Posted April 5, 2023
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).
- A proposed annual payment update of 2.8 percent, and proposed updates to the hospice wage index and the aggregate cap
- In-depth examination of hospice utilization data and a Request for Information related to hospice utilization, non-hospice spending, ownership transparency, and hospice election decision-making
- A Request for Information on health equity under the hospice benefit
- A proposed regulation related to use of telehealth to conduct the hospice face-to-face encounter and proposed elimination of a regulation governing use of technology-based routine home care visits during the COVID-19 Public Health Emergency (PHE)
- Proposals and Updates to the Hospice Quality Reporting Program (HQRP)
- Proposed Hospice Outcomes & Patient Evaluation (HOPE) Update
- Proposed Update on Future Quality Measures (QM) Development
- Proposed Health Equity Updates Related to HQRP
- Proposed CAHPS Hospice Survey Updates
- An update on hospice survey and enforcement – Special Focus Program (SFP)
- Proposals Regarding Hospice Ordering/Certifying Physician Enrollment
- A proposal 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.
- More broadly, CMS stated that this proposal is likely one of additional future actions on program integrity in the hospice benefit. In the Fact Sheet accompanying the proposed rule, CMS states “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.”
It should also be noted that starting with FY2024, hospices failing to comply with the HQRP reporting requirements will be subject to a 4% (rather than a 2%) payment reduction, as reflected in the proposed rule.
Source: CMS and NAHC
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