Last week, CMS issued a proposed rule (Proposed Rule) for fiscal year (FY) 2025 aiming to update Medicare hospice payments and aggregate cap amount in accordance with existing statutory and regulatory requirements. The Proposed Rule includes CMS’s routine updates to the hospice payment rates and aggregate cap amount for FY 2025 along with adoption of the most recent Office of Management and Budget (OMB) statistical area delineations, which would affect the hospice wage index, clarify policies on hospice “election statement” and “notice of election” (NOE), and clarify language regarding hospice certification. Additionally, the Proposed Rule suggests collection of Hospice Quality Reporting Program (HQRP) metrics using the Hospice Outcomes and Patient Evaluation (HOPE) tool, proposes two HOPE-based measures and details future development plans for it, seeks information on integrating social determinants of health (SDOH) elements, updates on Health Equity, future quality measures (QMs), public reporting standards, and changes to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey. Certain of the proposed changes are highlighted below, and interested stakeholders are encouraged to submit comments by May 28, 2024.
FY 2025 Annual Rate Changes & Payment Policies
The Proposed Rule suggests a 2.6% increase in payments for FY 2025, resulting in an estimate increase of $705 million in payments from FY 2024. The hospice payment update also includes an updated aggregate cap of $34,364.85 which limits the overall payments per patient that may be made to a hospice annually. As proposed, hospices that fail to submit the required quality data would have a -1.4% hospice payment update percentage.
CMS also proposes to update the current Medicare hospice payment policies by incorporating the latest OMB statistical area delineations based on the 2020 Decennial Census and applying a 5% cap to limit any decrease in the wage index from the prior year. CMS aims for this cap to prevent geographic area’s wage index from falling below 95% of its wage index calculated in the prior fiscal year. Also, CMS invites comments on the potential implementation of a separate payment mechanism to account for high-intensity palliative care services, such as that of chemotherapy and radiation, provided under the hospice care.
Hospice Quality Reporting Program (HQRP)
The Proposed Rule adds two new measures to the Hospice Quality Reporting Program (HQRP)—Timely Reassessment of Pain Impact and Timely Reassessment of Non-Pain Symptom Impact which will determine how many patients assessed with moderate or severe pain/moderate or severe non-pain were reassessed by the hospice within two calendar days. Additionally, the HOPE patient-level data collection tool, planned for FY 2025 introduction, will collect detailed patient data throughout the hospice stay and expand several domains over the current Hospice Item Set by including an updated sociodemographic, expanded diagnoses, symptom impact assessment, and imminent death factors.
Additionally, the Proposed Rule sets out changes to the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. These changes include the addition of a web-mail mode (email invitation to a web survey, with mail follow-up to non-responders), shortened and simplified survey, prenotification letter and extended field period, addition of a new, two-item Care Preferences measure, revisions to the existing Hospice Team Communication measure and the existing Getting Hospice Care Training measure, and removal of certain items related to nursing homes. Comments related to the Hospice SFP as finalized in the CY 2024 Home Health final rule (88 FR 77876) are still being reviewed and considered as to whether an amendment may be necessary.
Hospice Conditions of Participation Technical Update
The Proposed Rule also sets out technical changes to the Conditions of Participation (CoPs) to address the language discrepancies related to a medical director and physician designee. These changes include (1) addition of the “physician member of the hospice [interdisciplinary group (] IDG[)] as an individual who may review the clinical information for each patient and provide written certificate that it is anticipated that the patient's life expectancy is six months or less if the illness runs its normal course” and (2) “update to the medical director and admission to hospice care CoPs to clarify that if the medical director is unavailable, the physician designee may review the clinical information and certify the terminal illness.” Additionally, CMS is proposing clarifications to the election statement and notice of election in the CoPs to enhance understanding of the separate requirements without altering the current policy.
The Proposed Rule is scheduled to be published on April 4, 2024 and can be found here. The CMS fact sheet is available here.
