2016 Hospice Proposed Rule: LeadingAge Submits Comments

Members | June 18, 2015

LeadingAge submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the fiscal year (FY) 2016 Medicare Hospice Proposed rule (CMS-1629-P) to address the changes in the hospice payment system, wage index, the HQRP Reconsideration and Appeals Procedure and clarification regarding diagnosis reporting.

LeadingAge submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the fiscal year (FY) 2016 Medicare Hospice Proposed rule (CMS-1629-P) to address the following sections of the rule:

 

  • Proposed Routine Home Care Rates and Service Intensity Add-On Payment.
  • Proposed FY 2016 Hospice Wage Index and Rate Update Transition Period.
  • HQRP Reconsideration and Appeals Procedures for the FY 2016 Payment Determination and Subsequent Years.
  • Clarification Regarding Diagnosis Reporting on Hospice Claims

 

Proposed Routine Home Care Rates and Service Intensity Add-On Payment 

LeadingAge recommends that CMS: 

 

  • Develop a reimbursement methodology that reflects the actual costs of caring for individuals with different diagnosis related to the terminal illness as well as individuals that receive higher cost treatments. 

  • Allow sufficient time for Hospice providers, CMS and the Medicare Administrative Contractors to prepare and test the new payment system to assure the required infrastructure and information systems are in place to effectively and efficiently implement the proposed Routine Home Care Rates and Service Intensity Add-On Payments. 

  • Clarify how hospice days will be counted for beneficiaries in existing hospice episodes that continue thru October 1, 2015, and beyond.

  • Annually propose additional refinements to the Routine Home Care Rates and Service Intensity Add-On Payments that may be needed based on new data collected. Stakeholders should be given the opportunity to submit comments on these proposed payment changes through the rulemaking process. 

  • Give Hospices the opportunity to provide additional RN and SW services approved by the patient’s physician to provide more than 4 hours of RN/SW time, and receive payment for these additional service hours.

  • Develop criteria that would warrant payment for additional hours per day. 

  • Allow RNs and SWs be paid for telephone communication with the hospice beneficiary as part of the Service Intensity Add-on. 

  • Increase their oversight of hospice providers not providing the services required under the Hospice Conditions of Participation, and are exhibiting inappropriate practices highlighted by the Office of Inspector General and the Medicare Payment Advisory Commission. 

  • Include the Service Intensity Add-On payment for a hospice provider’s care of patients residing in SNF/NFs.

  • Give stakeholders adequate time to assess and comment on any changes to the SIA payments.

 

Proposed FY 2016 Hospice Wage Index and Rate Update Transition Period 

LeadingAge recommends that CMS: 

 

  • Support a change in statute to address the additional labor costs for hospice providers that occur in rural and frontier areas, similar to the rural add on given to home health providers.

  • Analyze the impact of the change in wage index area delineation especially on labor costs for hospices in rural and frontier areas.

 

HQRP Reconsideration and Appeals Procedures for the FY 2016 Payment Determination and Subsequent Years

LeadingAge recommends that CMS: 

 

  • Clarify what information would be included on the HQRP website, and at what point in the process could the hospice correct erroneous information related to hospice compliance reports. 

 

Clarification Regarding Diagnosis Reporting on Hospice Claims 

 

LeadingAge recommends that CMS: 

 

  • Complete a Regulatory Impact Analysis of the financial impact of requiring hospices to have their coders include codes unrelated to the terminal illness on the hospice claims. Stakeholders should be given the opportunity to submit comments on the Regulatory Impact Analysis of the financial impact of requiring hospices to have their coders include codes unrelated to the terminal illness on the hospice claims.

  • Provide more details on the process of how the hospice will differentiate the diagnosis related to terminal illness from the diagnosis not related to the terminal illness.

  • Work with stakeholders to determine what constitutes "terminal illness" and "related conditions."

  • Increase oversight of hospices using fraudulent and unethical coding practices, and hold them accountable.

 

LeadingAge appreciates all of the hospice members that joined us on conference calls to share their expertise on the ramifications of the proposed rule and helped us develop our comments to CMS.