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Meg S.L. Pekarske

Meg has devoted her legal practice to serving the everchanging legal needs of the hospice industry. As chair of Husch Blackwell's Hospice and Palliative Care Practice Group, she manages the firm's hospice practice. In working day in and day out with hospice clients across the country, Meg is intimately familiar with the operational challenges of hospices and has the experience to address the full spectrum of legal issues facing the industry, from routine regulatory compliance issues to multimillion dollar Zone Program Integrity Contractor (ZPIC), Medicaid and other government audits. Additionally, Meg routinely advises hospices on palliative care program development, innovative inpatient unit structures, fraud investigations and a wide range of contracting issues. With an extensive background in long-term care, Meg brings a unique perspective and skill set to helping hospices create successful partnerships with nursing homes and assisted living facilities and providing quality end-of-life care to patients.

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The Centers for Medicare and Medicaid Services (“CMS”) confirmed that hospice physicians and nurse practitioners who serve as a patient’s attending physician (“NPs”) can use telehealth to perform medically necessary visits during the COVID-19 pandemic. To assist hospices in evaluating the feasibility of using telehealth for medically necessary visits with Medicare patients, Husch Blackwell has created a “Hospice Telehealth Flowchart.” The Flowchart addresses important operational considerations as well as the Medicare requirements related to rendering and billing for such telehealth visits.

Change is fast-paced in the world of COVID-19. On Monday, March 30th, CMS released an interim final rule along with hospice specific waivers. In this episode, your Hospice Team discusses these recent developments and their impact on telehealth, face-to-face encounters, virtual visits and Medicare appeals and audits.

For resources related to this episode, please

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The Families First Coronavirus Response Act (“FFCRA”) goes into effect today, April 1, 2020, and applies to leave taken between April 1, 2020 and December 31, 2020.  The FFCRA expands certain medical leave rights previously established by the Family and Medical Leave Act (“E-FMLA”) to provide up to twelve (12) weeks of paid, job-protected leave for employees with school closure or childcare coverage issues related to the current coronavirus pandemic.  The FFCRA also provides for two (2) weeks of paid sick leave under the Emergency Paid Sick Leave Act (“E-PSLA”) for certain COVID-19-related reasons (the E-FMLA and E-PSLA are collectively referred to as “Expanded Leave”).[1]  However, employers who employ “health care providers” may, but are not required to, exempt these individuals from Expanded Leave.  Most, if not all, of a hospice’s employees will fall within the broad definition of “health care provider.”  Therefore, hospices will need to evaluate who of its employees it will exempt or not, being certain to treat similarly situated employees equally and to consider the potential impact to its workforce.

In this episode, your Hospice Team shares insights on operationalizing recent government guidance for hospices facing coronavirus obstacles. We discuss the role of virtual visits, how to use telehealth, and the practical impact of the Medicare appeal waiver. Listen to the full episode here: https://bit.ly/2JmhkMV

On March 22, 2020, and as subsequently clarified on March 27, 2020, the Centers for Medicare and Medicaid Services (“CMS”) temporarily lifted the requirements for hospices to submit Hospice Item Set (“HIS”) data and hospice Consumer Assessment of Healthcare Providers and Systems (“CAHPS”) survey data.  Prior to CMS’s action, failure to comply with these data reporting requirements of the Hospice Quality Reporting Program (“HQRP”), absent an exception, resulted in a 2 percent reduction to a hospice’s annual Medicare payment update.

Telehealth

The Husch Blackwell Hospice Team has been receiving reports from hospices throughout the country that nursing facilities are prohibiting hospice workers from entering the facility to provide essential end-of-life care to hospice patients. Such access is being denied pursuant to visitor restrictions. However, hospice personnel are not visitors but are recognized by the Centers for Medicare and Medicaid Services (“CMS”) as essential health care personnel who must be given access.

These are extraordinary times. COVID-19, or the novel coronavirus, has disrupted the life of every American and every business. Hospices are no exception. In fact, they are on the frontlines, responsible for providing care to the elderly, a population extremely susceptible to COVID-19. The Husch Blackwell Hospice Team is fundamentally a group of problem solvers,…

In this “Hospice Insights: The Law and Beyond” episode, the hospice team shares insights on how to manage and succeed in responding to additional documentation requests (“ADR”) stemming from Targeted Probe and Educate (“TPEs”) projects. We discuss the unique features of TPE and winning strategies for responding. Check out the Hospice Resource Library for tips…