Posted Wednesday, April 14, 2021
FY 2022 Hospice Wage Index Proposed Rule
On April 8th, CMS released the proposed rule for the Hospice Wage Index for fiscal year 2022. Every year, these updates cover multiple items impacting your Hospice agency. But at 173 pages, and written in government-speak, it can be difficult to find the time to wade through the entire document, so we have done the homework for you. Below are the key takeaways from the proposed rule.
And in the coming weeks, we will deep dive into the more complicated items to give you better clarity and action items so you can prepare your agency and care team for the year ahead.
A brief overview of the proposed changes:
*The proposed Hospice payment increase for 2022 is 2.3% and the aggregate cap amount has also been increased 2.3%
*The approach for calculating labor shares, which is the percentage of reimbursement allocated to labor and thus adjusted by local salary rates, are being revised using Medicare data for freestanding hospices for 2018.
| Proposed Labor Shares | Current Labor Shares | |
| Continuous Home Care | 74.6% | 68.71% |
| Routine Home Care | 64.7% | 68.71% |
| Inpatient Respite Care | 60.1% | 54.13% |
| General Inpatient Care | 62.8% | 64.01% |
*The Hospice Election Statement (Notice of Election, or NOE) requirement has been modified for clarity:
-The hospice may provide the Hospice Election Statement Addendum within 5 days from the date a beneficiary of representative requests it if the request is within 5 days from the date of a hospice election.
-The date of providing the addendum, or “date furnished”, to the patient must be within the required time frame, not the signature date. “Date Furnished” should be included in the patient’s medical record and on the addendum itself.
-CMS clarifies that there is no requirement to provide a requested addendum if the patient dies or is discharged within five days.
-If the patient or representative refuses to sign the addendum, the hospice must document the reason the beneficiary has refused to sign.
-If a non-hospice provider or Medicare contractor requests the addendum (and not the beneficiary or representative), a signed copy is not required in the medical record.
-Change in language for time frame allowed to hospices to provide the addendum when an addendum is requested during the course of a hospice election, but outside the 5 days of the date of election window. The rule currently states the addendum must be furnished within 72 hours, and the proposal is to change to “within 3 days”.
*Detailed information on hospice utilization trends, including
-Number of beneficiaries using hospice benefit
-Live discharges
-Reported diagnoses on hospice claims
-Medicare hospice spending
-Parts A, B, and D non-hospice spending during hospice election
*Update to the Hospice Conditions of Participation
Regulatory blanket waivers issued during Covid are being proposed for permanent implementation:
-Hospice aide competency evaluations may use pseudo-patients and simulation, both of which are defined in the proposed rule.
-If the supervising nurse verifies an area of concern in a hospice aide’s performance during an on-site visit, the hospice must conduct and hospice aide must complete a competency evaluation related to the deficiency and all related skills. This replaces the requirement for another full competency evaluation.
* Update to Hospice Quality Reporting Program
-Increase in penalty to Hospices failing to meet both HIS and CAHPS reporting requirements from 2% to 4% by 2024
-Addition of claims-based Hospice Care Index (HCI) measure
-Hospice visits in the last days of life (HVLDL)
-Removal of the 7 Hospice Item Set (HIS) measures and leaving only the HIS Comprehensive Assessment Measure, comprised of the average of the 7 HIS measures, and is already reported
-Further development of the HOPE assessment instrument
*Request for information on advancing to digital quality measurement
*Use of Fast Healthcare Interoperability Resources
*Addresses White House Executive Order related to health equity in the Hospice Quality Reporting Program
*Updates to advancing Health Information Exchange
*Changes in public reporting of HH Quality reporting to address exceptions related to Covid
The following tables show the dates of public reporting and the quarters being reported at that time.
CAHPS
| Data Refresh date | Publicly Reported Quarters |
| February 2022 | Q4 2018-Q4 2019
Q3 2020-Q1 2021 |
| May 2022 | Q1 2019-Q4 2019
Q3 2020-Q2 2021 |
| August 2022 | Q2 2019-Q4 2019
Q3 2020-Q3 2021 |
| November 2022 | Q3 2019-Q4 2019
Q3 2020-Q4 2021 |
| February 2023 | Q4 2019, Q3 2020-Q1 2022 |
| May 2023 | Q3 2020-Q2 2022 |
HIS
| Quarter Refresh | HIS Quarters in Original Schedule for Care Compare | HIS Quarters in revised/proposed schedule for Care Compare |
| November 2020 | Q1 2019-Q4 2019 | Q1 2019-Q4 2019 |
| February 2021 | Q2 2019-Q1 2020 | Q1 2019-Q4 2019 |
| May 2021 | Q3 2019-Q2 2020 | Q1 2019-Q4 2019 |
| August 2021 | Q4 2019-Q3 2020 | Q1 2019-Q4 2019 |
| November 2021 | Q1 2020-Q4 2020 | Q1 2019-Q4 2019 |
| February 2022 | Q2 2020-Q1 2021 | Q3 2020-Q1 2021 |
All these items are proposed rules. CMS has an open comments period during which time, the public and Hospice industry can comment, lodge complaints, and ask questions about the proposed rules. Your opinions and insights matter! As industry leaders, you have important insights into how these rules will impact you, your business, your co-workers, and especially your patients. Comments may be made electronically at http://www.regualtions.gov and information for mailing in comments is available in the proposed rule using file code: CMS-1754-P. Comments must be received by June 7, 2021.
The full rule can be read here.
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