Healthcare Provider Solutions

Centers for Medicare & Medicaid Services (CMS) has rescinded Change Request 9114 and has posted a replacement CR 9114 and a related Medlearn Matters article.

This is in response to concerns that the original CR was inconsistent with statements issued as part of the final hospice payment rule for 2015 surrounding designation of the attending physician. The final rule, published in August 2014, suggested that in identifying the attending physician the election statement should include the physician’s name, address or NPI. The original CR indicated that the physician’s name and NPI must be included on the election statement. In the reissued CR 9114, CMS has used the language included in the final rule. Because the new attending physician requirements were effective 10/01/14, and the new language is reflective of what was included in the final payment rule, the effective date of the changes in the revised CR 9114 is 10/01/14.

Following are two excerpts from the new CR 9114 on attending physician designation; these excerpts represent language that will be incorporated in Chapter 9 of the Medicare Benefit Policy Manual. Please note that the use of italics represents changes to existing Manual text.

20.2.1 – Hospice Election (Rev.209, Issued: 05-08-15, Effective: 10-01-14, Implementation: 05-04-15)

Each hospice designs and prints its election statement. The election statement must include the following items of information:

  • Identification of the particular hospice that will provide care to the individual;
  • The individual’s or representative’s (as applicable) acknowledgment that the individual has been given a full understanding of hospice care, particularly the palliative rather than curative nature of treatment;
  • The individual’s or representative’s (as applicable) acknowledgment that the individual understands that certain Medicare services are waived by the election;
  • The effective date of the election, which may be the first day of hospice care or a later date, but may be no earlier than the date of the election statement. An individual may not designate an effective date that is retroactive;
  • The individual’s designated attending physician (if any). Information identifying the attending physician recorded on the election statement should provide enough detail so that it is clear which physician or Nurse Practitioner (NP) was designated as the attending physician. This information should include, but is not limited to, the attending physician’s full name, office address, NPI number, or any other detailed information to clearly identify the attending physician.
  • The individual’s acknowledgment that the designated attending physician was the individual’s or representative’s choice.
  • The signature of the individual or representative.

40.1.3.1 – Attending Physician Services Rev.209, Issued: 05-08-15, Effective: 10-01-14, Implementation: 05-04-15)

The attending physician is a doctor of medicine or osteopathy or a nurse practitioner and is identified by the individual, at the time he or she elects to receive hospice care, as having the most significant role in the determination and delivery of the individual’s medical care.

The election statement must include the patient’s choice of attending physician. The information identifying the attending physician should be recorded on the election statement in enough detail so that it is clear which physician or NP was designated as the attending physician. This information should include, but is not limited to, the attending physician’s full name, office address, NPI number, or any other detailed information to clearly identify the attending physician. Hospices have the flexibility to include this information on their election statement in whatever format works best for them, provided the content requirements in 42 CFR 418.24(b) are met. The language on the election form should include an acknowledgement by the patient (or representative) that the designated attending physician was the patient’s (or representative’s) choice.

If a patient (or representative) wants to change his or her designated attending physician, he or she must follow a procedure similar to that which currently exists for changing the designated hospice. Specifically, the patient (or representative) must file a signed statement with the hospice that identifies the new attending physician in enough detail so that it is clear which physician or NP was designated as the new attending physician. This information should include, but is not limited to, the attending physician’s full name, office address, NPI number, or any other detailed information to clearly identify the attending physician. The statement must include the date the change is to be effective, the date that the statement is signed, and the patient’s (or representative’s) signature, along with an acknowledgement that this change in the attending physician is the patient’s (or representative’s) choice. The effective date of the change in attending physician cannot be earlier than the date the statement is signed.

Following is the link to the revised CR 9114: Revised CR 9114