Operation of Hospice Across State Lines

2085 - Operation of Hospice Across State Lines (Rev. 69, Issued: 12-15-10, Effective: 10-01-10, Implementation: 10-01-10) When a hospice provides services across State lines each respective State Agency (SA) must be aware of and approve the action. Each SA must verify that applicable state licensure, personnel licensure, and other State requirements are met in its respective State. The provision of services across State lines is appropriate in most circumstances. Areas in which community services, such as hospitals, public transportation, and personnel services are shared on both sides of State boundaries are most likely to generate an extension of hospice services. When a hospice provides services across State lines, it must be certified by the State in which its CMS certification number (CCN) is based, and its personnel must be qualified in all States in which they provide services. The appropriate SA completes the certification activities. The involved States must have a written reciprocal agreement permitting the hospice to provide services in this manner. The reciprocal agreement must indicate that both States are aware of their respective responsibilities for assessing the hospice’s compliance with the CoP within their State. The agreement should assure that home visits are conducted to a sample of all patients, in all States served by the hospice. The CMS Regional Office (RO) will review the required reciprocal agreement between the States to assure that the SA where the practice location resides is assuming responsibility for any necessary surveys of the location. If the SAs are unable to come to a reciprocal agreement on assuring the necessary surveys of the location, the location should not be approved as a part of the hospice. The provision of interstate service without a written reciprocal agreement could severely undermine the State’s ability to fulfill its statutory responsibilities under Section 1864 of the Act to enforce Medicare’s health and safety requirements. It is at the discretion of the States to decide whether entering into reciprocal agreements is in the best interest of their residents, provider markets, and quality assurance and oversight systems. Exhibit 289 ”Model Reciprocal Agreement Survey and Certification” contains a model reciprocal agreement document for States to use to assist them in fulfilling their statutory responsibility to enforce Medicare’s health and safety requirements when a hospice provides services across State lines. In States that have a reciprocal agreement in place, providers are not required to be separately approved in each State; consequently, they would not have to obtain a separate Medicare provider agreement/certification number in each State. Providers residing in a State that does not have a reciprocal agreement with a contiguous State are precluded from providing services across State lines. In the event that the hospice operates in two CMS ROs, the RO responsible for the State in which the hospice provider agreement/certification number is based should take the lead in assuring that the required survey and certification activities are met.