CMS Finalizes Updates to Medicare Hospice Benefit and Hospice Quality Reporting Requirements

—Via CMS, WASHINGTON, D.C. (August 1, 2017)—On August 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1675-F) that updates fiscal year (FY) 2018 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries, and also updates the hospice quality reporting requirements.

Summary
This final rule will update the hospice wage index, payment rates and cap amount for fiscal year (FY) 2018. It also makes changes to the Hospice Quality Reporting Program (HQRP) that would continue to ensure high quality, accessible care, without added burden.

Background
This rule finalizes updates to the hospice payment rates for fiscal year (FY) 2018, as required under section 1814(i) of the Social Security Act (the Act). This final rule also specifies public reporting measures derived from the CAHPS Hospice Survey, and provides an update on the Hospice QRP consistent with the requirements of section 1814(i)(5) of the Act, as added by section 3004(c) of the Affordable Care Act. In accordance with section 1814(i)(5)(A) of the Act, hospices that fail to meet quality reporting requirements receive a 2.0 annual percentage point reduction to their payments.

Final Rule Details
Routine Annual Rate Setting Changes
Section 411(d) of the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. 114-10) (MACRA) amends section 1814(i) of the Social Security Act to set the market basket percentage increase at 1 percent for hospices in FY 2018. As such, hospices will generally see a 1.0 percent ($180 million aggregate) increase in their payments for FY 2018.

The hospice payment system includes a statutory aggregate cap. The aggregate cap limits the overall payments made to a hospice annually. As mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (Pub. L. 113-185) (IMPACT Act), the cap amount for accounting years that end after September 30, 2016, and before October 1, 2025, must be updated by the hospice payment update percentage, rather than the Consumer Price Index (CPI). Therefore, the cap amount for FY 2018 will be $28,689.04 (2017 cap amount of $28,404.99 increased by 1 percent).

Hospice Quality Reporting Program
The rule finalizes eight measures from CAHPS Hospice Survey data already submitted by hospices. Further, the rule finalizes the extension or exception for quality reporting purposes from 30 calendar days to 90 calendar days after the date that an extraordinary circumstance occurred. The rule describes plans to publically display quality measure data via Hospice Compare in August 2017. Additionally, this rule outlines policies and procedures associated with the public reporting of the quality measures used in the hospice program. The final rule also discusses the public comments received on two claim-based measures under consideration and the Hospice Evaluation & Assessment Reporting Tool (HEART), a patient assessment tool.

Hospice CAHPS Experience of Care Survey
The Hospice CAHPS Survey is a component of the Hospice Quality Reporting Program. This final rule sets out requirements for the Hospice CAHPS Survey for the FY 2020, FY 2021 and FY 2022 annual payment updates. In addition, the rule adopts two global CAHPS Hospice Survey measures and six composite CAHPS Hospice Survey-based measures, which would be derived from data submitted on the survey. The rule also finalizes how these measures will be calculated based on the survey data. More information about the survey can be obtained at the survey website, hospicecahpssurvey.org.

Hospice CAHPS is important for the hospice community because the results of the survey allow comparisons among hospices nationally. Once it is publically reported, CMS believes the data will help beneficiaries and their families select a hospice program. CMS also believes public reporting of survey results will encourage hospices to improve quality.

Hospice Quality Reporting Program Submission Exemption and Extension Requirements for the FY 2019 Payment Determination and Subsequent Years
For FY 2019 payment determination and subsequent years, CMS finalized that it will extend the period of time a hospice may have to submit a request for an extension or exception for quality reporting purposes from 30 calendar days to 90 calendar days after the date that an extraordinary circumstance occurred. This change will align the HQRP with the other post-acute care quality reporting programs, as well as the Hospital Inpatient Quality Reporting Program, and will give additional time for providers to focus on operations related to patient care should a situation arise, such as an unforeseen environmental emergency.

Public Reporting
CMS will begin public reporting hospice quality reporting program (HQRP) data via a Hospice Compare Site in August 2017 to help customers make informed choices. While HQRP includes both the Hospice Item Set (HIS) and Hospice CAHPS Survey data, this new website will initially display only HIS data. The public display of the Hospice CAHPS Survey data will be added in winter 2018. In this final rule, CMS has also finalized policies and procedures associated with the public reporting of the quality measures used in the Hospice Program, including release of the aggregate quality data file and the Provider Preview Reports.

Quality Measure Concepts Under Consideration for Future Years
Although CMS did not add new measures based on the Hospice Item Set in this final rule, we discussed and received public feedback on two measure concepts under consideration for future years. Those measure concepts are: 1) potentially avoidable hospice care transitions, and 2) access to levels of hospice care. Both measure concepts would be claims-based measures. These two measure concepts are under development. We discussed the comments received and will carefully consider them for any future rulemaking proposals. This includes details regarding measure definitions, specifications, and timeline for implementation, all of which would be communicated in future rulemaking.

New Data Collection Mechanisms Under Consideration: Hospice Evaluation & Assessment Reporting Tool (HEART)
CMS discussed enhancing the current Hospice Item Set data collection instrument to be more in line with other post-acute care settings. CMS received public feedback on considering this revised data collection instrument, HEART, which would be a patient assessment tool, rather than the current chart abstraction tool. We discussed the comments received and will carefully consider them for any future rulemaking proposals.

The final rule went on display on August 1 at the Federal Register’s Public Inspection Desk and will be available under “Special Filings,” at federalregister.gov/inspection.aspx.

For further information, see cms.gov/center/provider-type/hospice-center.html.