CMS Announces Further Changes to Support Hospice Eligibility Inquiries in HETS

Over recent years the Centers for Medicare & Medicaid Services (CMS) has sought to streamline hospice beneficiary eligibility inquiries and establish the HIPAA Eligibility Transaction System (HETS) as the single source for this data. This effort was delayed due in part to the availability of insufficient information in the HETS system regarding hospice benefit period utilization. On March 27, 2019, the MCARE system issued a notice indicating that changes had been made to the HETS system and that, beginning in fall of 2019, CMS will terminate access to Common Working File (CWF) eligibility queries for entities that already use HETS for that purpose.

As referenced previously, the National Association for Home Care & Hospice (NAHC) sought additional information from CMS, as concerns remained that HETS eligibility queries might not provide sufficient information to allow hospices to determine whether a patient being taken onto service required a face-to-face encounter.  In a response, CMS’ MCARE Help Desk indicated that CMS “plans to make a change in the upcoming HETS R2019Q300 release to remove the Hospice Occurrence Count and instead return all available CWF Hospice Occurrences and/or Notices of Election on the 271 response.”

More recently, as part of Change Request 11277/Transmittal 2285, CMS formally announced instructions designed to address hospice eligibility and face-to-face encounter eligibility data needs in HETS by ensuring that all hospice benefit periods (regardless of age) are submitted to HETS and by populating HETS with separate record of Hospice Election Period data and Hospice Benefit Period data.  These changes are scheduled to become effective on October 1, 2019 (with an implementation date of October 7, 2019).  MCARE has not yet announced a specific date on which CMS will eliminate access to CWF queries for those providers who conduct eligibility queries in HETS but NAHC will be monitoring for announcement of this change and provide updates via NAHC Report as they are available.