Regulatory Updates

State: All

Date Effective : 01/1/2024

Program: Hospice

On November 2, 2023, the CY 2024 Medicare Physician Fee schedule final rule was published.  This rule includes provisions for hospice. Beginning January 1, 2024, hospice agencies will have the option of utilizing a social worker, a marriage and family therapist, or a mental health counselor for counseling services provided to hospice patients as both the MFT and MHC can now be part of the hospice interdisciplinary team.  Medicare definitions for the qualifications a Marriage and Family Therapist and a Mental Health Counselor can be found in the CAA of 2023.  CMS is currently working on a resource document to address provider questions.

State: All

Date Effective : 01/1/2024

Program: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Home Health, Hospice

On November 1, 2023, CMS issues the CY 2024 Home Health PPS final rule.  This rule became effective Jan 1, 2024. The final rule included updates for home health, hospice, and DME. Home Health:  The final rule included home health payment updates including codification of statutory requirements for disposable negative pressure wound therapy devices, Home Health Quality Reporting program updates Home Health Value-Based Purchasing Model updates. DME: The final rule notes the end of the IVIG demonstration program with a new permanent DME payment for in-home administration of IVIG for the treatment of primary PIDD.  The rule codifies the longstanding Medicare definition of a brace.  A benefit was established in this rule for lymphedema compression treatment items and outlines the scope and payment of this coverage.  Finally, the rule addressed the 30-day refill policy for DMEPOS providers. Hospice: This final rule finalized both the Hospice Special Focus Program and has added an Informal Dispute Resolution process which closely aligns with the existing IRD process for home health providers.  There were also several hospice provider enrollment provisions in this final rule including subjecting hospices to the highest level of provider enrollment screening, expanding the existing change in majority ownership rule at 42 CFR §424.550(b) to include hospices, and clarifies the definition of managing employee to include both the hospice administrator and medical director.

State: All

Date Effective : 10/1/2023

Program: Hospice

On July 28, 2023, CMS issued a final rule updating Medicare hospice payments and the aggregate cap amount for FY 2024.  This rule provided updates to the Hospice Quality Reporting Program as well as established new Hospice Certifying Physician Enrollment.  This final rule was effective October 1, 2023, with exception to the provider enrollment provision which are effective May 1, 2024.

State: California

Date Effective : 01/3/2024

Program: Home Health

California home health agencies (HHAs) having difficulty recruiting nurses who meet experience qualifications can now seek help from the state. The California Department of Public Health is currently accepting requests for flexibility of the one-year professional nursing experience requirement stipulated under Title 22 CCR sections 74707 (c) and (d). Flexibility requests may be made agency-wide or for an individual registered nurse (RN) or licensed vocational nurse (LVN). The HHA must provide additional training and supervision while preserving patient safety and quality of care.

State: All

Date Posted : 01/12/2024

Program: Ambulatory Surgical Centers (ASC)

Make sure your billing staff knows about system updates to the Ambulatory Surgical Center Payment System for January 2024.

• Addition of HCPCS codes C1600-C1603
• Eight HCPCS codes that expired from the Pass-Through Status
• New HCPCS code for Biology-Guided Radiation Therapy Services
• Newly established codes for Drugs and Biologicals
• Procedure codes for procedures new to ASCs

State: All

Date Posted : 12/8/2023

Date Effective : 01/1/2024

Program: Home Infusion Therapy

The CY 2024 GAFs have been revised to reflect the extension of the work GPCI floor through January 19, 2024, as authorized by Section 501 of the Further Continuing Appropriations and Other Extensions Act, 2024. The GAF standardization factors, which are calculated to ensure that GAF updates are implemented in a budget neutral manner, have also been revised to 1.0026. The CY 2024 national and geographically adjusted HIT payment rates were updated to reflect the changes to the GAF standardization factor.