After a series of CMS surveys caused confusion in the hospice industry regarding the role and responsibilities of the medical director, CMS Region V issued much-needed clarification. CMS Region V, which covers hospices in the states of Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin, clarified that:
- There can be only one hospice medical director per hospice provider number; and
- Either the medical director or a physician from the interdisciplinary team (“IDT”) may certify or recertify patients for terminal illness and eligibility for the Medicare hospice benefit.
The National Hospice and Palliative Care Organization (“NHPCO”) reported in early fall 2017, that it received numerous calls and emails from hospices in CMS Region V that were cited for various conditional level survey deficiencies related to the medical director’s role and responsibilities. See NHPCO Report. According to NHPCO, the citations largely focused on the surveyors’ claims that the medical director must certify and recertify all patients. In response to these citations, many providers dramatically altered their certification and recertification processes to ensure the direct involvement of the hospice’s medical director. Now such changes can be undone, as hospices take this opportunity to revise their processes to comply with CMS Region V’s latest clarification, paying especially close attention to the roles of the hospice’s physicians.
In addition to hospice certification and recertification processes now allowing physicians from the IDT to certify and recertify patients for terminal illness and Medicare eligibility, hospices can perform other reviews to prepare for future surveys. Each hospice should ensure that it, in fact, has only one hospice medical director, even if the hospice has multiple locations. The hospice medical director’s duties must include those set forth in Medicare’s Conditions of Participation (42 CFR § 418.102). Other hospice physicians should be designated to act under the supervision of the hospice medical director. Job titles and duties given to other hospice physicians should make it clear that such physicians are not and cannot be construed to act as the medical director.