We estimate that this rulemaking exceeds the $100 million threshold under section 3(f)(1). In addition, there are important proposed updates to the HQRP, the hospice certification Start Printed Page 20045. FY 2024 Hospice Wage Index and Quality Reporting edition of the Federal Register. [31] Coverage under the Medicare hospice benefit requires that hospice services must be reasonable and necessary for the palliation and management of the terminal illness and related conditions. CY 2023 data submissions compliance impacts the FY 2025 APU. hospicepolicy@cms.hhs.gov. Division CC, section 407 of the CAA 2021, amended Part A of Title XVIII of the Act to add a new section 1822, and amended sections 1864(a) and 1865(b) of the Act, establishing new hospice program survey and enforcement requirements, required public reporting of survey information, and a new hospice hotline. As noted in section C.5. B. We intend to continue to host HQRP Forums to allow hospices and other interested parties to engage with us on the latest updates and ask questions on the development of HOPE and related quality measures as appropriate. The SBNF is used to reduce the overall RHC rate in order to ensure that SIA payments are budget-neutral. Section 1814(i)(5)(C) of the Act requires that each hospice submit data to the Secretary on quality measures specified by the Secretary. Extremely long lengths of stay influence both the average length of election and average lifetime length of stay. WebThe 2024 hospice proposed rule: A view into the future of hospice The windows on your screen can be resized and moved. A 30-day call for nominations was held July 14 through August 14, 2022 and nine TEP members were selected, representing a diverse range of experience and expertise related to hospice care and quality. Because 0.8556 is greater than 0.8, County B's hospice wage index would be 0.8. February 1, 2023. 2014;312(18):18881896. As we move this important work forward, we will continue to take input from hospice stakeholders into account and monitor the application of proposed health equity policies across CMS and other HHS initiatives. We are committed to developing approaches to meaningfully incorporate the advancement of health equity into the HQRP. These physicians, as already stated, would be required to enroll or opt-out under our proposal. In the FY 2022 Hospice Wage Index final rule (86 FR 42539), we finalized conforming regulations text changes at 418.309 to reflect the provisions of the CAA, 2021. 3/31/2022 10:59:05 AM Call for Speakers to the 2022 Home Care and Hospice Conference and Expo 3/28/2022 11:52:18 AM Testimonials One of the most significant benefits of joining a professional organization, like NAHC, is the opportunity it provides to either be a mentor or to find one. By looking at measure results for different populations separately, CMS and providers can see how care outcomes may differ between certain patient populations in a way that would not be apparent from an overall score ( The BNAF phase-out reduced the amount of the BNAF increase applied to the hospice wage index value, but was not a reduction in the hospice wage index value itself or in the hospice payment rates. on March 1, 2016 (81 FR 10720), we proposed to significantly expand the scope of 424.507(a) and (b) to include physicians and eligible professionals furnishing, ordering, referring, certifying, or prescribing any Part A and Part B service, item, or drug. Hospice. Our proposal would therefore result in a 1,087-hour burden at a cost of $241,966 (1,087 $222.60). To receive payment for covered Part A or Part B home health services or for covered hospice services, a provider's home health or hospice services claim must meet all of the following requirements: (1) The ordering/certifying physician for hospice or home health services, or, for home health services, the ordering/certifying physician assistant, nurse practitioner, or clinical nurse specialist working in accordance with State law, must meet all of the following requirements: (3) For claims for hospice services, the requirements of paragraph (b) of this section apply with respect to any physician described in 418.22(c) of this chapter who made the applicable certification described in 418.22(c). We also solicit comments on our analysis of utilization and spending patterns including non-hospice spending during a hospice election. Table 13HQRP Reporting Requirements and Corresponding Annual Payment Updates. We also recognize that different types of entities are in many cases affected by mutually exclusive sections of this proposed rule, and therefore for the purposes of our estimate we assume that each reviewer reads approximately 50 percent of the rule. Start Printed Page 20029 https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/MarketBasketResearch. For questions regarding hospice certifying physician provider enrollment, contact Frank Whelan at (410) 7861302. Register (ACFR) issues a regulation granting it official legal status. 49. There are four payment categories that are distinguished by the location and intensity of the hospice services provided. The analysis included in this proposed rule shows increased overall non-hospice spending for Part D drugs for beneficiaries under a hospice election. Submit at least 90 percent of all HIS records or its successor instrument within 30 days of the event date (patient's admission or discharge) for patient admissions/discharges occurring 1/1/2412/31/24. However, there are distributional effects of the FY 2024 hospice wage index. These patterns are consistent across all hospices regardless of ownership type. Such data includes, but is not limited to, general identifying information (for example, legal business name), licensure and/or certification data, and practice locations. After a hospice election, many maintenance drugs or drugs used to treat or cure a condition are typically discontinued as the focus of care shifts to palliation and comfort measures. https://www.govinfo.gov/content/pkg/FR-2021-11-09/pdf/2021-23993.pdf. It includes a proposed update to hospice payments [26] Section 424.507(a) and (b) would no longer have been restricted to the four services and items referenced therein. [23] 24. 32. rendition of the daily Federal Register on FederalRegister.gov does not Call for Speakers to the 2022 Home Care and Hospice Conference and Hospices were required to begin collecting quality data in October 2012 and submit those quality data in 2013. Patients with neurological and organ-based failure conditions (with the exception of kidney disease/kidney failure) tend to have much longer lengths of stay compared to patients with cancer diagnoses. https://www.hhs.gov/ocr/civilrights. Content last reviewed November 2022. Ibid, p. 12. Potential measure changes will be submitted to the Measures Under Consideration (MUC) process in 2023 and may be proposed in future rulemaking. Section 1861(dd)(1) of the Act establishes the services that are to be rendered by a Medicare-certified hospice program. 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. Hospices are responsible for covering drugs and biologicals related to the palliation and management of the terminal illness and related conditions while the patient is under hospice care. 11/17/21. We estimate that in FY 2024, hospices in urban areas will experience, on average, a 2.8 percent increase in estimated payments compared to FY 2023; while hospices in rural areas will experience, on average, a 2.5 percent increase in estimated payments compared to FY 2023. 31. Laws, Regulations & Manuals | Hospice | Health & Senior Services 50. Consolidated Appropriations Act, 2021 (CAA, 2021), 13. Medscape Nurses. Patient Liability Reduction Due to Other Payer Amount. 9. We project that the 4 percentage point penalty for hospices will represent approximately $53 million in hospice payment dollars during the reporting period, out of an estimated total $23.8 billion paid to all hospices. 5. developer tools pages. This rate increase results from a 6.1% net market basket update to Stakeholders report that such information can be used to educate hospices on Medicare policies to help ensure compliance. 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). of all required HIS or successor instrument records within 30 days of the event (that is, patient's admission or discharge) and submit the data through the CMS designated data submission systems. Continuous Home Care (CHC) or General Inpatient (GIP) Provided. We will continue to review our policies to support ownership transparency, patient education and transparency of hospice benefits, and to analyze the type of care that patients are receiving while in hospice to help to inform future rulemaking. We believe that it would be unusual and exceptional to see services provided outside of hospice for those individuals who are approaching the end of life and we have reiterated since 1983 that virtually all care needed by the terminally ill individual would be provided by the hospice. February 1, 2023. More Rate Cuts Combined with Provider Enrollment Changes, HHVBP Tweaks, and More The Centers for Medicare and the Federal Register. The TEP was charged with providing input on a potential cross-setting health equity structural composite measure concept as set forth in the FY 2023 Hospice Payment Rate Update proposed rule (87 FR 19442) as part of an RFI related to the HQRP Health Equity Initiative. In percentage terms, we found a notable increase in billing related to skilled nursing facility claims in recent years. Thirty-nine hospices could not be linked to the POS file and are listed as unknown. By express or overnight mail. Burdensome Transitions (Type 2)Live Discharges from Hospice Followed by Hospitalization with the Patient Dying in the Hospital. FY 2016FY 2022 hospice claims data from CCW on January 20, 2023. Moreover, in response to the Office of Inspector General (OIG) reports highlighting vulnerabilities in the Medicare hospice benefit (for example, hospices engaging in inappropriate billing, not providing needed services and crucial information to beneficiaries in order for them to make informed decisions about their care[4] It was viewed 697 times while on Public Inspection. Impact of Hospice Ordering/Certifying Physician Enrollment, 1. https://journalofethics.ama-assn.org/article/racial-disparities-hospice-moving-analysis-intervention/2006-09. HOPE updates can be found at: [40] The purpose of 424.507(a) and (b) is to confirm that the physicians and eligible professionals who order or certify the items and services referenced in those paragraphs are qualified. The proposed rule can be viewed at the Federal Register at. Start Printed Page 20037 What factors do hospices observe that influence beneficiaries in electing and accessing hospice care? Ibid. https://www.healthit.gov/sites/isa/files/2023-01/Draft-USCDI-Version-4-January-2023-Final.pdf. As finalized in the FY 2016 Hospice Wage Index and Payment Rate Update final rule (80 FR 47142, 47192), hospices' compliance with HIS requirements beginning with the FY 2020 APU determination (that is, based on HIS-Admission and Discharge records submitted in CY 2018) are based This policy would apply beginning with the FY 2024 annual payment update (APU) that is based on calendar year (CY) 2022 quality data. Set it up how you like it! To support new health equity measure development, the Home Health and Hospice Health Equity Technical Expert Panel (Home Health & Hospice HE TEP) was convened by a CMS contractor in Fall 2022. 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 selection; and ways to examine health equity under the hospice benefit. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. These regulations are generally codified in 42 CFR part 424, subpart P (currently 424.500 through 424.575 and hereafter occasionally referenced as subpart P). However, OMB occasionally issues minor updates and revisions to statistical areas in the years between the decennial censuses. We also have a dedicated email account, The HQRP requires the active collection under OMB control number #09381153 (CMS 10390; expiration 02/29/2024) of the Hospice Items Set (HIS) and CAHPS Hospice Survey (OMB control number 09381257) (CMS10537; expiration 01/31/2023). Amend 424.507 by revising paragraphs (b) introductory text and (b)(1) introductory text and adding paragraph (b)(3) to read as follows: (b) ); (2) The APU is subsequently applied to FY payments based on compliance in the corresponding Reporting Year/Data Collection Year; and (3) For the CAHPS Hospice Survey, the Reference Year is the CY before the Data Collection Year. Hospice rates were to be updated by a factor equal to the inpatient hospital market basket percentage increase set out under section 1886(b)(3)(B)(iii) of the Act, minus 1 percentage point. Limited, short-term, intermittent, inpatient respite care (IRC) is also available because of the absence or need for relief of the family or other caregivers. HOPE is intended to provide quality data to calculate outcomes and develop additional quality measures. Exceptions and Extensions for Quality Reporting Requirements for Acute Care Hospitals, PPS-Exempt Cancer Hospitals, Inpatient Psychiatric Facilities, Skilled Nursing Facilities, Home Health Agencies, Hospices, Inpatient Rehabilitation Facilities, Long-Term Care Hospitals, Ambulatory Surgical Centers, Renal Dialysis Facilities, and MIPS Eligible Clinicians Affected by COVID19 are available at: L. 116260), the reduction for Analysis of Part D prescription drug events (PDEs) data suggests that the current use of prior authorization (PA) by Part D sponsors has reduced Part D program payments for drugs in four targeted categories (analgesics, anti-nauseants, anti-anxiety, and laxatives), which are typically used to treat common symptoms experienced during the end of life. 57. CMS' goals are in line with Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government.[22], Health inequities persist overall in hospice and palliative care, where Black and Hispanic populations are less likely to utilize care and over 80 percent of patients are White. The FY 2024 Hospice proposed rule with comment went on display at the Office of the Federal Registers Public Inspection Desk on March 31, 2023, and will be This means CMS requires that hospices submit 90 percent of all required HIS records within 30 days of the event (that is, patient's admission or discharge). ahcm-screeningtool-companion. Statutes of the Department of Health At the same time, racial and ethnic diversity has increased in recent years with an increase in the percentage of people who identify as two or more races accounting for most of the change, rising from 2.9 percent to 10.2 percent between 2010 and 2020. We seek comment on this proposal. What are the overall barriers to providing higher intensity levels of hospice care and/or complex palliative treatments for eligible Medicare beneficiaries (for example, are there issues related to established formal partnerships with general inpatient/inpatient respite care facilities)? Additionally, an individual or representative may revoke the individual's election of hospice care at any time during an election period in accordance with the regulations at 418.28. CMS intends to develop several quality measures based on information collected by HOPE when it is implemented. 2024 This rule also proposes conforming regulations text changes related to the anticipated expiration of the COVID19 public health emergency (PHE). 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. Senior Living & Long-Term Care. The proportion of live discharges occurring between the lengths of stay intervals was relatively constant from FY 2019 to FY 2022 where approximately 25 percent of live discharges occurred within 30 days of the start of hospice care, and approximately 33 percent occurred after a length of stay over 180 days of hospice care. These markup elements allow the user to see how the document follows the [52], A physician received kickbacks for recruiting beneficiaries, many of whom were not terminally ill but seeking opioids. 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. should verify the contents of the documents against a final, official Source: Analysis of 100% Medicare Part A and B claims analytic files, FYs 20192022, from the CCW, accessed January 20, 2023. Section 1814(i)(5)(A)(i) of the Act requires that 17. The current labor portion of the payment rates are: for RHC, 66.0 percent; for CHC, 75.2 percent; for GIP, 63.5 percent; and for IRC, 61.0 percent. The aggregate impact of the changes in column three is zero percent, due to the hospice wage index standardization factor. The majority of hospice visits are Medicare paid visits and therefore the majority of hospice's revenue consists of Medicare payments. February 26, 2020. Meanings and misunderstandings: a social determinants of health lexicon for health care systems. Proposed Routine FY 2024 Hospice Wage Index and Rate Update, 2. 418.204 on an interim basis to specify that when a patient is receiving routine home care, hospices may provide services via a telecommunications system, if it is feasible and appropriate to ensure that Medicare patients can continue receiving services that are reasonable and necessary for the palliation and management of a patients' terminal illness and related conditions without jeopardizing the patients' health or the health of those who are providing such services during the COVID19 PHE. Start Printed Page 20046. As outlined in 424.510, one requirement is that the provider or supplier must complete, sign, and submit to its assigned Medicare Administrative Contractor (MAC) the appropriate enrollment form, typically the Form CMS855 (OMB Control No. In addition, CMS was required to consult with hospice programs and the Medicare Payment Advisory Commission (MedPAC) regarding additional data collection and payment revision options. This measure helps to ensure all hospice patients receive a holistic comprehensive assessment. All expenditures are classified as transfers to hospices. Start Printed Page 20051 Federal government websites often end in .gov or .mil. In this section, we also solicit comments from the public, including hospice providers, beneficiaries, and patient advocates related to the following: increasing access to higher levels of hospice care; our analysis of non-hospice spending during a hospice election; ownership As finalized in the FY 2022 Hospice Wage Index and Payment Rate Update final rule (86 FR 42552), public reporting of the two new claims-based quality measures (QMs), the Hospice Visits in Last Days of Life (HVLDL) and the Hospice Care Index (HCI) is available on the Care Compare/Provider Data Catalogue (PDC) web pages as of the August 2022 refresh. Submission requirements are codified in 418.312. In the FY 2017 Hospice Wage Index proposed rule (81 FR 25498), we received comments on our previously finalized policies for form, manner, and timing of data collection. CMS will not post on Hospices covered by this rule must comply with applicable civil rights laws, including section 1557 of the Affordable Care Act, section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act, which require covered programs to take appropriate steps to ensure effective communication with patients with disabilities and patient companions with disabilities, including the provisions of auxiliary aids and services when necessary for effective communication. Finally, this rule discusses updates on the Consolidated Appropriation Act, 2021 (CAA 2021) hospice special focus program (SFP). (For a copy of this bulletin, we refer readers to the following website: https://oig.hhs.gov/oei/reports/oei-02-16-00570.pdf, This proposed rule would update the hospice wage index, payment rates, and aggregate cap amount for fiscal year (FY) 2024. 2024 hospice proposed rule The Office of Disease Prevention and Health Promotion and Healthy People defines social determinants of health (SDOH) as the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. https://www.regulations.gov. Hospice Ibid, p. 7. The development and implementation of the Preliminary Adult and Pediatric Universal Foundation Measures will promote the best, safest, and most equitable care for individuals as we all come together on these critical quality areas. After the exclusions, we are left with 54,287 beneficiaries. These categories include beta blockers, calcium channel blockers, corticosteroids, and insulin. Federal Register. FY 2015 Hospice Wage Index and Payment Rate Update Final Rule, 9. For FY 2024 hospice rate setting, we are continuing our longstanding policy of using the most recent data available. Finally, we looked at the distribution of live discharges by length of stay intervals. HOPE would also contribute to the patient's plan of care through providing patient data ongoing throughout the hospice stay. For those beneficiaries with no overlap between their hospice and ESRD claims, we examined the number of days that passed from the last ESRD service claim and their day of death. Fifty-six large hospices participated in the mode experiment, representing a range of geographic regions, ownership, and past performance on the CAHPS Hospice Survey. This Universal Foundation of quality measure will focus provider attention, reduce burden, identify disparities in care, prioritize development of interoperable, digital quality measures, allow for cross-comparisons across programs, and help identify measurement gaps. For example, what and how should CMS publicly provide information around hospice ownership? https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/default-document-library/jun21_ch3_medpac_report_to_congress_sec.pdf. The beneficiary cost sharing amount was approximately $69 million. Our analysis included 8,991,619 beneficiaries with a date of death from FY 2017 through FY 2022. The need for the information collection and its usefulness in carrying out the proper functions of our agency. Proposed Rule CMS.gov Hospices receiving Medicare Part A funds or other Federal financial assistance from the Department are also subject to additional Federal civil rights laws, including the Age Discrimination Act, and are subject to conscience and religious freedom laws where applicable. Start Printed Page 20038 In addition, we removed the seven Hospice Item Set (HIS) Process Measures from the program as individual measures and public reporting because the HIS Comprehensive Assessment Measure is sufficient for measuring care at admission without the seven individual process measures. Start Printed Page 20052. The proposed hospice cap amount for the FY 2024 cap 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 percent. Part A and B cost sharing is calculated by summing together the deductible and coinsurance amounts for each claim. We refer readers to the FY 2023 Hospice Payment Rate Update final rule (87 FR 45669) for a summary of the public comments and suggestions received in response to the health equity RFI. This rule includes a proposal to codify hospice data submission thresholds and discusses updates to hospice survey and enforcement procedures. 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. Federal Register In accordance with the provisions of Executive Order 12866, this regulation was reviewed by the Office of Management and Budget. This estimate is based on the data for 5,640 hospices in our impact analysis file, which was constructed using FY 2022 claims available in January 22, 2023. Existing hospices had the option of having their cap calculated through the original streamlined methodology, also within certain limits. Start Printed Page 20041 The non-labor portion is equal to 100 percent minus the labor portion for each level of care. We plan to provide additional information regarding HOPE testing results on the HQRP website in late Spring of 2023. In the FY 2017 Hospice Wage Index and Rate Update final rule (81 FR 52156), we initiated a policy of applying a wage index standardization factor to hospice payments in order to eliminate the aggregate effect of annual variations in hospital wage data. 15 Hospice Facilities in Branson, MO - Find Reviews, Photos The proposed FY 2024 hospice wage index would include a 5-percent cap on wage index decreases. Medicare hospice expenditures have risen from $5 billion in FY 2003 to approximately $23 billion in FY 2022. The report described how some hospice fraud schemes involved paying recruiters to target beneficiaries who are not eligible for hospice care; other schemes involved physicians falsely certifying beneficiaries as terminally ill when they were not.
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