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00;00;00;00 - 00;00;26;26
Bryan Nowicki
Hello and welcome to Hospice Insights: The Law and Beyond, where we connect you to what matters in the ever-changing world of hospice and palliative care. Ready, Fire, Aim: The Calendar Year 2027 Home Health Proposed Rule’s Shoot-First Approach to Provider Enrollment. Andrew, how are you doing? It's great to have you on the podcast.
00;00;26;29 - 00;00;31;18
Andrew Brenton
Hey, Bryan, I'm doing great. Always great to be on the podcast.
00;00;31;19 - 00;00;49;13
Bryan Nowicki
Good, good. And there's certainly been a lot of talk, talk about this year as the year of crushing fraud and expanding authority. And we've tried to keep up with our podcast. It's almost like we need a weekly podcast instead of every 2 or 3 weeks just to stay on top of things.
00;00;49;16 - 00;00;50;19
Andrew Brenton
Right? Right.
00;00;51;06 - 00;01;17;07
Bryan Nowicki
But, I know we've, we've had podcasts about these developments with, the, the what PPEO. We've had a podcast on some court successes our hospice team has had, and so we know CMS is being aggressive, but there are rays of hope out there and certainly winning strategies. So yes, I like the the title of this particular podcast
00;01;17;15 - 00;01;47;06
Bryan Nowicki
Andrew, the ready, fire, aim, because that seems to have been, a modus operandi for CMS, where you can call it casting a wide net. Ready, fire, aim where really taking a very broad-based approach to enforcement or crushing fraud that, that captures some of, you know, some innocent bystanders or collateral damage within. And that's where you and I have been able to help hospices get through that.
00;01;47;06 - 00;02;11;02
Andrew Brenton
Yeah, totally. Kind of, guilty until proven innocent approach. And we've seen that with like, all the hospice and home health payment suspensions out in California. You know, our providers are being suspended based on an aggregate metric as opposed to any kind of particularized findings. So this is sort of this, proposed rule that we're going to be talking about is sort of in a similar vein.
00;02;11;03 - 00;02;19;07
Bryan Nowicki
Yes, yes. And so now the title of this refers to the home health rule. So Andrew is this just about home health?
00;02;19;07 - 00;02;48;10
Andrew Brenton
Yes. No, it's not the. Yeah. This this is a proposed rule that it's the vehicle itself is the kind of annual home health payment rule. But within that rule, CMS put a wide, wide variety of, you know, Medicare wide provider enrollment provisions that, yeah, you know, don't apply just to home health agencies. Although some of the provisions actually do apply specifically to hospices and health agencies.
00;02;48;16 - 00;03;09;24
Bryan Nowicki
Okay. And that's you know, we see that from time to time with CMS coming out with rules, you can't just go by the title of their proposed rule. You kind of have to dig into the details to see, is this really affecting our provider type. And and this is one of those instances. So, we're going to talk about the way this proposed rule affects enrollment.
00;03;09;24 - 00;03;55;27
Bryan Nowicki
It does it has the rule has implications beyond just enrollment. There's program integrity. There's home health stuff. But let's focus on the enrollment part of it, which goes beyond just home health. And I think there's a number of, of topics to talk about. The first one relates to affiliations and, the requirement to disclose affiliations. And when I think of affiliations in the enrollment and revocation of billing privileges context, it makes me think of recent strategies by CMS where, if they are, investigating a hospice, and they review some medical records, they believe the, the medical records do not support a terminal prognosis
00;03;55;27 - 00;04;23;20
Bryan Nowicki
they could revoke that hospice’s billing privileges. And let's say that happens to hospice A well, what we have seen is the medical director for hospice A may also be the medical director for hospice B and may also have his or her own private geriatric practice, for example. And based upon that affiliation, the commonality of that medical director, CMS then goes to hospice B and the physician's geriatric practice and revokes their billing privileges.
00;04;23;20 - 00;04;31;22
Bryan Nowicki
So we've seen the consequences of affiliation. What is this rule do in that area? What's the impact?
00;04;31;22 - 00;05;01;26
Andrew Brenton
So I think the the impact will be that, CMS is just going to have, you know, a broader array of, this affiliation information that it can use as you were, you know, suggesting to revoke downstream providers. So what's changing is the actual affiliation disclosure requirement is becoming broader. So if CMS requests, you know, affiliation information, providers are going to have to give more of that.
00;05;01;26 - 00;05;30;03
Andrew Brenton
So currently there is a five year limitation on affiliation disclosures. So that's going to be going away. So these disclosures or the information contained in them is not going to be time bound anymore. And then there's, you know, a current kind of more limited, array of relationship that qualify as affiliations that's going to be broadly, broadly expanded to basically cover any business relationship.
00;05;30;03 - 00;06;03;17
Andrew Brenton
There's going to be a new category of affiliation that is any marketing, business, fulfillment, financial, managerial or beneficial area relationship. So that sort of, you know, translating that to me, kind of just sounds like any business relationship you have. So not just a managing employee of the provider, but right, any kind of business relationship. So I if this were, you know, were to pass or be finalized, if this rule were then I think right
00;06;03;23 - 00;06;10;10
Andrew Brenton
we may kind of see even more of those kind of cascading affiliation based revocations you were describing.
00;06;10;10 - 00;06;29;29
Bryan Nowicki
Yeah. Right. Exactly. Define business. I mean, that's how much broader you can't get much broader than just say, business. You raise a good point, though. And before we get too far ahead of ourselves, this is a proposed rule, right? Yes. So so why don't you describe the implications of this being a proposed rule?
00;06;29;29 - 00;06;59;00
Andrew Brenton
Yeah so the rule was proposed as this kind of part of the annual home health rulemaking cycle, that it is a calendar year rule. So, you know, this rule in some form or another will be finalized, you know, November somewhere around then, and it will go into effect for calendar year 2027. So kind of these changes that we're talking about do assume that, you know, there these proposals are finalized as proposed.
00;06;59;19 - 00;07;03;23
Andrew Brenton
And then they would take effect, next year, 2027.
00;07;03;25 - 00;07;30;10
Bryan Nowicki
And part of this rulemaking process is a public comment period. So folks are able to comment and raise concerns about or object to or support any of these. And then when that final rule comes out, CMS will publish a summary of all the comments and their response to them. I think the feeling is and what often happens is nearly all of these proposed rules do eventually get into the final rule.
00;07;30;10 - 00;07;51;21
Bryan Nowicki
There's certain exceptions from time to time, but it may be a safe bet, especially under the current environment that where CMS is trying to obtain for itself broader authority and more tools, that that's exactly what they're aiming for. And even if people object to them in comments, CMS has the final word on all of that. So. Right.
00;07;51;24 - 00;08;05;26
Andrew Brenton
Yeah. Totally. And I mean, there's just so many proposals. We're we're only covering kind of a few high level ones today. So even if right, you know, not 100% of these are finalized as proposals, I think in all likelihood most of them will be.
00;08;05;26 - 00;08;30;28
Bryan Nowicki
So getting back to the topic of this, affiliations disclosure, you talked about the current five year limit being eliminated. So if you have an affiliation with a a person who ten years ago had an adverse event, that would be disclosed upon request. Yes. Okay. All right. Yeah. So definitely more for CMS to look into if it chooses.
00;08;30;28 - 00;08;50;02
Bryan Nowicki
And the domino effect we've seen with medical directors could be expanded to all number, any number of other kinds of relationships that are out there. So. Right. All right. So we have an expanded affiliation disclosure standard. What else is in this new rule relating to Revit or enrollment as.
00;08;50;04 - 00;09;23;26
Andrew Brenton
Yeah, well, there's a ton of new revocation and denial bases. So and by denial I mean a denial of an initial enrollment application or a revalidation, enrollment application, and then a revocation of courses, when CMS takes action against you and revokes you from, Medicare, and terminates your Medicare provider agreement. So currently there are enumerated bases, you know, whereby CMS can take those actions.
00;09;23;26 - 00;09;33;09
Andrew Brenton
This proposed rule expands those bases. It adds additional denial bases and adds additional revocation bases. So I.
00;09;33;11 - 00;09;54;29
Bryan Nowicki
I think one of the more common ones we've seen so far as a revocation is called abuse of billing privileges. Right. And that's where through the PPO process, they look at medical records. It's kind of the medical director example. I just shared that they they deny claims. They think you're admitting patients who aren't eligible. And they say, well, that's an abuse of billing privileges.
00;09;54;29 - 00;10;09;09
Bryan Nowicki
So a very common one. I think we've also seen false or misleading or, information on the 855 or failure to report. 855 so but there's a number in addition to that already on the books, right?
00;10;09;12 - 00;10;11;25
Andrew Brenton
Yes. There is. Yeah, absolutely.
00;10;11;27 - 00;10;14;21
Bryan Nowicki
And then what's new? What's in the works?
00;10;14;24 - 00;10;33;03
Andrew Brenton
Well, I wasn't even planning to talk about this, but you mentioned the abuse of billing privileges. That's that isn't new, that currently exists. But there is a proposal related to it. That would essentially make the standard, that CMS uses this much easier to meet the, you know, currently there's like I think is a four part test.
00;10;33;03 - 00;10;44;00
Andrew Brenton
They have to meet that's going away is it's going to be much easier for CMS to determine that either these your billing privileges and revoke you based on reviewing just a few claims.
00;10;44;03 - 00;11;11;24
Bryan Nowicki
So and that tend to be well, and in our experience it was already a very low bar. So that for you to say that it's even easy, I mean, even I didn't know it could get any easier for them to, to find an abuse of billing privileges. You're supposed to show a pattern and practice problems, but we've seen them on the the very thinnest of evidence, argue that, a lot of things are a pattern in practice, so I kind of wish you wouldn't have shared that.
00;11;11;24 - 00;11;22;00
Bryan Nowicki
Now it's just another another thing to look out there. Look out for it. So very important. But but, but yeah, that's another one. So what is new? What is kind of, being proposed.
00;11;22;01 - 00;11;49;03
Andrew Brenton
Yeah. So there's a new revocation, basis that is called the high risk geographic area basis. So yeah, this is completely new. And if this is finalized, CMS will be able to revoke your enrollment, because and this is, you know, the language that CMS is using because you're located in a limited geographic area that has an excessive number of providers.
00;11;49;09 - 00;12;15;03
Andrew Brenton
So there doesn't have to be any finding of, fraud or wrongdoing. It literally is just you are in an area where there are too many providers, and CMS doesn't articulate any standards for, you know, what a limited geographic area is or what excessive means that it really does appear to be completely at their discretion as to, you know, they just don't want more providers in this specific area.
00;12;15;03 - 00;12;16;02
Andrew Brenton
So they're going to revoke you.
00;12;16;02 - 00;12;24;12
Bryan Nowicki
I guess they're they're drawing from the Los Angeles experience, where I don't know how many hundreds of hospices were in Los Angeles County.
00;12;24;12 - 00;12;25;27
Andrew Brenton
Yeah, I think so.
00;12;26;11 - 00;12;32;09
Bryan Nowicki
Yeah. But it's it's kind of like, a post hoc certificate of need. It sounds like.
00;12;32;12 - 00;12;34;16
Andrew Brenton
It's actually in the federal. Well, exactly.
00;12;34;22 - 00;12;58;17
Bryan Nowicki
You will write a national like we you know, we work in states where you before you can enroll, you need to show that the area you want to enroll in provide services in as a need for those services, as kind of a gateway. And I guess now, because this is revocation, you've already gotten the enrollment. They'll just say, well, they don't really need you in that neighborhood or in those counties or in that state.
00;12;58;17 - 00;13;11;28
Bryan Nowicki
Yeah. Troubling that the, the key terms are not, are not defined. So, but but consistent with the theme of CMS just drawing to itself maximum discretion and flexibility. So.
00;13;11;28 - 00;13;12;26
Andrew Brenton
Right, right.
00;13;13;03 - 00;13;15;28
Bryan Nowicki
All right. What is next Andrew.
00;13;16;00 - 00;13;43;18
Andrew Brenton
So wanted to talk about a new denial ground. So again this is this is when CMS denies your enrollment application. And obviously we're in a moratorium right now for hospice and home health. So no one's filing new enrollment applications. But I do think a revalidation application, would count here in terms of this denial authority. And this is specific to hospice.
00;13;43;18 - 00;14;18;15
Andrew Brenton
So the new denial ground, pertains to hospice medical directors and hospice administrators. So under this new proposal, CMS could deny your enrollment if your medical director serves at multiple other hospices, is too geographically distant to realistically perform required functions, if the administrator serves at multiple hospices and similarly, is is too far away, or if the medical director medical director lacks a physician license in the in the practicing state.
00;14;19;02 - 00;14;43;02
Andrew Brenton
So, you know, several things kind of problematic with this proposal. And like the last thing we were talking about, unclear what multiple hospices mean. So if the medical director serves at just one other hospice, is that too many or does it need to be ten? I mean, CMS isn't specifying a number. The geographic distance, how far away is too far?
00;14;43;27 - 00;15;10;18
Andrew Brenton
And then we also we do see a number of hospices where it might have like kind of a system tied medical director who doesn't necessarily have a license. And, you know, each state or they're listed as the medical director, this specific proposal would kind of target that practice. So I think this has the potential to impact, a lot of our clients or just the general hospice, community
00;15;10;28 - 00;15;13;01
Andrew Brenton
at least at that kind of the revalidation level.
00;15;13;02 - 00;15;37;06
Bryan Nowicki
Yeah. The title chief medical officer of an organization. So, hospices who are multi-state, many locations, they may have a chief medical officer, over a sprawling organization. And they're not going to be licensed in the 5 or 10 or, you know, 20 states that are in, is that person under age, 55, or other otherwise have a leadership role?
00;15;37;06 - 00;16;04;18
Bryan Nowicki
You may want to be, be wary of doing that given this consequence. Right. And I, I, we and I, and I see a theme developing here when you talk about medical directors serving at multiple hospices, Los Angeles again comes to mind. I think, CBS did a story on a medical director not long ago who was the medical director for 129 or so hospices or some crazy number like that.
00;16;05;06 - 00;16;37;00
Bryan Nowicki
And when I see stuff like that with the government, developing regulations based on a worst case scenario, I, I get worried that they're going to see everything as a worst case scenario. So we might be able to agree that a medical director shouldn't be a medical director for 100 hospices. But, as I understand that, Andrew, there's no safeguard in here to say, well, three is okay, but five is not or seven is fine as long as your, kind of responsibilities are this.
00;16;37;00 - 00;16;42;02
Bryan Nowicki
Isn't that so? Who knows where the government's going to take this, this authority.
00;16;42;04 - 00;16;42;23
Andrew Brenton
Exactly.
00;16;42;26 - 00;16;44;28
Bryan Nowicki
All right, what else do you have for us?
00;16;45;18 - 00;17;17;11
Andrew Brenton
So there's a new, revocation basis that's actually related to denial. So. Right. I mentioned that the proposed rule is going to add, several enrollment denial bases, including this hospice medical director administrator thing we just talked about. In addition to that, CMS is proposing that if your enrollment is denied, that that in itself and serve as a basis for revoking the enrollments of, of that same provider.
00;17;17;11 - 00;17;37;18
Andrew Brenton
So, so if the legal entity that had the enrollment denial, you know, if they're issued that denial, then CMS under this proposal would have the authority to look at the enrollments of that legal entity and revoke them based on the denial. That is a, I think, a brand new authority that CMS is, assigning to itself.
00;17;37;19 - 00;18;07;02
Bryan Nowicki
Well, let's say you're, a corporation, XYZ Hospice Corporation, or LLC, and you operate a few different towns. You'll want to, you know, perhaps, open up and another provider type, maybe a palliative care or something like that. And so you apply for that and it's denied. Am I is that a scenario where that denial might jeopardize what could be long standing hospice operations for that entity?
00;18;07;02 - 00;18;22;10
Andrew Brenton
Yes. Yes, exactly. So if, if that new like part B enrollment application were denied, in theory, CMS, CMS could then revoke the enrollments like, like the current and existing enrollments of that applicant.
00;18;22;12 - 00;18;46;08
Bryan Nowicki
Okay. So, you know, another thing for, business development, and, you know, people who are involved in strategic thinking around hospices, how to grow your business, diversify your service lines. Another risk we're identifying here to keep in mind, you may not want to jeopardize long standing business lines, with an effort like this. Or maybe you do.
00;18;46;08 - 00;19;08;12
Bryan Nowicki
I mean, that might fit within your calculus, but, you know, good to know that that is out there. At least if this rule, that part of the rule gets finalized. Andrew, I know you're going to talk about retroactive revocations, and that's been something that we've been seeing an increasing number of with, revocations that have resulted from the PPEO kind of medical review.
00;19;08;13 - 00;19;34;21
Bryan Nowicki
Those, when they it didn't turn out well. What we first saw were you'd get a notice of revocation, a hospice would that the revocation of billing privileges is effective 30 days later. So 30 days past the notice you receive. So it gives that hospice time to transfer patients. Bill kind of, run out the services provided to patients and transfer them out if that's what they choose to do
00;19;34;21 - 00;20;00;05
Bryan Nowicki
in light of the effects of the revocation. But more recently, in the past year, we have seen some retroactive revocations in the PPEO context, where they will revoke, retroactive to the last month of claims that they reviewed, which could be 3 or 4 months. So, we've started to see that, what is the new proposed rule have to say about retroactive revocations?
00;20;00;10 - 00;20;34;22
Andrew Brenton
The proposed rule would make every revocation basis retroactive. So so right now, the, kind of the, the default rule is that, if you're revoked, that revocation is prospective. There are currently some revocation bases that result in a retroactive revocation. And a piece of failure privileges is one of them. But this proposed rule would take every other currently prospective revocation basis, including all, you know, these new ones, and make them retroactive.
00;20;34;24 - 00;21;03;22
Andrew Brenton
So basically, going forward, if you are revoked, you're going to be revoked, retroactive to another underlying event that led to your revocation. Right. Which is, you know, then I don't like what you're saying. This is gonna result in you getting a notice that you've been revoked. Oh, and you have, you know, also a large overpayment liability because you got paid for claims, you know, during this period that you didn't even know you were revoked until now because you have a retroactive revocation.
00;21;04;03 - 00;21;28;04
Bryan Nowicki
So so what CMS is saying is with the retroactive revocation is what is it? You know, let's say we're in August 2026. You're revoked. Retroactive to February 2026. CMS is saying you were because you were revoked. Effect of that date. Every dollar you receive from Medicare since February 3rd, you shouldn't have received because you were a revoked hospice.
00;21;28;04 - 00;21;45;14
Bryan Nowicki
And now, you get a demand letter and you have to pay that back. But in a revocation, they're doing that in the context of cutting off your ability to get any more revenue. Ouch. I mean, that, how how can you, you know, they're not leaving you with any opportunity to actually satisfy the debt thing.
00;21;45;16 - 00;21;46;14
Andrew Brenton
Right? Yes.
00;21;46;20 - 00;22;01;09
Bryan Nowicki
Yeah, I and I know, I know, we've had some clients dealing with that when revocations on enrollment bases, getting some pretty hefty demand letters, and even having an unpaid debt to CMS, that has its own implication, doesn't it?
00;22;01;09 - 00;22;22;10
Andrew Brenton
Right. Yeah. Yeah. If if you have, a Medicare debt that's referred to Treasury, that currently is a basis to be revoked. And then there's also a denial basis, based on Medicare debt. So, yeah, Medicare debt is currently hard under under CMS’s existing authority. Okay.
00;22;22;17 - 00;22;55;01
Bryan Nowicki
And I know I mean to give some people in some insight, some insider knowledge about our team. We're kind of we've been familiar with a lot of these revocation issues for some time, and trying to examine, you know, what's the what's the authority of CMS to do a lot of these? And we're exploring some areas or some arguments to say maybe CMS is stepping outside of its authority around retroactive revocations or revocations themselves.
00;22;55;02 - 00;23;17;26
Bryan Nowicki
So, you know, when we're working with clients, we're exploring all of those opportunities there, an expanded rule and a rule that expands their authority. Certainly the CMS believes it has this authority and takes it, to the hilt, is taking it to the hilt or wants to, but, but we are kind of trying to noodle on some ways to push back against that.
00;23;18;05 - 00;23;25;04
Bryan Nowicki
So yeah, hopefully we'll be able to deploy those successfully, but we'll see as, as the future unfolds.
00;23;25;08 - 00;23;25;20
Andrew Brenton
Yes.
00;23;25;27 - 00;23;31;16
Bryan Nowicki
All right, Andrew, anything else to report on for this enrollment, based episode? Yeah.
00;23;31;19 - 00;24;00;05
Andrew Brenton
Yes. Just just one more and one key provision I wanted to talk about, and it relates to the moratorium. So obviously, right now there is a nationwide Medicare enrollment moratorium, for both hospice and home health, that that applies to new enrollments, as well as a 55 applications to add new locations to existing enrollments. So, right.
00;24;00;08 - 00;24;40;04
Andrew Brenton
That's been in place since May, may be extended, you know, after it's set to expire in November. But in this proposed rule, CMS is proposing that if you submit a reactivation application that that counts as a new enrollment. So therefore would be prohibited by the moratorium. So as this proposal is finalized, what this means is that if you are deactivated, so if you have your Medicare mailing privileges deactivated, which is sort of a much easier your standard to me, this is a more common occurrence than like a revocation.
00;24;40;08 - 00;24;50;00
Andrew Brenton
And if you're deactivated, you have to submit a reactivation application to get reactivated. While you can't do that during the moratorium if this proposal goes into effect.
00;24;50;07 - 00;25;00;21
Bryan Nowicki
What's an example of how a provider can get deactivated? In, in, you know, without in, in a, in a relatively what might seem a mundane manner.
00;25;00;21 - 00;25;25;26
Andrew Brenton
Yes. Well, I mean, the most common way that I see this happening is you fail to respond to, like, a development request. So you submitted a 855 application, maybe to change your medical director. The MAC emails you because they want you to do something else with the 855. You missed the email. Maybe. Or you respond, but you do so in a way that the MAC thinks is insufficient.
00;25;25;29 - 00;25;48;18
Andrew Brenton
That is, the basis can be the basis and is in fact the base as we see all the time for deactivation. Another common one would be if you're if you're not billing Medicare, you know, for a six month period, you can be deactivated. So we see that happen often as well. But yeah, like you said, these can be very mundane.
00;25;48;18 - 00;26;12;13
Andrew Brenton
We've even seen the MAC, kind of erroneously deactivate providers based on some kind of glitch within the MAC system. So, I mean, I think this is kind of an alarming provision because if you are, you know, kind of mundane, deactivated in the way we're talking about, well, then you're you basically can't bill Medicare for however long the moratorium lasts, which is a complete unknown.
00;26;12;14 - 00;26;34;21
Bryan Nowicki
Yeah. And, you know, deactivation is familiar to me in the PPEO process because PPEO can be imposed on new hospices in those six states where it currently applies. And one way to be a new hospice is reactivation. So it sounds like, you know, it's you know, the good news is you won't get a PPEO if you're deactivated.
00;26;35;28 - 00;26;40;25
Bryan Nowicki
And because but you won't get one because you won't be able to reactivate. Right.
00;26;40;25 - 00;26;41;29
Andrew Brenton
So yeah.
00;26;41;29 - 00;27;03;19
Bryan Nowicki
So they already had, they already had a way to, kind of scrutinize you with PPEO, but, seemingly that was not enough. They're just going to cut you out entirely, so, you know. All right. Well, so, so that's kind of maybe the world, hospices are going to live in in the next, you know, starting in 2027, if the rule, if the rule goes through.
00;27;03;19 - 00;27;26;21
Bryan Nowicki
So, yeah, now again, people are able to comment, on this. So public comments are welcome. And if you have something to say about these rules, you know, feel free to do that. I think a lot of the national organizations, they typically submit comments, of support or criticism or objection depending upon the topic. So those are publicly available.
00;27;26;21 - 00;27;37;25
Bryan Nowicki
You'll be able to see those as well. You mentioned maybe later this year. Do we have a sense of when the these kinds of rules are typically finalized that we might see what actually got into the final rule?
00;27;37;28 - 00;28;03;11
Andrew Brenton
I feel like that calendar year rules tend to be finalized in November. So yeah, I'm sort of into it because I think comment period closes at the end of August. Then I'll probably be a couple month period where CMS is entertaining the comments and deciding where to go. You know, ends up in the final rule. So yeah, I would anticipate, sometime in November, we'll, we'll find out what the final rule looks like.
00;28;03;15 - 00;28;11;29
Bryan Nowicki
All right. Any any final comments? Andrew, regarding this, the interesting development and all this new enrollment, activity.
00;28;12;03 - 00;28;44;15
Andrew Brenton
I mean, just yeah, this is just kind of continuing, the, the trend, you know, that we're seeing with CMS really focusing on fraud and, you know, particularly in the hospice and home health space. And, you know, casting that wide net, you know, a shoot first kind of mentality. So, you know, kind of part and parcel of what we see in these are, you know, times to be very vigilant and have, you know, active compliance program if your hospice or home health agency.
00;28;44;15 - 00;28;48;22
Andrew Brenton
So. Yeah, you know, stay with it, I guess.
00;28;48;24 - 00;29;11;16
Bryan Nowicki
Yeah. Stay with it. Andrew, does, he leads our regulatory work. So he and, the attorneys that he and I both both work with and our colleague, Adam Royal, Zaina Niles, we're here to support whatever hospices encounter along the way. And, Andrew, you've you and I have mentioned the moratorium that is set to expire, maybe October
00;29;11;16 - 00;29;37;16
Bryan Nowicki
November. And I've, I've heard some comments about perhaps the enrollment limitations in this proposed rule will be viewed as a way to lift the moratorium, because with these new enrollment limitations, they're kind of accomplishing something that the moratorium was designed to do in a, in a relatively, you know, more immediate way. My my perspective is moratorium
00;29;37;16 - 00;29;51;28
Bryan Nowicki
moratoria have often been imposed for more than six months. So I think it's that I would hope that it's, they would move away from the moratorium if these are all finalized. But I wouldn't hold your breath.
00;29;51;28 - 00;30;09;20
Andrew Brenton
Right. I wouldn't either. And I mean, even that last topic we were talking about, if CMS is intending to to not extend the moratorium after November, why would it be proposing that starting in January, there's a new type of enrollment that's covered under the moratorium? So. Yeah.
00;30;09;20 - 00;30;34;06
Bryan Nowicki
Maybe that's that's a great that's a great point that I that kind of went over my head. Exactly. They're already thinking of ways to change the moratorium. Effective 2027. That might be the biggest tell or reveal. And an obvious point that, I'm glad you, you made it obvious to me. So. All right, so we probably anticipate the moratorium continuing on top of these things.
00;30;34;06 - 00;30;54;27
Bryan Nowicki
And hopefully CMS will achieve its goals, and then we get to hear about all this deregulation that the current administration has been talking about. We'll see. So thank you very. Yeah. Thank you very much, Andrew. It's, as always, a pleasure. I appreciate all the knowledge and depth of, information and experience you're able to share.
00;30;54;27 - 00;31;20;04
Bryan Nowicki
So thank you very much.
Andrew Brenton
Thank you Byan.
Bryan Nowicki
All right. Take care everybody. That's it for today's episode of Hospice Insights: The Law and Beyond. Thank you for joining the conversation. To subscribe to our podcast, visit our website at huschblackwell.com or sign up wherever you get your podcasts. Until next time, take care.