In the proposed CY2024 Physician Fee Schedule Rule, for which comments are due September 11, the Centers for Medicare & Medicaid Services (CMS) is proposing to implement a provision from the Consolidated Appropriations Act of 2023, that allows marriage and family therapists (MFTs) and mental health counselors (MHCs) to serve on the hospice IDG in the role that a social worker plays.

Our understanding from the authors of the provision is that the utilization of MFTs and MHCs were meant to be options for hospice organizations—not a requirement in addition to having a social worker on the IDG. The language in the proposed rule was confusing on this point and LeadingAge planned to comment for clarification.

During the August 30 open door forum, CMS clarified that their interpretation and what they are proposing is that hospices will need to have all three disciplines available—SW, MFT, and MHC. Only the social worker would need to be directly employed.

We do not agree with this interpretation and will follow up with the Congressional authors, as well as submit comments to CMS regarding this discrepancy. LeadingAge will keep members posted on this issue.