CMS Part D and Hospice Election Data Pilot Set to Begin 

Situation Report | October 26, 2020

Our colleagues at the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO) have been working with the National Council of Prescription Drug Plans (NCPDP) to improve coordination between hospice providers and Part D plans to ensure appropriate coverage for prescription drugs while patients are on hospice service.  

A key issue is the length of time it takes for information about a patient’s hospice election to filter through the U.S. Centers for Medicare and Medicaid Services (CMS) systems to the Part D prescription drug plans. CMS is now set to launch a pilot study under which hospice electronic medical review (EMR) vendors and Part D plans will test whether hospice election information can be transmitted more timely from hospice providers through their EMR vendor and an intermediary directly to the patient’s Part D plan.

The following EMR vendors have been recruited to be part of this pilot project: Axxess, MatrixCare and Netsmart. They will transmit basic election information using the 837i standard electronically to the patient’s Part D plan. This 837i electronic standard is used for electronic submission of Notices of Election (NOEs), Notices of Change (NOCs), and Notices of Termination/Revocation (NOTRs).

If your EMR software vendor asks you to participate in the pilot, and you utilize the 837i electronic standard to submit your hospice NOEs, NOCs, and NOTRs, HCA and our colleagues at the national association level encourage you to participate. Your hospice could be part of something that will solve an important communication challenge that has troubled hospices, Part D plans, CMS and others for a number of years.