On March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1787-P) that would update Medicare hospice payments and the aggregate cap amount for fiscal year (FY) 2024 in accordance with existing statutory and regulatory requirements. This rule includes information on hospice utilization trends and solicits comments regarding information related to the provision of higher levels of hospice care, spending patterns for non-hospice services provided during the election of the hospice benefit, ownership transparency, equipping patients and caregivers with information to inform hospice election decision-making selection, and ways to examine health equity under the hospice benefit. This rule also proposes conforming regulations text changes related to the expiration of the COVID-19 public health emergency (PHE).
This rule proposes to codify the Hospice Quality Reporting Program (HQRP) data submission threshold policy that was adopted in the FY 2016 Hospice final rule at §418.312. The rule discusses the Hospice Outcomes and Patient Evaluation (HOPE) tool; provides an update on future Quality Measures (QM) development and health equity efforts and provides updates on the Consumer Assessment of Healthcare Providers and Systems, Hospice Survey mode experiment.
This rule also proposes that physicians who order or certify hospice services for Medicare beneficiaries must be enrolled in Medicare or validly opted-out as a prerequisite for payment for the hospice period of care in question. CMS is looking closely at the hospice industry, as we have increasing concerns about fraud, waste and abuse in this space. 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.
Finally, this rule discusses updates on the Consolidated Appropriation Act, 2021 (CAA 2021) hospice special focus program (SFP).
Medicare Hospice Payment Policies
This proposed rule includes data analysis on historical hospice utilization trends, including data on the number of beneficiaries using the hospice benefit, live discharges, reported diagnoses on hospice claims, Medicare hospice spending, and Medicare Parts A, B, and D non-hospice spending during a hospice election. In this rule, we also solicit comments from the public, including hospice providers, beneficiaries, and patient advocates related to increasing access to higher levels of hospice care. We also solicit comments on our analysis of utilization and spending patterns including non-hospice spending during a hospice election, ownership transparency, equipping patients and caregivers with information to inform hospice selection, as well as information examining health equity under the hospice benefit.
Additionally, we are proposing regulations text changes related to the provision of telehealth services for Routine Home Care at the expiration of the COVID-19 PHE and for the use of telecommunications technology for the face-to-face encounter conducted by a hospice physician or hospice nurse practitioner for the sole purpose of hospice recertification through December 31, 2024.
FY 2024 Routine Annual Rate Setting Changes
The FY 2024 hospice payment update percentage is 2.8% (an estimated increase of $720 million in payments from FY 2023). This is a result of the 3.0% market basket percentage increase reduced by a 0.2 percentage point productivity adjustment. Section 1814(i)(5)(A)(i) of the Act was amended by section 407(b) of Division CC, Title IV of the CAA, 2021 (Pub. L. 116–260) to change the payment reduction for failing to meet hospice quality reporting requirements from 2 to 4 percentage points. Therefore, beginning in FY 2024 and for each subsequent year, hospices that fail to meet quality reporting requirements receive a 4-percentage point reduction to the annual hospice payment update percentage increase for the year. The proposed FY 2024 rates for hospices that do not submit the required quality data would be updated by the proposed FY 2024 hospice payment update percentage of 2.8% minus 4 percentage points, which results in a -1.2% update.
The hospice payment update includes a statutory aggregate cap that limits the overall payments per patient that is made to a hospice annually. The proposed hospice cap amount for the fiscal year is $33,396.55, which is equal to the FY 2023 cap amount ($32,486.92) updated by the proposed FY 2024 hospice payment update percentage of 2.8%.
Hospice Quality Reporting Program
CMS proposes to codify the HQRP data completion threshold policy at §418.312. CMS also provides several updates on initiatives relative to the development of a patient assessment instrument, titled Hospice Outcomes & Patient Evaluation (HOPE), and future quality measures. CMS provides an update on health equity related to HQRP and efforts to develop health equity.
The proposed rule can be viewed at the Federal Register at https://www.federalregister.gov/public-inspection/2023-06769/medicare-program-fiscal-year-2024-hospice-wage-index-and-payment-rate-update-hospice-conditions-of
Public comments on the proposals will be accepted until May 30, 2023.
For further information, see the hospice webpage here: https://www.cms.gov/Center/Provider-Type/Hospice-Center
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