Linda Rouse O’Neill
By Linda Rouse O’Neill, Vice President, Government Affairs
Reimbursement rules place new requirements on hospice industry
Your hospice customers may be facing some notable changes in the near future based on current 2016 and proposed 2017 Centers for Medicare & Medicaid Services (CMS) reimbursement rules. Hospices have expanded well beyond their traditional scope of caring for cancer patients due to increased patient interest in receiving end-of-life care in non-acute settings. As a result, rising use of these services has prompted regulators and lawmakers to take a closer look at reimbursement for these providers.
CMS has proposed a new rule for FY 2017 that will update hospice payment rates and includes important reporting changes, such as new quality measures. Some of these measures are already shaping how the market will operate over the next few years, while others have yet to be determined.
FY 2016 rule recap
The current rules from CMS for hospice payment took effect last October and included:
- A 1.3 percent hospice payment increase
- Varying payments for routine home care based on a beneficiary’s length of stay
Additionally, the post-acute market as a whole is still reacting to the passage of the 2014 IMPACT Act, which seeks to apply common metrics across multiple post-acute settings. The act, which is still in the process of implementation, specifically requires Medicare-certified hospice providers to submit patient assessment data every three years for the next decade. This information will be based on surveys analyzing quality measure performance, resource use, and other measures.
FY 2017 proposed rule highlights
Overall, hospices will see a 2.0 percent aggregate payment increase (approximately $330 million) for FY2017, though this increase could vary substantially by region. Specifically, providers in the rural Pacific region are expected to see a payment increase of 2.7 percent, while rural areas of the West North Central region would only receive a 1.0 percent increase. The rule would also increase the hospice cap – which calculates the value of services rendered per newly admitted beneficiary during a given accounting year – for the 2017 cap year to $28,377.17 from the FY 2016 cap of $27,820.75.
Along with the payment increase, the proposed rule includes a new set of quality measures for the Hospice Quality Reporting Program. These include:
- A measure for hospice visits when death is imminent, which assesses hospice staff visits to both patients and caregivers in the final week of life.
- A Hospice and Palliative Care Composite Process Measure, which measures “the percentage of hospice patients who received care processes consistent with existing guidelines,” according to the rule.
Notably, hospices failing to report on these measures will see their payments reduced by two percentage points, so it’s important your customers are aware of these proposed metric additions.
This rule is still under consideration and the comment period closes at the end of this month on June 20. As always, if you would like more information, please contact HIDA Government Affairs at HIDAGovAffairs@HIDA.org.