.
- Service providers and CDS employees can practice clocking in and clocking out using their program provider’s or FMSA’s selected EVV system, and the visit data will be transmitted to the EVV Aggregator.
EVV Claims Matching with Denials
Effective Jan. 1, 2024, and after, when an HHCS EVV claim is submitted without a matching EVV visit transaction, the EVV claim will be denied. This applies to all program providers and FMSAs required to use an EVV system. Program providers and FMSAs will be able to view EVV claim match results in the EVV Portal.
Resources
- For questions about HHAeXchange onboarding, technical help with using the HHAeXchange Portal or issues related to data, email HHAeXchange or call 833-430-1307.
- Review FAQs about the EVV HHCS Implementation (PDF), found on the EVV 21st Century Cures Act web page.
- For specific HHCS billing codes combinations that require the use of EVV, refer to the EVV HHCS Service Bill Codes table in Excel or PDF.
Visit HHS EVV for more information about EVV.
Update for the EVV PSO 2024 ORR Session Requests
The Texas Medicaid & Healthcare Partnership (TMHP) has published an update for the upcoming EVV Proprietary System Operator (PSO) 2024 Operational Readiness Review (ORR) sessions. To view the 2024 PSO onboarding schedule and Proprietary System (PS) Request Form, refer to the Update: EVV Proprietary System Operator (PSO) 2024 ORR Session Requests notice on TMHP’s EVV webpage.
Program providers and financial management services agencies (FMSAs) who would like to become a PSO must submit a PS Request Form to get on the waitlist. Please note, TMHP has a limited number of slots based on the available capacity. Program providers and FMSAs are onboarded from the waitlist on a first come, first served basis.
The Health and Human Services Commission and TMHP are evaluating the available capacity to determine whether the number of slots can be increased.
Email TMHP with any questions.
EVV Claims Matching Resumes Jan. 1 – Claims Without Matching EVV Visits Will Deny for Payment
This is a reminder that Electronic Visit Verification (EVV) claims matching for all services required to use EVV will begin on Jan. 1, 2024. EVV claims with dates of service Jan. 1, 2024, and after that do not have an EVV visit match, will be denied payment.
Email TMHP to request assistance with EVV claims mismatch results.
Email EVV Operations with any questions.
API EVV Third-Party Software System Integration
Application Programming Interface (API) can be used to exchange data between third-party software systems to the new EVV vendor, HHAeXchange.
Responsibility for the integration and performance of a third-party software system is between the program provider or financial management services agencies (FMSAs), and their third-party system. To assist program providers and FMSAs, HHAeXchange has APIs available for third-party software systems to make functionality possible.
Program providers and FMSAs can email HHAeXchange to see if their selected third-party software system has tested successfully with HHAeXchange. They may also email the Texas Medicaid & Healthcare Partnership (TMHP) for assistance or questions related to their third-party system.
Resources
- To confirm system submission of EVV claims, review the EVV Third-Party Software System Integration with HHAeXchange.
- The HHAeXchange Web Service API Guide (PDF) lists specifications to integrate a third-party software system with HHAeXchange.
- To begin the integration process, submit a ticket through the HHAeXchange Client Support Portal.
For questions or help with HHAeXchange, call 833-430-1307, email HHAeXchange or visit the HHAeXchange Texas Info Hub.
EVV Visits on Hold in the EVV Transaction Manager in HHAeXchange – LTC Authorization Issue
The Health and Human Services Commission (HHSC) is aware of the issues impacting visits being on hold in the transaction manager in the EVV system, HHAeXchange, and is working with the Texas Medicaid & Healthcare Partnership (TMHP) to resolve the issues as quickly as possible. HHSC will update EVV HHAeXchange users when the issues are resolved and will provide further guidance, as needed.
Disclaimer: The Texas and New Mexico Hospice Organization publishes the Regulatory Update as an information only item. TNMHO has no attorneys nor does it represent the state and federal governments. All legal questions or concerns should be directed to your attorney or the governments involved.
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