On April 27, 2017, CMS released a proposed rule (the Proposed Rule) that would update the hospice wage index, payment rates and cap amount for fiscal year (FY) 2018. It also provides an update with respect to quality measures under the Hospice Quality Reporting Program (HQRP). The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) amended the Social Security Act to provide for a market basket percentage increase of 1 percent for FY 2018, after application of the productivity adjustment and 0.3 percent reduction, if applicable. Thus, the hospice payment update percentage is 1 percent for FY 2018. Accordingly, the FY 2018 hospice cap amount, which is the maximum amount that Medicare will pay annually for a beneficiary, is $28,689.04, which reflects the FY 2017 hospice cap amount updated by the 1 percent hospice payment update. We set forth below some additional highlights of the Proposed Rule.
There are 4 hospice payment categories based upon the location and intensity of services provided, each of which are adjusted for geographic wage differences: routine home care (RHC), continuous home care (CHC), inpatient respite care (IRC) and general inpatient care (GIP). With respect to payment for RHC, the FY 2016 hospice final rule implemented a payment rate for the first 60 days of care that is separate from the rate applied for days 61 and beyond, as well as a Service Intensity Add-on (SIA) payment for RHC when direct patient care is provided during the last 7 days of the beneficiary’s life by an RN or social worker. The payment rates must be budget neutral and are subject to a budget neutrality factor. The Proposed Rule proposes a 1.0018 budget neutrality adjustment for days 1 through 60 and an adjustment of 1.0005 for days 61 and beyond. After applying the proposed hospice payment update of 1 percent, the wage index standardization factor as well as the SIA budget neutrality adjustments, the FY 2018 proposed RHC payment rate for days 1-60 is $192.80 and for days 61 and beyond is $151.41. After applying the wage index standardization factor and the 1 percent hospice payment update, the FY 2018 proposed payment rate is $976.42 for CHS, $172.78 for IRC and $743.55 for GIP.
The FY 2012 hospice final rule implemented the HQRP as mandated by the Affordable Care Act. Beginning with FY 2014, the Secretary is required to decrease the market basket update by 2 percent for any hospice that does not comply with quality data submission requirements. Accordingly, the FY 2018 payment rates for hospices that fail to submit the requisite quality data would be updated by the 1 percent hospice payment update, but would also be subject to a decrease of 2 percentage points.
The Proposed Rule also solicits comment on the source of the clinical information that may serve as the basis for initial hospice eligibility determinations. Specifically, CMS requests comments on specifying that: (i) the referring physician’s and/or the acute/post-acute care facility’s medical record serve as the basis for the determination; and (ii) that documentation of an in-person visit from either the hospice physician member of the interdisciplinary team or the medical director could be used as documentation to support the determination only if needed to bolster the clinical information from the referring physician/facility’s medical records.
Finally, with respect to the HQRP, CMS neither proposes to remove any of the current HQRP measures nor to add any new measures. However, CMS identifies two high priority areas that the agency plans to address by claims-based measure development: (i) potentially avoidable hospice care transitions and (ii) access to levels of hospice care, with a goal of assessing the rates at which hospices provide different levels of hospice care.
The Proposed Rule is expected to be published in the Federal Register on May 3, 2017. Comments are due by June 26, 2017. A copy of the Proposed Rule is available here.
