2019 Hospice Rule Finalized

On August 1, the Centers for Medicare & Medicaid Services (CMS) finalized regulations first proposed in late April regarding the FY2019 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements. 

Payment rates for FY2019 were recalculated using the hospital market basket of 2.9 percent and reducing it by Affordable Care Act-enacted adjustments (a productivity adjustment for FY2019 at 0.8 percent and an additional 0.3 percent reduction specific to hospice providers). The hospice payment update for FY2019 has been finalized at 1.8 percent. Hospices failing to meet the quality reporting requirements for FY2019 will have their payments reduced by 2 percentage points. A chart showing the reductions can be found on page 40 of the final rule.

The hospice cap is mandated by the IMPACT Act of 2014. For FY2019 it will be $29,205.44, reflecting the 1.8 percent payment change.

Hospice Wage Index
The rule does not list the hospice wage index for FY2019, but CMS has provided a webpage with the information and a downloadable Excel file for quick reference.

Medications and Durable Medical Equipment (DME)
Effective October 1, 2018, CMS is no longer requiring the detailed reporting of drug data from providers, because this data is not used for quality, payment or program integrity purposes. In the final rule, CMS gave providers the option to report items as a monthly aggregate charge or as line items. CMS asks that providers pick a method and remain consistent.

Physician Assistants
Under the Bipartisan Budget Act of 2018, physician assistants (PA) can serve as the attending physician for hospice care. The change becomes effective on January 1, 2019. The final rule defines a PA as a “professional who has graduated from an accredited physician assistant educational program who performs such services as he or she is legally authorized to perform - in accordance with state law - and who meets the training, education and experience requirements as the Secretary may prescribe.” 

The rule further specifies that PAs:
  • may not serve as hospice medical directors, 
  • may not lead a hospice interdisciplinary team,
  • may not certify a beneficiary’s terminal illness, and
  • may not conduct the hospice face-to-face encounter.
Hospice Quality Reporting Program (HQRP)
The updates to the Hospice Quality Reporting Program (HQRP) include a new measure removal factor, revised data review and correction timeframes for submitting data to the Hospice Data Set (HIS), and additional quality measures publicly available websites to determine quality measure readiness for public reporting.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey 
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey collects data on family member and caregiver experiences with hospice care. The final rule addresses the preferred caregiver language of the survey, approved CAHPS vendors, public reporting of survey data, the exemption of small providers (under 50 qualified surveys), and the one-time exemption of new providers. After reviewing comments, CMS continued all policies.

Hospice Compare
The final rule addresses the timeliness of new quality measures for public review and the HIS-based Visits when Death is Imminent quality measure. CMS is taking comments into consideration and working with key stakeholders to craft language to ensure that consumers understand the quality measures’ intent, relationship to quality and any necessary measure-specific nuance. CMS has decided to separate the data into two sections on Hospice Compare—a “Family Experience of Care” section and a “Quality of Patient Care” section.

There are seven HIS component measures for Hospice Compare. Under the final rule, providers will still report these components, but CMS will no longer directly display the measures. The measures will remain accessible for consumers on Hospice Compare in a separate section.

The Public Use data file on Hospice Compare contains information on utilization, payment (Medicare payment and standard payment), submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number (6-digit provider identification number) and state. CMS notes that much of the information is not user-friendly. Commenters pointed out that the information is not quality-related and may be misleading to consumers. CMS is moving forward with plans to make the data user-friendly and post on Hospice Compare.

The full final rule can be found here. Contact Joy Cameron with any questions or concerns.

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