Hospice providers get a 3.1% payment increase in final rule
Physicians who certify patient eligibility for hospice services must be enrolled in Medicare or have validly opted out.
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The Centers for Medicare and Medicaid Services has released hospice payment updates in its FY 2024 final rule.
The payment increase is 3.1%, which is an estimated increase of $780 million from FY 2023. This results from the 3.3% inpatient hospital market basket percentage increase reduced by a 0.2 percentage point productivity adjustment.
The payment reduction for failing to meet hospice quality reporting requirements is changing from 2 to 4 percentage points. Therefore, beginning in FY 2024 and for each subsequent year, hospices that fail to meet quality reporting requirements receive a 4 percentage point reduction to the annual hospice payment update percentage increase for the year.
The FY 2024 rates for hospices that do not submit the required quality data would be updated by -0.9%, which is the FY 2024 hospice payment update percentage of 3.1% minus 4 percentage points.
The hospice payment update includes a statutory aggregate cap limiting the overall payments per patient made to a hospice annually. The hospice cap amount for FY 2024 is $33,494.01, which is equal to the FY 2023 cap amount of $32,486.92, updated by the FY 2024 hospice payment update percentage of 3.1%.
WHY THIS MATTERS
CMS said this rule is taking several important steps as part of CMS' efforts to closely examine the hospice industry, as it has increasing concerns about fraud, waste, and abuse in this space. The rule finalizes its proposal that physicians who certify patient eligibility for hospice services must be enrolled in Medicare or validly opted out as a prerequisite for payment for the hospice period of care in question.
The certifying physician enrollment requirement is part of a larger effort by CMS to address hospice fraud, waste, and abuse among these providers. Additional hospice-related enrollment proposals were included in the 2024 Home Health Prospective Payment System Rate Update proposed rule.
In response to concerns raised by commenters, CMS will not implement or enforce this requirement until May 1, 2024, to give unenrolled and non-opted-out physicians more time to enroll in or opt out of the Medicare program.
THE LARGER TREND
The final rule addresses ownership transparency; equipping patients and caregivers with information to inform hospice selection; and ways to examine health equity under the hospice benefit. This rule also finalizes conforming regulation text changes related to the expiration of the COVID-19 public health emergency.
The rule also finalizes the codification of the Hospice Quality Reporting Program data submission threshold policy adopted in the FY 2016 hospice final rule.
It discusses the Hospice Outcomes and Patient Evaluation (HOPE) tool; provides an update on future Quality Measures development and health equity efforts and provides updates on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey mode experiment.
Finally, this rule discussed updates on the hospice special focus program established under the Consolidated Appropriations Act, 2021, which is being proposed in the CY 2024 Home Health Prospective Payment System Rate Update proposed rule. CMS is seeking comments on the proposed CY 2024 Home Health Prospective Payment System Rate Update proposed rule through August 29.
Additionally, CMS is finalizing regulations' text changes related to the provision of telehealth services for Routine Home Care with the expiration of the COVID-19 PHE and for the use of telecommunications technology for the face-to-face encounter conducted by a hospice physician or hospice nurse practitioner for the sole purpose of hospice recertification through December 31, 2024.
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
