NAHC and NHPCO FY 2024 Proposed Rule Listening Session 2 . The comprehensive nature of the services covered under the Medicare hospice benefit is structured so that hospice beneficiaries would not have to routinely seek items, services, and medications beyond those provided by hospice. section. We will post acceptable comments from multiple unique commenters even if the content is identical or nearly identical to other comments. For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services proposes to amend 42 CFR chapter IV as set forth below. These public comments were considered and summarized in the FY 2017 Hospice Wage Index final rule (81 FR 52143). https://www.medscape.com/viewarticle/925769#vp_1. The information received on the CAHPS Hospice Survey Mode Experiment CMS conducted in 2021, resulted in the following findings: In addition, the following changes were tested as part of the revised CAHPS Hospice Survey: CMS will use mode experiment results to inform decisions about potential changes to administration protocols and survey instrument content. (Pursuant to 42 CFR 418.20(b), a physician must certify the beneficiary as being terminally ill in order for the beneficiary to be eligible to elect hospice care.) [14] Given the hospice program integrity concerns previously mentioned, we believe that each certification required under 418.22(c) should be by an enrolled or validly opted-out physician. Additionally, the rule proposes to require hospice certifying physicians to be Medicare-enrolled or to have validly opted-out. 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 1/1/2312/31/23. We stated in the FY 2022 Hospice Wage Index and Payment Update final rule (86 FR 42528) that while the standardized patient assessment data elements for certain post-acute care providers required under the IMPACT Act of 2014 are not applicable to hospices, it would be reasonable to include some of those standardized elements that appropriately and feasibly apply to hospice to the extent permitted by our statutory authority. In addition, this rule proposes provider enrollment requirements for ordering/certifying physicians for hospice services. The Hospice Comprehensive Assessment Measure is one measure that is calculated and rolled-up by completion of the seven individual measures. Our expectation continues to be that hospices offer and provide comprehensive, virtually all-inclusive care. Ibid. In addition to routine annual payment changes, the FY2024 hospice proposed rule is heavily weighted with data and insights on hospice utilization and performance in areas including non-hospice spending, live discharges and CMS concern about reports The Medicare hospice per diem payment amounts were developed to cover all services needed for the palliation and management of the terminal illness and related conditions, as described in section 1861(dd)(1) of the Act. On July 26, 2022, the CBE endorsed the claims-based Hospice Visits in the Last Days of Life measure (HVLDL). 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. 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. Section 424.507(a) and (b) collectively state that for payment to be made for ordered imaging services, clinical laboratory services, DMEPOS items, or home health services, the service or item must have been ordered or certified by a physician or, when permitted, an eligible professional who(1) is enrolled in Medicare in an approved status; or (2) has a valid opt-out affidavit on file with a Part A and B MAC. Register (ACFR) issues a regulation granting it official legal status. Hospice is compassionate beneficiary and family/caregiver-centered care for those who are terminally ill. As referenced in our regulations at 418.22(b)(1), to be eligible for Medicare hospice services, the patient's attending physician (if any) and the hospice medical director must certify that the individual is terminally ill, as defined in section 1861(dd)(3)(A) of the Act and our regulations at 418.3; that is, the individual has a medical prognosis that his or her life expectancy is 6 months or less if the illness runs its normal course. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues: We are soliciting public comment on each of these issues for the following sections of this rule that contain information collection requirements. Patients Treated with an Opioid who are Given a Bowel Regimen. We propose to add or through December 31, 2024, whichever is later after During a Public Health Emergency, as defined in 400.200 of this chapter.. 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. Assuming an average reading speed of 250 words per minute, it would take approximately 1 hour for staff to review half of it. We post all comments received before the close of the comment period on the following website as soon as possible after they have been received: We found that roughly half of the SNF non-hospice spending that occurred in FY 2020 and FY 2021 was driven by SNF claims with a diagnosis of COVID19. We also propose that if more recent data become available after the publication of this proposed rule and before the publication of the final rule (for example, a more recent estimate of the inpatient hospital market basket update and/or productivity adjustment), we would use such data, if appropriate, to determine the hospice payment update percentage for FY 2024 in the final rule. 10. Those hospices that fail to submit their aggregate cap determinations on a timely basis have their payments suspended until the determination is completed and received by the Medicare contractor (79 FR 50503). Strictly for purposes of establishing an estimate, we would project that the average hospice physician would complete a Form CMS855O enrollment application (Medicare Enrollment ApplicationRegistration for Eligible Ordering and Referring Physicians and Non-Physician PractitionersOMB Control No. The SIA payment is in addition to the routine home care rate. More information and documentation can be found in our Obermeyer Z, Makar M, Abujaber S, Dominici F, Block S, Cutler DM. and services, go to Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color or national origin in federally assisted programs or activities. 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). In the FY 2020 Hospice Wage Index and Rate Update final rule (84 FR 38484), we finalized rebased payment rates for CHC and GIP and set those rates equal to their average estimated FY 2019 costs per day. In the FY 2022 Hospice Wage Index and Rate Update final rule (86 FR 42532 through 42539), we finalized a policy to rebase and revise the labor shares for CHC, RHC, IRC, and GIP using Medicare cost report (MCR) data for freestanding hospices (collected via CMS Form 198414, OMB No. [41] holding company, investment firm, etc. Amend 418.204 by removing paragraph (d). 11. CMS Proposed CY2024 Home Health Rule. CMS provides an update on health equity related to HQRP and efforts to develop health equity. WebPalliative care is provided by a team of professionals that seek to provide medical, emotional, social and practical support in order to address the entire person and their serve to further advance health equity, expand coverage, and improve health outcomes for the more than 170 million individuals supported by our programs, and sets a foundation and priorities for our work, including: strengthening our infrastructure for assessment, creating synergies across the health care system to drive structural change, and identifying and working to eliminate barriers to CMS-supported benefits, services, and coverage. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822363/. 2024 The rate of live discharge varies by ownership status, where non- profit hospices have live discharge rates of approximately 12 percent per year, for-profit hospices have approximately 2122 percent of live discharges per year, and government/other types of hospices have live discharge rates of approximately 15 percent per year. With fringe benefits and overhead, the total per hour rate is $222.60. We refer readers to [60] Hospices that listed their ownership status as Other, Government, or had an unknown ownership status accounted for the remaining 9 percent of hospice days. Fifty-six large hospices participated in the mode experiment, representing a range of geographic regions, ownership, and past performance on the CAHPS Hospice Survey. Our intended changes to 424.507(b)(1) in this proposed rule would be significantly less burdensome on health care providers and suppliers than our March 1, 2016 proposal because they would only impact one additional provider/supplier type. In light of the foregoing, we believe that expanding 424.507(a) and (b) to include hospice services could strengthen the program integrity aspect of physician certifications. dialysis, radiation, The accuracy of our estimate of the information collection burden. Thirty-nine hospices could not be linked to the POS file and are listed as unknown. Division FF, section 4162 of the CAA, 2023 amended section 1814(i)(2)(B) of the Act and extended the provision that currently mandates the hospice cap be updated by the hospice payment update percentage (hospital market basket update reduced by the productivity adjustment) rather than the CPIU for accounting years that end after September 30, 2016, and before October 1, 2032. This rule will only affect hospices. For-profit hospices include the proprietary categories. should verify the contents of the documents against a final, official 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. Only the beneficiary (or representative) can revoke the hospice election. For example, if County A has a pre-floor, pre-reclassified hospital wage index value of 0.3994, we would multiply 0.3994 by 1.15, which equals 0.4593. A summary of the Home Health & Hospice HE TEP meetings and final TEP recommendations would be available in 2023. Start Printed Page 20037 2024 Hospice Submission requirements are codified in 418.312. 13. A regulatory impact analysis (RIA) must be prepared for rules that are significant under section 3(f)(1) as described above. https://www.nejm.org/doi/pdf/10.1056/NEJMp2215539. Conversely, for-profit hospices make up 68.5 percent of the hospices that provide CHC in a given FY, indicating for-profit hospices are more likely to provide CHC compared to other ownership types. 6. [28] Content last reviewed November 2022. https://hospicenews.com/2021/05/27/hospice-providers-leverage-data-to-reach-the-underserved/. We finalized the FY 2020 proposal to reduce the RHC payment rates by 2.72 percent to offset the increases to CHC, IRC, and GIP payment rates to implement this policy in a budget-neutral manner in accordance with section 1814(i)(6) of the Act (84 FR 38496). 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. Our analysis shows that there have only been slight changes over time in how hospices have utilized the different levels of care. For instance, we proposed in a December 15, 2022 Paperwork Reduction Act submission (87 FR 76626) to revise the Form CMS855A Medicare provider enrollment application (Medicare Enrollment ApplicationInstitutional Providers; OMB Control No. If the NOE is filed beyond this 5-day period, hospice providers are liable for the services furnished during the days from the effective date of hospice election to the date of NOE filing (79 FR 50474). For information regarding the hospice special focus program, send your inquiry via email to https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-QRP-Provider-Engagement-Opportunities. The SIA payment is provided for visits of a minimum of 15 minutes and a maximum of 4 hours per day (80 FR 47172). These physicians, as already stated, would be required to enroll or opt-out under our proposal. Under the Medicare hospice benefit, the election of hospice care is a patient choice and once a terminally ill patient elects to receive hospice care, a hospice interdisciplinary group is essential in the seamless provision of primarily home-based services. The proposed FY 2024 hospice wage index would include a 5-percent cap on wage index decreases. These tools are designed to help you understand the official document McGuireWoods Consulting - Washington Healthcare Update 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. West South Central=Arkansas, Louisiana, Oklahoma, Texas. For subsequent hospice periods, 418.22(c)(2) states that only one of the physicians in 418.22(c)(1)(i) must provide the certification. [53], More generally, the OIG expressed concern that: (1) beneficiaries are put at risk when they are inappropriately enrolled in hospice care because they might be unwittingly forgoing needed treatment;[54] PMID: 29710217; PMCID: PMC5988968. FAQ about the 2024 hospice proposed rule - WellSky Source: Hospice claims data accessed from the CCW on January 20, 2023. 51. We believe that some of the aforementioned examples of improper behavior the OIG found can be at least partially avoided through closer vetting of the physician. 45. Section 1814(a)(7)(D)(i) of the Act, as added by section 3132(b)(2) of the PPACA, required that effective January 1, 2011, a hospice physician or nurse practitioner have a face-to-face encounter with the beneficiary to determine continued eligibility of the beneficiary's hospice care prior to the 180th day recertification and each subsequent recertification and to attest that such visit took place. Hospice. Alderwick H, Gottlieb LM, 2019. Second, we finalized two new quality measures for the HQRP for the FY 2019 payment determination and subsequent years: Hospice Visits when Death is Imminent Measure Pair and Hospice and Palliative Care Composite Process Measure-Comprehensive Assessment at Admission (81 FR 52173). In effect, the proposed hospice payment update percentage for FY 2024 would be 2.8 percent. 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)? The amount of coinsurance for each respite care day is equal to five percent of the payment made by CMS for a respite care. 3. In addition, the FY 2015 Hospice Wage Index and Rate Update final rule (79 FR 50496) provided background, described eligibility criteria, identified survey respondents, and otherwise implemented the Hospice Experience of Care Survey for informal caregivers. Data submission requirements under the hospice quality reporting program. Specifically, the national trends[19] For FY 2024 hospice rate setting, we are continuing our longstanding policy of using the most recent data available. 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. 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. 1302 and 1395hh. non-hospice services received outside of the Medicare hospice benefit are subject to beneficiary cost sharing. [26] 7500 Security Boulevard, Baltimore, MD 21244, Fiscal Year (FY) 2024 Hospice Payment Rate Update Proposed Rule (CMS-1787-P). As discussed in the FY 2016 Hospice Wage Index and Rate Update final rule (80 FR 47172), we implemented two different RHC payment rates, one RHC rate for the first 60 days and a second RHC rate for days 61 and beyond. https://doi.org/10.1111%2F1468-0009.12390. Results are similar when looking at hospice and ESRD service claims in the 14 days before death, 60 days before death, and 90 days before death. Hospices comply by utilizing a CMS-approved third-party vendor. DATES FY 2024 Hospice Wage Index and Payment Rate Update Proposed Rule Summary HFMA April 19, 2023 4:55 pm Print On April 4, 2023, CMS published in the Federal Register (88 FR 20022) a proposed rule updating the Medicare hospice payment rates, wage index, the cap amount and the quality reporting requirements for federal Start Printed Page 20026 Association Between Hospice Length of Stay, Health Care Utilization, and Medicare Costs at the End of Life Among Patients Who Received Maintenance Hemodialysis. The Fiscal Year 2024 Hospice Payment Rate Update Proposed Rule (CMS-1787-P) seeks to balance the need for fair compensation and quality improvement in the hospice Hospices must meet or exceed a data submission threshold set at 90 percent of all required HIS or successor instrument records within 30 days of the event (that is, patient's admission or discharge). There have been notable changes in the pattern of diagnoses among Medicare hospice enrollees since the implementation of the Medicare hospice benefit from primarily cancer diagnoses to neurological diagnoses, including Alzheimer's disease and other related dementias (80 FR 25839). This repetition of headings to form internal navigation links Response rates to the revised survey were 35.1 percent in mail only mode, 31.5 percent in telephone only mode, 45.3 percent in mail-telephone, and 39.7 percent in web-mail mode; Response rates to web-mail mode were similar to mail only mode for those without email addresses (35.2 percent vs. 34.4 percent), but 13 percentage points higher for those with email addresses (49.6 percent vs. 36.7 percent); Response rates to mail-only administration of the revised and current survey were similar (35.1 percent vs. 34.2 percent); Mailing of a prenotification letter resulted in an increased response rate of 2.4 percentage points; Extending the field period to 49 days (from the current 42 days) resulted in an increased response rate of 2.5 percentage points in the mail only mode. Hospice care changes the focus to comfort care (palliative care) for pain relief and symptom management instead of care to cure the patient's illness. FY 2020 Hospice Wage Index and Payment Rate Update Final Rule, 12. Hospices were required to begin collecting quality data in October 2012 and submit those quality data in 2013. MedPAC. By regular mail. 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. 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. 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. Therefore, considering tracking key demographic and social risk factor items that apply to hospice could support our goals for continuity of care, overall patient care and well-being, development of infrastructure for the interoperability of electronic health information, and health equity which is also discussed in this rule. In addition to the hospice payment reform changes discussed, the FY 2016 Hospice Wage Index and Rate Update final rule implemented changes mandated by the IMPACT Act, in which the cap amount for accounting years that end after September 30, 2016 and before October 1, 2025, would be updated by the hospice payment update percentage rather than using the CPIU (80 FR 47186). February 26, 2020. Depending on the amount of the annual update for a particular year, a reduction of 4 percentage points beginning in FY 2024 could result in the annual market basket update being less than zero percent for a FY and may result in payment rates that are less than payment rates for the preceding FY. At the end of March, CMS released the proposed payment rule for hospice providers for FY 2024. 1. In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. Most hospices that fail to meet HQRP requirements do so because they miss the 90 percent threshold. The impact analysis of this proposed rule represents the projected effects of the changes in hospice payments from FY 2023 to FY 2024. We believe the information gathered under this RFI would help to improve the continuum of care under the hospice benefit by: (1) heightened patient and family satisfaction; (2) improvement in quality indicators; (3) lower rates of hospitalization (to include decreased intensive care unit admission and invasive procedures at the end of life); and (4) significantly lower health care expenditures at the end of life. Starting with FY 2013 (and in subsequent FYs), the market basket percentage increase under the hospice payment system referenced in sections 1814(i)(1)(C)(ii)(VII) and 1814(i)(1)(C)(iii) of the Act are subject to annual reductions related to changes in economy-wide productivity, as specified in section 1814(i)(1)(C)(iv) of the Act. https://www.cms.gov/files/document/cms-framework-health-equity.pdf. We seek comment on this proposal. and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. Section 4443 of the BBA amended sections 1812(a)(4) and 1812(d)(1) of the Act to provide for hospice benefit periods of two 90-day periods, followed by an unlimited number of 60-day periods. has no substantive legal effect. We want hospices to be successful with meeting the HQRP requirements. SUPPLEMENTARY INFORMATION This would further the NQS to align quality measures across our programs as part of the Universal Foundation.[43]. As with the NOE, the claims processing system must be notified of a beneficiary's discharge from hospice or hospice benefit revocation within 5 calendar days after the effective date of the discharge/revocation (unless the hospice has already filed a final claim) through the submission of a final claim or a Notice of Termination or Revocation (NOTR). Before sharing sensitive information, make sure youre on a federal government site. 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: It includes a proposed update to hospice payments Fourth quarter 2022 Provider of Service (POS) File ( Proposed

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