Bipartisan Budget Act of 2018 was passed by Congress in February. The Act includes changes that directly impact hospice providers.

Regulatory Update – April 2018
Service Line – Hospice

by Melisa Rittenberry

Effective January 1, 2019

PHYSICIAN ASSISTANTS (PA) will be allowed to act as the attending physician for patients in hospice care. Currently a patient can only elect a nurse practitioner (NP), or a doctor of medicine (MD) or osteopathy (DO) as their attending physician. This amendment to the law provides an increase in continuity of care to those individuals who utilized a PA prior to electing hospice care.  

It is important to note that while there may be additional clarification and details published in the hospice proposed rule expected to be released in late April or May 2018, the law did not change who can certify a patient as terminally ill. At this time, only a licensed physician (MD, DO) is able certify that a patient meets the requirements for a terminal certification.  

The impact of this second change is less clear for hospice providers.  This change relates to the - TRANSFER POLICY FOR EARLY DISCHARGE TO HOSPICE SERVICES. Under this new policy, which effects discharges on or after October 1, 2018, hospitals may be penalized through a reduction in payment for patients discharged early to hospice services. 

For hospice providers using EMR (Electronic Medical Records), there may be a required change in software that allows a PA to sign as an attending physician.

For hospice providers using CONNECTOFFICE™, HealthCare Strategies, Inc. will update our software as applicable. Communication on this update will be done through the website, , and via a release document to be published later this year.

Key points/concerns:

  • The Budget Act does not define “early”, but most likely any length of stay less than the average for a given HHRG may be subject to review. However, we expect there will be some definition and further explanation when the hospital rule for FY2019 is published. 
  • MedPAC has been asked to evaluate multiple elements that impact the policy change. The evaluation report is not due to Congress until March 2021. 
  • The primary concern for hospice providers is that they may receive referrals even later than at present. This could reduce the length of stay and ultimately decreases the benefits/value of the hospice service for the patient and their families. 

Additional details will be shared as information becomes available. Continue to visit the HCS website to stay up to date on industry changes,

To review the entire Budget Act, follow the link: 2018 Bipartisan Budget Act 

The next article will outline the OIG’s findings related to the need for hospices to improve statements and certifications of terminal illness along with the potential impact on providers.

Mark Song