Hospice Agencies & Residences

Hospice agencies and residences are required to be licensed. Once licensed, hospice agencies may choose to apply for certification to participate in Medicare and Medicaid programs. The Centers for Medicare and Medicaid Services (CMS) contracts with LARA to evaluate compliance with federal regulations by conducting surveys and complaint investigations. This page is designed to assist providers through the federal certification process, as well as provide additional resources to maintain compliance.

Hospice agencies and residences must be licensed with the State of Michigan before Medicare certification is approved.  Please visit Hospice Agencies & Residences to obtain information for state licensing.

Administrator/Leadership Change Request Form

Submitted form is sent to LARA-BSCSupport@michigan.gov.

• Your state license for the Hospice Agency must be updated prior to completing the following steps for federal certification:
• Complete the Provider Enrollment Application (CMS-855A) and submit to MAC within 90 days of the move.
• Please Note: Address and Location changes should remain within the approved geographic area.
• The MAC will provide you with a recommendation letter once the initial review is complete.
• For deemed providers, please submit the accrediting agency survey report that includes the new sites.

Once all the above documents have been received and deemed complete, the Bureau of Survey and Certification will review and forward the packet to the MAC for final determination and issuance of the final approval letter.

If you do not receive a final approval notice from the MAC within 90 days of submission, please reach out to LARA-BSCSupport@michigan.gov for assistance.

Quick Links:

Hospice IDR Request Form

Submit A Case | iMPROve Health

• Available for hospice programs when condition-level deficiencies are cited under federal regulations at Title 42, CFR, Part 418.
• Detailed in Chapter 10 of the State Operations Manual.
• iMPROve Health (a peer review organization), contracted by the Bureau of Survey and Certification (BSC), conducts the IDR reviews and sends recommendations to BSC for the final IDR decision.
• The State Agency conducts the final review and notifies the facility of the outcome.

Submitting a Case:

• Acceptable and expected written case submission into the iMPROve Portal include:
  • The applicable request form.
  • A list of condition-level deficiencies being disputed and why.
  • Documentation supporting your rebuttal.
• Case must be submitted into the iMPROve portal within ten calendar days of the date on the CMS-2567.
• You waive the right to an IDR request if the information required above is not received on time.
• Do not submit copies of federal standards, deidentified documents, post-survey information, or legal arguments.

Details:

• Agencies can request IDR for each survey citing condition-level deficiencies.
• Findings from previous surveys cannot be challenged if IDR was already attempted or available.
  • Deficiencies not corrected and carried forward from previous surveys are not eligible for IDR.
  • New condition-level deficiencies from a subsequent survey are eligible for IDR.
• IDR cannot be used to delay sanctions or challenge the survey process.
• Unacceptable IDR requests include:
  • The severity assessment of a deficiency at the standard level that constitutes substandard care or immediate jeopardy (IJ).
  • Sanctions imposed by the enforcing agency.
  • Alleged failure of the survey team to comply with a requirement of the survey process.
  • Alleged inconsistency of the survey team in citing deficiencies among agencies.
  • Alleged inadequacy or inaccuracy of the IDR process.

Optional Conference Call:

• Agencies may request a conference call with iMPROve Health to present their case, in addition to the desk review.
• The hospice program bears the cost of the call.
• The call will be scheduled and led by iMPROve Health.
• BSC will designate a representative to attend in a listen-only capacity.

Contact 

• Questions? LARA-BSC-IDR@michigan.gov
• iMPROve Contacts: Aris Rhodes-Bond (248) 465-7405 or Bailey Brokmeyer (248) 465-1035

The situations under which a hospice may discharge a patient are addressed in the regulation at 42 CFR 418.26 and include the following situations:

• The patient moves out of the hospice’s service area or transfers to another hospice.
• The hospice determines that the patient is no longer terminally ill.
• The hospice determines under a policy set by the hospice for the purpose of addressing discharge for cause, that the patient’s (or other persons in the patient’s home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the hospice to operate effectively is seriously impaired. 

The hospice must do the following before it seeks to discharge a patient for cause:

• Advise the patient that a discharge for cause is being considered.
• Make a serious effort to resolve the problems presented by the patient’s (or other persons in the patient’s home) behavior or situation.
• Ascertain that the patient’s proposed discharge is not due to the patient’s use of necessary hospice services.
• Document in the clinical record, the problem and efforts made to resolve the problem.

Prior to discharging a patient for any reason stated above, the hospice interdisciplinary group (IDG) must obtain a written physician's discharge order from the hospice medical director. If a patient has an attending physician involved in his or her care, this physician should be consulted before discharge, and his/her review and decision should be included in the discharge note.

NOTE:  The hospice should notify its Medicare administrative contractor (MAC) and SA (LARA-BSCSupport@michigan.gov) of the circumstances surrounding the impending discharge.