In FY 2022, for-profit hospices provided approximately 64 percent of all hospice days while non-profit hospices provided approximately 27 percent of all hospice days. In the FY 2022 Hospice Wage Index and Rate Update final rule (86 FR 42532 through 42539), we finalized a policy to rebase and revise the labor shares for CHC, RHC, IRC, and GIP using Medicare cost report (MCR) data for freestanding hospices (collected via CMS Form 198414, OMB No. In effect, the proposed hospice payment update percentage for FY 2024 would be 2.8 percent. Beliefs/Values Addressed (if desired by the patient). [52], A physician received kickbacks for recruiting beneficiaries, many of whom were not terminally ill but seeking opioids. daily Federal Register on FederalRegister.gov will remain an unofficial [39] Section 1814(a)(7)(D)(i) of the Act, as added by section 3132(b)(2) of the PPACA, required that effective January 1, 2011, a hospice physician or nurse practitioner have a face-to-face encounter with the beneficiary to determine continued eligibility of the beneficiary's hospice care prior to the 180th day recertification and each subsequent recertification and to attest that such visit took place. We believe this screening process has greatly assisted CMS in executing its responsibility to prevent Medicare fraud, waste, and abuse. Under the current payment system, hospices are paid for each day that a beneficiary is enrolled in hospice care, regardless of whether services are rendered on any given day. For questions regarding hospice certifying physician provider enrollment, contact Frank Whelan at (410) 7861302. It is not an official legal edition of the Federal We solicited public comments via the aforementioned RFI on a potential health equity structural composite measure in the Hospice Quality Reporting Program. We estimate that the net impact of the policies in this rule is a 2.8 percent or approximately $720 million in increased revenue to hospices in FY 2024. The owner submitted fraudulent charges and received more than $1 million from Medicare. It has always been our expectation that the certifying physicians would use their best clinical judgment, as described in our regulations at 418.22 and 418.25, to determine if an individual has a life expectancy of 6 months or less with each certification and recertification. What are reasons why non-hospice spending is growing for beneficiaries who elect hospice? Specifically, we stated that for accounting years that end after September 30, 2016, and before October 1, 2025, the hospice cap is updated by the hospice payment update percentage rather than using the CPIU. 2024 hospice proposed rule A total of 15,515 decedents/caregivers were randomly sampled from these hospices. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-Quality-Reporting-Training-Training-and-Education-Library. Hospice https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/Downloads/2014-PartD-Hospice-Guidance-Revised-Memo.pdf. The exemption is determined by CMS and is only for 1 year. [29] When implementing this provision, CMS finalized, in the FY 2011 Hospice Wage Index final rule (75 FR 70435), that the 180th day recertification and subsequent recertifications would correspond to the beneficiary's third or subsequent benefit periods. 202306769 Filed 33123; 4:15 pm]. [email protected], For a detailed discussion of the historical use for measure selection and removal for the HQRP quality measures, we refer readers to the FY 2016 Hospice Wage Index and Rate Update final rule (80 FR 47142) and the FY 2019 Hospice Wage Index and Rate Update final rule (83 FR 38622). Comments, including mass comment submissions, must be submitted in one of the following three ways (choose Section 1814(a)(7)(B) of the Act requires that a written plan for providing hospice care to a beneficiary, who is a hospice patient, be established before care is provided by, or under arrangements made by, the hospice program; and that the written plan be periodically reviewed by the beneficiary's attending physician (if any), the hospice medical director, and an interdisciplinary group (section 1861(dd)(2)(B) of the Act). CMS Framework for Health Equity In examining overall non-hospice spending during a hospice election, Medicare paid over $1.4 billion in non-hospice spending during a hospice election in FY 2022 for items and services under Parts A, B, and D Medicare payments for non-hospice Part A and Part B items and services received by hospice beneficiaries during a hospice election increased from $685 million in FY 2019 to nearly $883 million in FY 2022 (see Figure 4). While this rule takes initial steps, this is part of a larger effort by CMS to address hospice fraud, waste and abuse that will continue this year. https://journalofethics.ama-assn.org/article/racial-disparities-hospice-moving-analysis-intervention/2006-09. Approved Hospice CAHPS vendors must successfully submit data on the hospice's behalf to the CAHPS Hospice Survey Data Center. Based on our analysis, we conclude that the policies finalized in this rule would result in an estimated total impact of 3 to 5 percent or more on Medicare revenue for greater than 5 percent of hospices. 47. L. 111148), required hospices to begin submitting quality data, based on measures specified by the Secretary of the Department of Health and Human Services (the Secretary), for FY 2014 and subsequent FYs. Additionally, as illustrated in Figure 1, the percentages of hospices providing no CHC, IRC, or GIP have also increased from FY 2019 to FY 2022. HQRP Compliance requires understanding three timeframes for both HIS and CAHPS: (1) The relevant Reporting Year, payment FY, and the Reference Year (The Reporting Year (HIS)/Data Collection Year (CAHPS). In the FY 2020 Hospice Wage Index and Rate Update final rule (84 FR 38484), we finalized rebased payment rates for CHC and GIP and set those rates equal to their average estimated FY 2019 costs per day. failure to report quality data changes to 4 percentage points beginning in FY 2024. The GAO observed therein that the number of: (1) Medicare hospice beneficiaries had almost tripled to nearly 1.5 million by fiscal year 2017; and (2) Medicare hospice providers had doubled. Division CC, section 404 of the CAA, 2021 extended the accounting years impacted by the adjustment made to the hospice cap calculation until 2030. A Proposed Rule by the Centers for Medicare & Medicaid Services on 04/04/2023. Before the enactment of this provision, the hospice cap update was set to revert to the original methodology of updating the annual cap amount by the CPIU beginning on October 1, 2025. CMS Proposed CY2024 Home Health Rule. Burdensome Transitions (Type 2)Live Discharges from Hospice Followed by Hospitalization with the Patient Dying in the Hospital. By providing data from multiple time points across the hospice stay, HOPE would provide information to hospice providers to improve practice and care quality. The payment rate updates are subject to changes in economy-wide productivity as specified in section 1886(b)(3)(B)(xi)(II) of the Act. The services offered under the Medicare hospice benefit must be available to beneficiaries as needed, 24 hours a day, 7 days a week (section 1861(dd)(2)(A)(i) of the Act). 13. The appropriate wage index value would be applied to the labor portion of the hospice payment rate based on the geographic area in which the beneficiary resides when receiving RHC or CHC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822363/. MedPAC stated that for more than a decade, the increasing number of hospice providers is due almost entirely to the entry of for-profit providers. Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature ( JAMA. First, the current heading of 424.507(b) is Conditions for payment of claims for covered home health services. On April 4, 2023, CMS released the fiscal year (FY) 2024 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Proposed Rule. Health-related social needs are defined as the individual-level manifestations of SDOH, such as housing instability and food insecurity. The proposed rule can be viewed at the Federal Register at. The base payments are adjusted for geographic differences in wages by multiplying the labor share, which varies by category, of each base rate by the applicable hospice wage index. From FY 2013 through FY 2022, the average live discharge rate has been approximately 17 percent per year. CY 2023 data submissions compliance impacts the FY 2025 APU. [37] Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on state and local governments, preempts state law, or otherwise has federalism implications. 31. In OMB Bulletin No. As outlined in the CY 2022 HH PPS final rule, we stated that we would take into account comments that we received and work on a revised proposal, seeking additional collaboration with stakeholders to further develop the methodology for the SFP since the publication of the CY 2022 HH PPS final rule. Other represents the other category. CHC is provided during a period of patient crisis to maintain the patient at home; IRC is short-term care to allow the usual caregiver to rest and be relieved from caregiving; and GIP care is intended to treat symptoms that cannot be managed in another setting. ), we continue to monitor both hospice and non-hospice spending under the hospice benefit. After considering public comments, CMS decided to convene a health equity technical expert panel to provide additional input to inform the development of health equity quality measures. In addition to the ownership transparency, equipping patients and caregivers with information to inform hospice selection, as well as information examining health equity under the hospice benefit. [28] To the extent that the instrument utilizes data already being collected for the Hospice QRP, our statutory authority for the HOPE instrument derives from section 1814(i)(5)(C) of the Act. 7. Ibid, p. 12. June 2021. For questions regarding the hospice conditions of participation (CoPs), contact Mary Rossi-Coajou at (410) 7866051. As of this publication, the Initial Proposals for Updating OMB's Race and Ethnicity Statistical Standards, 88 FR 5375, seeks public comment. Report to Congress, Medicare Payment Policy. 22. section. The amount of coinsurance for each respite care day is equal to five percent of the payment made by CMS for a respite care. (2021). For further information, see the hospice webpage here: https://www.cms.gov/Center/Provider-Type/Hospice-Center, https://www.federalregister.gov/public-inspection/2023-06769/medicare-program-fiscal-year-2024-hospice-wage-index-and-payment-rate-update-hospice-conditions-of, For the First Time, HHS Is Making Ownership Data for All Medicare-Certified Hospice and Home Health Agencies Publicly Available, Fiscal Year (FY) 2023 Hospice Payment Rate Update Final Rule (CMS-1773-F), CMS Updates Medicare Payment Policies for Several Types of Healthcare Providers, Fiscal Year 2021 Hospice Payment Rate Update Final Rule CMS-1733-F, COVID-19 Response News Alert: CMS Issues Frequently Asked Questions on Guidance to State Survey Agencies Suspending Non-Emergency Survey Inspections. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-QRP-Provider-Engagement-Opportunities. Under the Medicare hospice benefit, the election of hospice care is a patient choice and once a terminally ill patient elects to receive hospice care, a hospice interdisciplinary group is essential in the seamless provision of primarily home-based services. We did not consider any alternatives to our proposal to require physicians who order or certify hospice services for Medicare beneficiaries to be enrolled in or validly opted-out of Medicare as a prerequisite for the payment of the hospice service in question. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice. These can be useful FY 2016FY 2022 hospice claims data from CCW on January 20, 2023. In addition, while the anticipated health equity efforts that impact policy changes would proceed through the notice and comment rulemaking process, other activities would be completed through sub-regulatory channels and regular communication strategies, such as Open-Door Forums, Medicare Learning Network, We see value in aligning SDOH data items across all care settings and might consider adding SDOH data items used by other care settings into HQRP as we develop future health equity quality measures under our HQRP statutory authority. In August 2022, we began publicly reporting the two new claims-based measures. Hospice compliance with claims data requirements is based on administrative data collection. CY 2024 Proposed Payment Updates and Policy Changes Updates for Home Health Agencies This rule proposes routine, statutorily required updates to the In addition, small hospices would experience a greater estimated increase Amend 424.507 by revising paragraphs (b) introductory text and (b)(1) introductory text and adding paragraph (b)(3) to read as follows: (b) In the FY 2017 Hospice Wage Index and Rate Update final rule (81 FR 52160), we finalized several new policies and requirements related to the HQRP. 2001 in future rulemaking. This rule also proposes to codify hospice data submission thresholds and discusses updates to hospice survey and enforcement procedures. As already mentioned, we did not finalize our March 1, 2016 proposed revisions to 424.507(b)(1) due partly to the burden involved. Our proposal would therefore result in a 1,087-hour burden at a cost of $241,966 (1,087 $222.60). For FY 2024, the proposed hospice wage index would be based on the FY 2024 hospital pre-floor, pre-reclassified wage index for hospital cost reporting periods beginning on or after October 1, 2019 and before October 1, 2020 (FY 2020 cost report data). made non-substantive changes to specifications for HQRP measures as part of the measure re-endorsement process, we would continue to utilize the measure in its new endorsed status, without going through new notice-and-comment rulemaking. In addition to the hospice payment reform changes discussed, the FY 2016 Hospice Wage Index and Rate Update final rule implemented changes mandated by the IMPACT Act, in which the cap amount for accounting years that end after September 30, 2016 and before October 1, 2025, would be updated by the hospice payment update percentage rather than using the CPIU (80 FR 47186). The proposed FY 2024 hospice wage index would include a 5-percent cap on wage index decreases. However, there are distributional effects of the FY 2024 hospice wage index. This PDF is In FY 2022, beneficiaries receiving hospice services from for-profit hospices For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. The purpose of the experiment was to test: A web-mail mode (email invitation to a web survey, with mail follow-up to non-responders). Start Printed Page 20025 2011 Sep;89(3):34380. Under CMS's current policy, Part D sponsors are not expected to place hospice PA requirements on categories of drugs (other than the four targeted categories listed above) or take special measures beyond their normal compliance and utilization review activities. During this process, and notwithstanding the previously mentioned non-finalization, we have remained ready to propose expansions to 424.507(a) and (b) should circumstances warrant.

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