CMS clarifies rules regarding vaccines, respite care for hospice patients

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The Centers for Medicare & Medicaid Services has loosened regulatory language regarding which providers can furnish vaccines to hospice patients, and has tightened enforcement of a five-day payment limit for respite care.

Medicare systems currently prevent non-hospice providers from furnishing vaccines to hospice patients, to enforce the Medicare manual provision that vaccines “may be covered when furnished by the hospice.” CMS stated in a Feb. 6 transmittal. Because the manual does not say that vaccines can be covered “only” when provided by a hospice, CMS determined the current enforcement is “too restrictive,” according to the notification.

Therefore, CMS is removing previous changes to Medicare systems, the notification stated. After the implementation date of April 7, “any provider” will be able to furnish vaccines, such as the influenza vaccine, to hospice beneficiaries, according to the document.

In a separate transmittal, CMS addressed the five-day limit for respite care under the hospice benefit.

Respite care refers to short periods of inpatient care to relieve the at-home caregivers. It can be billed only in five-day increments, according to the Feb. 6 transmittal from CMS. This is not a policy change, CMS noted, but the recent manual revision is meant enforce the current policy.

Claims that report respite care exceeding five consecutive days will be returned to the provider, according to the update. More than one period of respite care can be reported in the billing period, but in this case, the provider must include the appropriate M2 occurrence span code.

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