CHA CHA Regulatory and Legal Framework 1 — Questions and Answers
Question 1: Under the Medicare Hospice Benefit, which federal regulation outlines the Conditions of Participation (CoPs) that hospice programs must meet?
- 42 CFR Part 418 (Correct answer)
- 42 CFR Part 484
- 42 CFR Part 482
- 42 CFR Part 488
Correct answer: 42 CFR Part 418
42 CFR Part 418 contains the Medicare Hospice Conditions of Participation that all certified hospice agencies must comply with.
Question 2: The False Claims Act (FCA) primarily protects the government against which type of hospice misconduct?
- Submitting fraudulent claims for Medicare reimbursement (Correct answer)
- Failing to maintain licensure
- Understaffing the interdisciplinary team
- Not providing bereavement services
Correct answer: Submitting fraudulent claims for Medicare reimbursement
The FCA imposes liability on individuals and organizations that submit false or fraudulent claims to government programs like Medicare.
Question 3: Which federal agency is responsible for conducting surveys to certify hospice programs for Medicare participation?
- Centers for Medicare & Medicaid Services (CMS) (Correct answer)
- Office of Inspector General (OIG)
- The Joint Commission
- Department of Veterans Affairs
Correct answer: Centers for Medicare & Medicaid Services (CMS)
CMS oversees the certification process for hospice programs, typically through State Survey Agencies acting on its behalf.
Question 4: A hospice patient electing the Medicare Hospice Benefit must have a prognosis of how long to live if the illness runs its normal course?
- 6 months or less (Correct answer)
- 12 months or less
- 3 months or less
- 9 months or less
Correct answer: 6 months or less
To elect the Medicare Hospice Benefit, two physicians must certify the patient has a terminal prognosis of 6 months or less if the disease runs its normal course.
Question 5: Which law established the anti-kickback statute that prohibits hospices from offering financial incentives to physicians for patient referrals?
- Social Security Act Section 1128B(b) (Correct answer)
- HIPAA Title II
- Stark Law Section 1877
- ACA Section 3132
Correct answer: Social Security Act Section 1128B(b)
The federal Anti-Kickback Statute under Social Security Act Section 1128B(b) prohibits offering, paying, soliciting, or receiving anything of value to induce referrals for federally reimbursed services.
Question 6: Under HIPAA, a hospice's Notice of Privacy Practices (NPP) must be provided to patients at which point?
- At the first service delivery encounter (Correct answer)
- Only upon patient request
- At discharge
- Annually by mail
Correct answer: At the first service delivery encounter
HIPAA's Privacy Rule requires covered entities, including hospices, to provide patients with a Notice of Privacy Practices no later than the date of first service delivery.
CHA CHA Regulatory and Legal Framework 1
Under the Medicare Hospice Benefit, which federal regulation outlines the Conditions of Participation (CoPs) that hospice programs must meet?