This evening, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2020 payment rule for hospices. The proposed rule includes a payment increase of 2.7 percent for FY 2020 as a proposed change to the hospice election statement, and a request for information (RFI) on the role of hospice care.

Comments on the rule are due June 18, 2019.

Payments to Hospices to Increase by 2.7 Percent in FY 2020

Overall, CMS estimates that the policies in this proposed rule will result in a $540 million increase in payments to hospices in FY 2020. A 2.7 percent increase is proposed for the FY 2020 update to hospice payments.

CMS is proposing to rebase continuous home care (CHC), general inpatient care (GIP), and inpatient respite care (IRF) per diem rates in a budget neutral way. The CHC and GIP payment rates would be set to the estimated FY 2019 average costs per day; the IRC rate will be set to the estimated FY 2019 average cost per day minus 5 percent to account for coinsurance. To maintain budget neutrality, routine home care (RHC) payment amounts would be reduced by 2.71 percent for FY 2020. CMS believes this will more accurately align payments with the cost of providing care.

In addition, CMS is proposing to remove the 1-year lag in data for the hospice wage index. The agency would now use the current year’s hospital wage data to establish the wage index. This will align hospice policy with other facilities, including skilled nursing facilities (SNFs), home health, and acute care hospitals that use the most current wage index data. Similar proposals have been put forward for inpatient psychiatric facilities and inpatient rehabilitation facilities (IRFs).

Finally, CMS is proposing a hospice payment cap amount of $29,933.99 for FY 2020. This amount is equal to the FY 2019 cap amount updated by the proposed 2.7 percent payment update.

Hospice Election Statement Addendum Proposed

Use of the Medicare hospice benefit requires a hospice election statement. This statement includes the designated hospice, beneficiary or representative acknowledgement of the palliative nature of hospice care and acknowledgement that the beneficiary waives the right to Medicare payment for services related to the terminal illness and related conditions except when provided by the designated hospice.

In light of agency concerns over patients being adequately informed about the services covered under the hospice benefit, CMS is proposing to require an addendum to the election statement to increase coverage transparency. The updated hospice election statement would have to include:

• Information about the holistic, comprehensive nature of the Medicare hospice benefit
• A statement that, while rare, there might be necessary items or services not covered by the hospice
• Information about beneficiary cost-sharing for hospice services
• Notification of the right to request an election statement addendum of a written list and rationale for the conditions, items, drugs, or services the hospice determines are unrelated to the terminal illness and that advocacy is available if the beneficiary or representative disagrees

If an election statement addendum is requested, CMS is proposing that the hospice would have to provide it within 48 hours if requested at time of hospice election or provide it immediately if requested during the course of hospice care.

CMS Proposes Automatic Volume-Based Exemption for CAHPS Survey Data for 2022 & Public Posting of Government Data to Hospice Compare

The Hospice Quality Reporting Program (HQRP) uses the CAHPS Hospice Survey to collect data on patient and caregiver experience. CMS previously finalized a volume-based exemption through FY 2021. In this proposed rule, beginning with FY 2022, CMS is proposing to provide an automatic exemption to hospices that are an active agency and have served less than a total of 50 unique survey-eligible decedents/caregivers in the reference year. The automatic exemption would be good for one year.

CMS notes that data submission will be moving to a new internet Quality Improvement and Evaluation System (iQIES) as soon as FY 2020. CMS is proposing to notify the public of any future changes to the system using subregulatory mechanisms, such as posting online, listserv messaging, and webinars.

As part of CMS’ efforts to improve the Hospice Compare website, the agency is proposing to post information from other publicly available government data, such as CDC and NIH data, to the website as soon as FY 2020. This would be in addition to the data from the public use file and other CMS data sources.

Rule Includes RFI on Role of Hospice Care

This proposed rule also includes a request for information (RFI) on the Medicare fee-for-service hospice benefit and coordination of end-of-life-care. CMS is looking for information on the interaction of the hospice benefit and alternative care delivery models as well as the impact of alternative models implemented outside of Medicare on the provision of hospice care.

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