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From Health Law Daily, March 20, 2017

Hospice’s reasons for late submission of quality data trumped by CMS guidance

By Susan L. Smith, J.D., M.A.

CMS properly reduced the annual payment update (APU) of a Medicare certified hospice for calendar year 2015 (CY) by two percent for failing to meet the reporting deadline under the requirements of the Hospice Quality Reporting Program (HQRP). The Provider Reimbursement Review Board (PRRB) found that the hospice did not take advantage of CMS resources, including guidance and telephone and e-mail hotlines nor did it contact Medicare program contractors or check the website to ensure proper submission. The PRRB concluded that the departure of a compliance officer and confusing log-in messages the hospice presented as evidence for late submission of the data were insufficient and its failure to seek out CMS guidance significantly contributed to its inability to submit the data timely (Hospice & Palliative Care of Westchester v. National Government Services, Inc., PRRB Hearing, Dec. No. 2017-D10, Case No.: 15-0839, March 7, 2017).

Quality reporting and penalties. Section 3004 of thePatient Protection and Affordable Care Act (ACA) (P.L. 111-148) established quality reporting requirements for hospices (see 42 U.S.C. §1395f(i)(5)(C)), requiring hospices to submit data on specified quality data at a time, form and manner specified by the HHS Secretary. If a hospice fails to comply with the program requirements, the Secretary will reduce the amount of the hospice’s APU by two percentage points (see 42 U.S.C. §1395f(i)(5)(A)(i)). To comply with this requirement for FY 2015, hospices were required to collect data throughout CY 2013 and submit it to the designated website by the April 1, 2014, due date published in the 2012 Final rule (see Final rule, 77 FR 67068, November 8, 2012).

Hospice contentions. The hospice contends it complied with the requirements by collecting and reviewing the requisite quality data and attempted to submit the data throughout the year but it was prevented from doing so because of confusing notices from CMS when it attempted to log in to the website. The hospice explained that its compliance officer, who left sometime in May 2013, instructed the office manager regarding the log in information needed to submit the required HQRP data for CY 2013. Although the office manager attempted multiple times to timely file the required data, a message appeared that indicated that the submissions were not being accepted. The hospice provided an example of the message as evidence of the pattern. The hospice received no other correspondence was received from the system until it received the Notice of Quality Reporting Program Non-Compliance.

The determinations and appeals. On June 27, 2014, CMS determined that the hospice failed to meet the requirements of HQRP for fiscal year (FY) 2015 because the hospice failed to submit the required quality data by the due date. On an appeal to reconsider requested by the hospice, CMS upheld its earlier determination on the grounds the hospice failed to prove the data was submitted timely. The hospice then appealed to the PRRB.

The PRRB concluded that CMS had issued adequate guidance regarding the submission for the CY 2013 data submissions. It pointed out that CMS established a website with comprehensive guidance on hospice quality reporting that contained information and resources for hospices to use to determine data submission requirements and how to comply with them, including a Fact Sheet (which included data submission due dates and links to training materials and user guides), User Guide, and a Technical User’s Guide that had detailed information on the collection and submission of data and registration requirements and deadlines. The User Guide also provides information on the telephone help desk, accessible by phone or e-mail, that CMS had set up to assist providers with questions and technical issues. In addition CMS published a reminder deadline for data reporting in an MLN Matters article (SE1301). The PRRB found that the date of the former compliance officer’s departure and the date of the hospice’s example of the log-in notice were eleven and eight months prior to the April 1, 2014, filing deadline and concluded that the hospice’s inaction to seek out the quality reporting requirements and guidance significantly contributed to the reporting failure. Therefore, the PRRB found that CMS properly reduced the hospice APU for FY 2015 by two percent.

Cost reporting period ending December 31, 2015.

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