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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