CMS has released updates to the Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) services section of the Medicare Benefit Policy Manual, Publication 100-2. This includes revisions to the Hospice Attending Practitioner and Provision of Services to Hospice Patients in a RHC or FQHC sections.
The revisions clarify the hospice and RHC or FQHC relationship related to attending practitioner services, services related and unrelated to the terminal diagnosis and billing for these services. The sections are copied below for your convenience. Items in italics are the revisions.
The full CR can be accessed here.
200.1 - Hospice Attending Practitioner (Rev. 173, Issued: 11-22-13, Effective: 01-01-14, Implementation: 01-06-14)
Medicare beneficiaries who elect the Medicare hospice benefit may choose either an individual physician or NP to serve as their attending practitioner(Section 1861(dd) of the Act). RHCs and FQHCs are not authorized under the statute to be hospice attending practitioners. However, a physician or NP who works for a RHC or FQHC may provide hospice attending services during a time when he/she is not working for the RHC or FQHC (unless prohibited by their RHC or FQHC contract or employment agreement). These services would not be considered RHC or FQHC services,since they are not being provided by a RHC or FQHC practitioner during RHC or FQHC hours.
200.2 - Provision of Services to Hospice Patients in a RHC or FQHC (Rev. 173, Issued: 11-22-13, Effective: 01-01-14, Implementation: 01-06-14)
RHCs and FQHCs can treat hospice beneficiaries for medical conditions not related to their terminal illness. However, if a Medicare beneficiary who has elected the hospice benefit receives care from a RHC or FQHC related to his/her terminal illness, the RHC or FQHC cannot be reimbursed for the visit, even if it is a medically necessary, face-to- face visit with a RHC or FQHC provider, since that would result in duplicate payment for services, except under either of the following circumstances:
- The RHC or FQHC has a contract with the hospice provider to furnish core hospice services related to the patient’s terminal illness and related conditions when extraordinary circumstances exist within the hospice. Extraordinary circumstances are described as “unanticipated periods of high patient loads; staffing shortages due to illness or other short-term temporary situations that interrupt patient care; and temporary travel of a patient outside the hospice’s service area” (42CFR 418.64);
- The RHC or FQHC has a contract with the hospice provider to furnish highly specialized nursing services that are provided by the hospice so infrequently that it would be impractical and prohibitively expensive for the hospice to employ a practitioner to provide these services. For example, a hospice may infrequently have a pediatric patient, and in those situations, contract with a RHC or FQHC that has a pediatric nurse on staff to furnish hospice services to the patient.
- In these situations, all costs associated with the provision of hospice services must be carved out of the RHC or FQHC cost report, and the RHC or FQHC would be reimbursed by the hospice. (42 CFR 418.64(b)(3)).
Any service provided to a hospice beneficiary by a RHC or FQHC practitioner must comply with Medicare prohibitions on commingling. (See section 90 of this chapter).