CHA CHA Regulatory and Legal Framework 2 — Questions and Answers
Question 1: Which Medicare hospice election period allows unlimited recertification as long as the patient continues to meet eligibility criteria?
- Subsequent 60-day benefit periods (Correct answer)
- Initial 90-day benefit period
- Second 90-day benefit period
- 30-day short-term period
Correct answer: Subsequent 60-day benefit periods
After the initial and second 90-day periods, patients may receive hospice in subsequent 60-day benefit periods with physician recertification, with no cap on the number of periods.
Question 2: The Stark Law (Physician Self-Referral Law) prohibits physicians from referring Medicare patients to a hospice in which the physician has a financial relationship unless:
- A specific statutory or regulatory exception applies (Correct answer)
- The referral is documented in the medical record
- The patient provides written consent
- The state licensing board approves it
Correct answer: A specific statutory or regulatory exception applies
The Stark Law bans self-referrals to entities with which the physician has a financial relationship unless a statutory or regulatory exception applies.
Question 3: Which document must be signed by the patient or representative when electing the Medicare Hospice Benefit, acknowledging the patient understands the scope of the benefit?
- Election statement (Correct answer)
- Advance directive
- POLST form
- DNR order
Correct answer: Election statement
The election statement is the required form that the patient or representative signs to formally elect the Medicare Hospice Benefit and acknowledge its scope.
Question 4: State hospice licensure requirements are typically administered by which state agency?
- State Department of Health (Correct answer)
- State Insurance Commission
- State Board of Pharmacy
- State Medical Board
Correct answer: State Department of Health
Most states delegate hospice licensure authority to the Department of Health, which issues and renews operating licenses and may conduct state surveys.
Question 5: Under CMS hospice regulations, which level of care must a hospice provide when a patient's pain or symptoms cannot be managed at home and require short-term inpatient nursing care?
- General inpatient care (Correct answer)
- Continuous home care
- Inpatient respite care
- Routine home care
Correct answer: General inpatient care
General inpatient care (GIP) is required when pain or symptom management cannot be achieved in the home setting and requires inpatient nursing care.
Question 6: The OIG Work Plan is a resource hospice administrators use primarily to:
- Identify areas of fraud and abuse focus for federal audits (Correct answer)
- Apply for Medicare certification
- File complaints against other agencies
- Request Stark Law exceptions
Correct answer: Identify areas of fraud and abuse focus for federal audits
The OIG Work Plan outlines areas the Office of Inspector General intends to review, helping hospice administrators prioritize compliance efforts.
CHA CHA Regulatory and Legal Framework 2
Which Medicare hospice election period allows unlimited recertification as long as the patient continues to meet eligibility criteria?