CMS Releases Hospice Payment Final Rule

WASHINGTON, D.C. (August 3, 2018)—On August 1, the Centers for Medicare & Medicaid Services (CMS) finalized regulations first proposed in late April regarding the FY2019 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements (CMS-1692-F). The National Association for Home Care & Hospice (NAHC) reports that, unlike previous years, the rule did not reflect major policy changes, but held changes that would be expected as part of the evolution of the Hospice Quality Reporting Program (HQRP).

The rule does not list the hospice wage index for FY2019, but CMS has provided a webpage with the information and a downloadable Excel file for quick reference.

Payment rates for FY2019 were recalculated using the hospital market basket of 2.9 percent and reducing it by Affordable Care Act-enacted adjustments (a productivity adjustment for FY2019 at 0.8 percent and an additional 0.3 percent reduction specific to hospice providers). The hospice payment update for FY2019 has been finalized at 1.8 percent. Hospices failing to meet the quality reporting requirements for FY2019 will have their payments reduced by 2 percentage points. A chart showing the reductions can be found on page 40 of the final rule.

The hospice cap is mandated by the IMPACT Act of 2014. For FY2019 it will be $29,205.44, reflecting the 1.8 percent payment change.

Regarding drugs and DME items, effective October 1, 2018, CMS is no longer requiring the detailed reporting of drug data from providers, because this data is not used for quality, payment or program integrity purposes. In the final rule, CMS gave providers the option to report items as a monthly aggregate charge or as line items. CMS asks that providers pick a method and remain consistent.

Under the Bipartisan Budget Act of 2018, physician assistants (PA) are able to serve as the attending physician for hospice care. The change becomes effective on January 1, 2019. The final rule defines a PA as a “professional who has graduated from an accredited physician assistant educational program who performs such services as he or she is legally authorized to perform … in accordance with state law … and who meets the training, education and experience requirements as the Secretary may prescribe.” The rule further specifies that PAs may not serve as hospice medical directors, may not lead a hospice interdisciplinary team, may not certify a beneficiary’s terminal illness or conduct the hospice face-to-face encounter.

The updates to the Hospice Quality Reporting Program (HQRP) include a new measure removal factor, revised data review and correction timeframes for submitting data to the Hospice Data Set (HIS), and additional quality measures publicly available websites to determine quality measure readiness for public reporting.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey collects data on family member and caregiver experiences with hospice care. The final rule addresses the preferred caregiver language of the survey, approved CAHPS vendors, public reporting of survey data, the exemption of small providers (under 50 qualified surveys) and the one-time exemption of new providers. After reviewing comments, CMS continued all policies.

CMS posts quality measures on Hospice Compare. The final rule addresses the timeliness of new quality measures for public review and the HIS-based Visits when Death is Imminent quality measure. CMS is taking comments into consideration and working with key stakeholders to craft language to ensure that consumers understand the quality measures’ intent, relationship to quality and any necessary measure-specific nuance. CMS has decided to separate the data into two sections on Hospice Compare—a “Family Experience of Care” section and a “Quality of Patient Care” section.

There are seven HIS component measures for Hospice Compare. Under the final rule, providers will still report these components, but CMS will no longer directly display the measures. The measures will remain accessible for consumers on Hospice Compare in a separate section.

The Public Use data file on Hospice Compare contains information on utilization, payment (Medicare payment and standard payment), submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number (6-digit provider identification number) and state. CMS notes that much of the information is not user-friendly. Commenters pointed out that the information is not quality-related and may be misleading to consumers. CMS is moving forward with plans to make the data user-friendly and post on Hospice Compare.

As part of CMS’s proposed hospice payment rule the agency included significant insights into data available from the revised hospice cost report that was implemented for cost reporting years beginning on or after October 1, 2014. NAHC submitted comments that CMS implement specific Level 1 edits that would reject a submitted cost report if it did not contain data on specified lines. In analysis referenced in the proposed rule, CMS indicated that if Level I cost report edits along the lines of those recommended by NAHC were implemented, close to 66 percent of all hospice cost reports would be rejected.  This finding underscores widespread concerns about the current quality of cost report submissions and the data that is being drawn from them, and being used to make policy decisions, reported NAHC.

Find the full final rule here.