CMS Issues Rule Outlining SNFs and Hospice Partnerships

The Centers for Medicare & Medicaid Services (CMS) have issued a final rule that outlines the roles and responsibilities for developing a written agreement between long-term care (LTC) and hospice providers, should a LTC resident or patient elect to receive hospice care. 

Under the rule, a LTC facility will be required to have only one written agreement with each hospice that provides services in the facility, rather than the facility having an individual agreement with a hospice for each resident receiving the end-of-life services.

The CMS rule also clarifies the responsibility of the facility that chooses not to arrange for the provision of hospice services at the facility through an agreement with a Medicare-certified hospice. 


In the event that a resident requests for a transfer to hospice care, these facilities must assist the resident and arrange for the provision of hospice services. 

Because developing a finalized written agreement will require time on the part of the staff, CMS estimates the burden associated with the first year to be $5,512,275 for the 16,139 LTC facilities that would be affected by this rule. The estimated annual burden associated with each successive year after the first, CMS notes, will be $2,204,910. 

The purpose of the finalized rule, according to CMS, is to ensure the coordination of care for LTC facility residents who elect hospice services, as coordination of care is linked to better patient outcomes and improved quality of care. 


CMS estimates that the overall economic impact of this rule will total $7,049,515 the first year and $3,742,150 thereafter for LTC facilities and hospice providers. 

The agency also estimates that these requirements laid forth will cost $437 per facility initially and $232 in the years following. 

As these figures are below 1% of companies revenues— according to CMS estimations that the majority of LTC facilities and hospices are considered to be small entities with revenues less than $7 million to $34.5 million a year—the agency does not anticipate its rule will have a significant impact on bottom lines.

Sections of the Social Security Act state that a SNF or NF must provide or arrange for the provision of, nursing and related services and specialized rehabilitative services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident. 

The Omnibus Budget Reconciliation Act of 1986 permitted States to add a hospice benefit to their State Medicaid plans, and specified that such care could be provided to an individual while he/she was a resident of a skilled nursing facility or intermediate care facility.

Additionally, eligible residents may also choose to receive hospice care services under the Medicare hospice benefit.

View the CMS rule.

Written by Jason Oliva

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