2025 CMS Proposed Rules for Hospice, Palliative Care, and More

2025 CMS Proposed Rules

It’s April, and that means it’s time for proposed rules for fiscal year 2025  to emerge. But the Centers for Medicare and Medicaid Services (CMS) prevailed this year, releasing proposed rules for inpatient rehabilitation, psychiatric patients, hospitals, and skilled nursing facilities (SNFs) in late March. I thought a suggestion was worth mentioning.

Additional Benefits for Hospice and Palliative Care:

CMS requests clarification on additional benefits that may be provided for hospice benefits and palliative care services. This may include services such as chemotherapy, radiation therapy, dialysis, and blood transfusions, but only if they are used to treat symptoms and are not part of the patient’s final treatment. Of course, if additional funding is provided, standards will need to be carefully developed so that the treatment target is truly the goal and not the aim of the treatment, or course for financial reasons.

There is absolutely nothing of public concern in the other laws. Yes, CMS makes regular payment adjustments every year, but as I said before, our job is to do the right thing and the payment will go where it belongs.

And before you ask, no, the Skilled Nurses Act does not specify a three-day rule for accessing Part A benefits.

Still Stuck on the Three-Day Rule: A Flawed Solution

I know we all still hate it, and I’m sure the CMS staff does too, but that’s about it. To Congress to fix it. I note that the Center for Medicare Advocacy and others continue to advocate for counting observation days as three days for SNF access, but we all know this is not a necessary solution.

Congress must allow a Part A SNF to see any Medicare-eligible patient for SNF care. But don’t hold your breath. Many of us had hoped that nonviolent exemptions needed during the public health emergency caused by COVID-19 would convince policymakers that we could be trusted, but so far they have not succeeded.

Moving on, I was recently notified of one of the most powerful calls I have ever seen. A process for appealing traditional Medicaid denials was developed in one southern state. For this government agency to approve an appeal, the provider must provide complete medical records regardless of the problem. This may not be so bad, but medical records must be accompanied by a contract signed by the notary Records Custodian; The notary must first confirm that “they are of sound mind, capable of making this decision, and personally able to tell the truth and then verify that the document is an original or a faithful copy and that no other documents exist.

Outrageous Medicaid Appeals Process: HIPAA Violation Risk and Provider Burden

The Registrar, often referred to as the medical registrar, simply prepares and transmits medical records; they don’t know what the Proposed rules is and have no reason to deny it. This is completely inappropriate and I wonder if anyone would sign off on publishing this information

Additionally, the appeal must contain a complete copy of the decision letter and must not contain a “single page”, whatever that means. You’d think the department would keep a record of rejections, so if it had the front page with patient numbers it could show its records. They also state that the objection is a request for reconsideration of the objection to the Office of the Auditor General of the Appropriations Review Office and must show that the provisions will generally be disregarded and that the objection will be rejected.

Imagine being so embarrassed by the quality of your audit team’s work that you had to develop such an extreme appeals process that most providers would just write a denial and you wouldn’t have to turn to your employees to defend it.

By the way, this agency might want to do a better job of preserving medical records provided by informants because I’ve heard they’ve been known to respond to calls with “we didn’t receive the record.” If the Provider has evidence of documentation provided and received by you and you say you do not have that documentation, reporting it to the Civil Rights Bureau is a violation of HIPAA. But in this case, I’m sure the providers will be happy to fill out a form informing you of the error.

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