Improving health is our policy
Directs CMS, by January 2, 2011, to update Medicare hospice cost reports and claims forms and mandate a face-to-face encounter between a doctor (or nurse practitioner) and the patient to determine the need for recertification after 180 days, and to implement reforms to the payment system to improve payment accuracy by no earlier than FY14.
Several of these provisions, including the new face-to-face recertification requirement, were implemented via the CY11 Home Health final rule. On October 7, 2011, CMS issued guidance regarding the ramifications for face-to-face encounters not occurring in a timely manner. For more information, see CMS’s “Hospice Center” webpage.
2013
On April 4, 2013, CMS published a new information collection delineating the agency’s intend to implement a “Hospice Experience of Care Survey,” consistent with the intent of the National Quality Strategy called for under this section of the ACA. Comments are due by June 3.
On April 29, CMS issued a proposed rule for FY14 Medicare hospice payments. Under the rule, CMS would increase hospice payments for FY14 by 1.1%, or $180 million. CMS also proposes amendments to hospice reporting requirements and the use of updated data in calculating wage index adjustments. Finally, the agency provides an update regarding its consideration of hospice reforms per the ACA but does not propose implementing any significant reforms this year. Per the requirements at section 3132 of the ACA, the approximate 1.1% increase in total payments includes the ACA mandated cut of -0.7%, among other adjustments. A CMS fact sheet is available here. Comments on the proposed rule are by due June 28.
On May 2, CMS released the proposed FY 2015 hospice wage index and payment rate update (available here; fact sheet), in which the agency estimates that FY15 hospice payments would increase by an estimated $230 million, 1.3% net, reflecting the following factors: (1) 2.0% proposed payment update to the hospice per diem rates (a “hospital market basket” increase of 2.7 percent minus 0.7 percentage point for statutory reductions); and -0.7% in hospice payments, stemming from “updated wage data and the sixth year of CMS’s seven-year phase-out of its wage index budget neutrality adjustment factor (BNAF),” the agency explains. The regulation addresses these ACA provisions. Comments are due by July 1.
On Apr. 30 CMS revised a currently approved information collection called “Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Cost Report Form.”
On July 31, CMS released its final FY 16 hospice wage index and payment rate update (available here; fact sheet), estimating that net Medicare payments to hospices will increase by $160 million, or 1.1%.
On Sep. 18, CMS submitted to OMB for approval a revision to the Form CMS-2552-10, Hospital and Hospital Health Care Complex Cost Report.
2016
On Apr. 21, CMS released a proposal updating Medicare payment regulations for hospices. Under the proposed rule, net Medicare payments to hospices will increase by $330 million or 2.0 percent. The update is based on a market basket of 2.8 percent less a 0.5 percent productivity adjustment and a 0.3 percentage point adjustment set by the ACA.
On July 29, CMS released a final rule that says net Medicare payments to hospices will increase by $350 million or 2.1 percent. The update is based on a market basket (MB) of 2.7 percent less a 0.3 percent productivity adjustment and a 0.3 percentage point adjustment set by the ACA. The final rule reflects a $20 million increase over proposed levels.
2017
On April 27, CMS released its hospice proposed rule updating the hospice wage index, payment rates, and cap amount for FY 2018. This provision of the ACA is addressed in the rule.
On Aug. 3, CMS released a final rule specifying the FY 2018 hospice wage index and payment rate update. This provision of the ACA is addressed in the rule.
SEC. 3132. HOSPICE REFORM. (a) HOSPICE CARE PAYMENT REFORMS.— (1) IN GENERAL.—Section 1814(i) of the Social Security Act (42 U.S.C. 1395f(i)), as amended by section 3004(c), is amended— (A) by redesignating paragraph (6) as paragraph (7); and (B) by inserting after paragraph (5) the following new paragraph: ‘‘(6)(A) The Secretary shall collect additional data and information as the Secretary determines appropriate to revise payments for hospice care under this subsection pursuant to subparagraph (D) and for other purposes as determined appropriate by the Secretary. The Secretary shall begin to collect such data by not later than January 1, 2011. ‘‘(B) The additional data and information to be collected under subparagraph (A) may include data and information on— ‘‘(i) charges and payments; ‘‘(ii) the number of days of hospice care which are attributable to individuals who are entitled to, or enrolled for, benefits under part A; and ‘‘(iii) with respect to each type of service included in hospice care ‘‘(I) the number of days of hospice care attributable to the type of service; ‘‘(II) the cost of the type of service; and ‘‘(III) the amount of payment for the type of service; ‘‘(iv) charitable contributions and other revenue of the hospice program; ‘‘(v) the number of hospice visits; ‘‘(vi) the type of practitioner providing the visit; and ‘‘(vii) the length of the visit and other basic information with respect to the visit. ‘‘(C) The Secretary may collect the additional data and information under subparagraph (A) on cost reports, claims, or other mechanisms as the Secretary determines to be appropriate. ‘‘(D)(i) Notwithstanding the preceding paragraphs of this subsection, not earlier than October 1, 2013, the Secretary shall, by regulation, implement revisions to the methodology for determining the payment rates for routine home care and other services included in hospice care under this part, as the Secretary determines to be appropriate. Such revisions may be based on an analysis of data and information collected under subparagraph (A). Such revisions may include adjustments to per diem payments that reflect changes in resource intensity in providing such care and services during the course of the entire episode of hospice care. ‘‘(ii) Revisions in payment implemented pursuant to clause (i) shall result in the same estimated amount of aggregate expenditures under this title for hospice care furnished in the fiscal year in which such revisions in payment are implemented as would have been made under this title for such care in such fiscal year if such revisions had not been implemented. ‘‘(E) The Secretary shall consult with hospice programs and the Medicare Payment Advisory Commission regarding the additional data and information to be collected under subparagraph (A) and the payment revisions under subparagraph (D).’’. (2) CONFORMING AMENDMENTS.—Section 1814(i)(1)(C) of the Social Security Act (42 U.S.C. 1395f(i)(1)(C)) is amended— (A) in clause (ii)— (i) in the matter preceding subclause (I), by inserting ‘‘(before the first fiscal year in which the payment revisions described in paragraph (6)(D) are implemented)’’ after ‘‘subsequent fiscal year’’; and (ii) in subclause (VII), by inserting ‘‘(before the first fiscal year in which the payment revisions described in paragraph (6)(D) are implemented), subject to clause (iv),’’ after ‘‘subsequent fiscal year’’; and (B) by adding at the end the following new clause: ‘‘(iii) With respect to routine home care and other services included in hospice care furnished during fiscal years subsequent to the first fiscal year in which payment revisions described in paragraph (6)(D) are implemented, the payment rates for such care and services shall be the payment rates in effect under this clause during the preceding fiscal year increased by, subject to clause (iv), the market basket percentage increase (as defined in section 1886(b)(3)(B)(iii)) for the fiscal year.’’. (b) ADOPTION OF MEDPAC HOSPICE PROGRAM ELIGIBILITY RECERTIFICATION RECOMMENDATIONS.—Section 1814(a)(7) of the Social Security Act (42 U.S.C. 1395f(a)(7)) is amended— (1) in subparagraph (B), by striking ‘‘and’’ at the end; and (2) by adding at the end the following new subparagraph: ‘‘(D) on and after January 1, 2011— ‘‘(i) a hospice physician or nurse practitioner has a face-to-face encounter with the individual to determine continued eligibility of the individual for hospice care prior to the 180th-day recertification and each subsequent recertification under subparagraph (A)(ii) and attests that such visit took place (in accordance with procedures established by the Secretary); and ‘‘(ii) in the case of hospice care provided an individual for more than 180 days by a hospice program for which the number of such cases for such program comprises more than a percent (specified by the Secretary) of the total number of such cases for all programs under this title, the hospice care provided to such individual is medically reviewed (in accordance with procedures established by the Secretary); and’’.
(202) 309-0796
Contact Us