The Centers for Medicare & Medicaid Services (CMS) released [CMS-1675-P] Medicare Program; FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements  proposed rule to update the hospice payment rates for fiscal year 2018, adds new quality measures and provides an update on the hospice quality reporting program (HQRP), solicits comments on the clinical certification of a medical prognosis of a life expectancy of six months or less, outlines new data collection mechanisms under consideration, including the Hospice Evaluation & Assessment Reporting Tool (HEART) and delineates the requirements for the Hospice CAHPS Survey for the FY 2020, FY 2021, and FY 2022 annual payment updates.

The proposed rule :

  • Contains an estimated $180 million increase, which is significantly lower than the update for 2017. 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 would generally see a 1.0 percent ($180 million) increase in their payments for FY 2018.
  • Includes the 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).
  • Adds a new quality measures and provides an update on the hospice quality reporting program (HQRP). The Hospice Compare website will be in place the summer of 2017. Hospice star ratings will be between 1 and 5 stars and , will be determined through methods yet to be announced. Public comments regarding how the rating system will determine star ratings, methods for calculations and the proposed timeline for implementation are forthcoming.
  • Discusses and solicits 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, and details regarding measure definitions, specifications, and timeline for implementation will be communicated in future rulemaking.
  • Discuss and solicits comments on the clinical certification of a medical prognosis of a life expectancy of six months or less. CMS wants to clarify the regulatory text change that identifies the source of the required clinical information used to certify a life expectancy of six months or less as the referring physician’s and/or the acute/post-acute care facility’s medical record. CMS longstanding expectation is that the referring physician/acute/post-acute care facility’s clinical documentation serves as the basis of the certification of terminal illness. Additionally, CMS are soliciting comments regarding the use of clinical documentation from an in-person visit from the hospice medical director or the hospice physician member of the interdisciplinary group to support the certification of terminal illness and whether such documentation is needed to augment the clinical information from the referring physician/facility’s medical records.
  • Outlines new data collection mechanisms under consideration, including the Hospice Evaluation & Assessment Reporting Tool (HEART). HEART would provide the quality data for the  Hospice Quality Reporting Program (HQRP) and the current function of Hospice Item Set (HIS), and  clinical data to inform payment refinements. CMS is considering enhancing the current Hospice Item Set data collection instrument to be more in line with other post-acute care settings. This revised data collection instrument, HEART, would be a patient assessment tool, rather than the current chart abstraction tool. By integrating a core standard data set into an assessment tool, hospices could use such a data set as the foundation for valid and reliable information for patient assessment, care planning, and service delivery. This would enable greater accuracy in quality reporting; decrease provider burden; help surveyors ensure hospices are meeting Conditions of Participation and providing high quality patient care; and, in the future, inform payment refinement efforts.
  • Outlines requirements for the Hospice CAHPS Survey for the FY 2020, FY 2021, and FY 2022 annual payment updates. In addition, the rule proposes to adopt two global CAHPS Hospice Survey measures and six composite CAHPS Hospice Survey-based measures, which would be based on data submitted on the survey. The rule also proposes how these measures would be calculated based on the survey data.                                                                                                                                                                                                      

The proposed rule and the Request for Information went on display on April 27 at the Federal Register’s Public Inspection Desk and will be posted in the May 3rd Federal Register . LeadingAge will be submitting comments on the proposed rule, and encourages members and state affiliates to also submit comments. Public comments on the proposal will be accepted until June 26, 2017.