On April 27, 2018 CMS released the FY2019 Hospice Proposed Rule. The rule includes a proposed increase in hospice reimbursements as well as changes to the Hospital Quality Reporting Program (HQRP), although no new measures are proposed.

Highlights of the FY2019 Hospice Proposed Rule include:

Payment Update

CMS is proposing a 1.8% increase in reimbursements to hospices with an overall economic impact estimated to be $340 million in increased payments to hospices during FY2019. The proposed payment update for FY2019 is based on the estimated inpatient hospital market basket up date of 2.9%, reduced by a 0.8% multi factor productivity adjustment and by a 0.3% adjustment, both mandated by the Affordable Care Act (ACA).

Meaningful Measures

In October 2017, CMS launched the Meaningful Measures Initiative aimed at identifying the highest priority areas for quality measurement and quality improvement in order to assess the core quality of care issues that are most vital to advancing our work to improve patient outcomes.

The Meaningful Measures Framework has the following objectives:

  • Address high-impact measure areas that safeguard public health
  • Patient-centered and meaningful to patients
  • Outcome-based where possible
  • Fulfill each program’s statutory requirements
  • Minimize the level of burden for health care providers (for example, through a preference for EHR-based measures where possible, such as electronic clinical quality measures)
  • Significant opportunity for improvement
  • Address measure needs for population based payment through alternative payment models
  • Align across programs and/or with other payers

In order to achieve the objectives of the initiative, CMS identified 19 Meaningful Measures and mapped them to six quality priorities, as shown below:

Quality Priority: Making Care Safer by Reducing Harm Caused in the Delivery of Care
Meaningful Measure Areas: Healthcare-Associated Infections, Preventable Healthcare Harm

Quality Priority: Strengthen Person and Family Engagement as Partners in Their Care
Meaningful Measure Areas: End of Life Care according to Preferences, Patient’s Experience of Care, Patient Reported Functional Outcomes

Quality Priority: Promote Effective Communication and Coordination of Care
Meaningful Measure Areas: Medication Management, Admissions and Readmissions to Hospitals, Transfer of Health Information and Interoperability

Quality Priority: Promote Effective Prevention and Treatment of Chronic Disease
Meaningful Measure Areas:  Preventive Care, Management of Chronic Conditions, Prevention, Treatment, and Management of Mental Health, Prevention and Treatment of Opioid and Substance Use Disorders, Risk Adjusted Mortality

Quality Priority: Work with Communities to Promote Best Practices of Healthy Living
Meaningful Measure Areas: Equity of Care, Community Engagement

Quality Priority: Make Care Affordable
Meaningful Measure Areas: Appropriate Use of Healthcare, Patient-focused Episode of Care, Risk Adjusted Total Cost of Care

Hospice Claims Processing – Removal of detailed drug data requirement

CMS initially began asking hospices to report detailed drug data on claims in support of hospice payment reform. However, per Change Request 10573, this requirement will be removed effective October 1, 2018, reducing significant burdens to Medicare hospices. Hospices will be allowed two options for reporting hospice drug information:

  1. Providers can continue to report infusion pumps and drugs, with corresponding NDC information, on the hospice claim as separate line items. However, this submission option will no longer be mandatory.
  2. Hospices can submit total, aggregate DME and drug charges on the claim, providing additional flexibility and reduced burden.

Please note that while this update was included in the proposed rule, it was also published in Change Request 10573 on April 27, 2018. This is not a “proposed” change and hospices should prepare for the October 1 implementation date.

Text Changes in Recognition of Physician Assistants as Designated Attending Physicians

Section 51006 of the Bipartisan Budget Act of 2018 (Pub. L. 115-123) amended CMS-1692-P 64 section 1861(dd)(3)(B) of the Social Security Act such that, effective January 1, 2019, physician assistants (PAs) will be recognized as designated hospice attending physicians, in addition to physicians and nurse practitioners. However, PAs cannot certify or recertify terminal illness (must be conducted by the attending physician and the hospice medical director) or conduct Face-to-Face encounters.

Effective January 1, 2019, Medicare will pay for medically reasonable and necessary services provided by PAs to Medicare beneficiaries who have elected the hospice benefit and who have selected a PA as their attending physician.

Hospice CAP Period Definition Technical Correction

In the FY2016 Final Rule, CMS finalized aligning the cap period, for both the inpatient cap and the hospice aggregate cap, with the federal FY for FY2017 and later. Therefore, the cap year now begins October 1 and ends on September 30 (80 FR 47186). The FY209 Hospice Proposed Rule proposes a technical correction in §418.3 to reflect these revised timeframes for hospice cap periods.

Hospice Item Set

To ensure that the data reported on Hospice Compare is accurate, CMS is proposing in the FY2019 Hospice Proposed Rule that hospices be provided a distinct period of time to review and correct the data that is to be publicly reported. According to CMS, “this approach would allow hospices a timeframe in which they may analyze their data and make corrections (up until 11:59:59 pm PST of the quarterly deadline) prior to receiving their preview reports.”

For each calendar quarter of data submitted using the Hospice Item Set (HIS), approximately 4.5 months after the end of each CY quarter CMS is proposing a deadline, or freeze date for the submissions of corrections to records. This newly proposed data correction deadline for HIS records would be separate and apart from the established 30-day data submission deadline.

This is a significant decrease in the amount of time allowed for review. Currently, hospices have 36 months to modify HIS records. However, only data modified before the public reporting “freeze date” are reflected in the corresponding CMS Hospice Compare website refresh.

The proposed deadlines for the correction of data for public reporting would begin January 1, 2019. See below for the proposed deadline date breakdown.

Data Reporting Period Data Correction Deadline for Public Reporting
Prior to January 1, 2019 August 15, 2019
January 1, 2019 – March 31, 2019 August 15, 2019
April 1, 2019 – June 30, 2019 November 15, 2019
July 1, 2019 – September 30, 2019 February 15, 2019
October 1, 2019 – December 31, 2019 May 15, 2020

Quality Measures to be Displayed on Hospice Compare in FY2019

CMS said that they anticipate that they will begin public reporting of the HIS-based Hospice Comprehensive Assessment Measure (NQF #3235), a composite measure of the seven original HIS Measures (NQF #1641, NQF #1647, NQF #1634, NQF #1637, NQF #1639, NQF #1638, and NQF #1617), on Hospice Compare in Fall 2019.

Additionally, CMS anticipates public reporting of the HIS-based Hospice Visits when Death is Imminent Measure Pair in FY2019. This measure pair assesses hospice staff visits to patients at the end of life.

Updates to the Public Display of HIS Measures

Reformatting of data on Hospice Compare is proposed. Designed to be clearer and reduce confusion, CMS intends to no longer directly display the 7 component measures as individual measures on Hospice Compare. Once the composite measure is displayed, Hospice Compare would still provide the public with the ability to view the component measures in an easier to understand manner. CMS plans to achieve this by reformatting the display of the component measures so that they are only viewable in an expandable/collapsible format under the composite measure itself, giving users the opportunity to view the component measure scores that make up the main composite measure score.

Display of Public Use File Data on Hospice Compare

As part of CMS’s ongoing efforts to make healthcare more transparent, affordable, and accountable, the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (PUF) has been available at the provider-level in the PUF since 2016. CMS proposes to post information from PUF and/or other publicly available CMS data to Hospice Compare in a user-friendly way that can be consumed by those who are looking for hospice information to support provider selection.

This information would be displayed in a new section of Hospice Compare that would provide additional information along with the already-displayed HIS and Hospice CAHPS quality measures and demographic information. This would be similar to what is currently displayed in the information sections of Nursing Home Compare and the End Stage Renal Disease Compare.

FY2019 Hospice Proposed Rule Feedback Encouraged

CMS encourages providers to provide comments on the FY2019 Hospice Proposed Rule. Comments must be received no later than 5 pm on June 26, 2018. Providers may submit comments electronically at http://www.regulations.gov, by regular mail to:  Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1692-P, P.O. Box 8010, Baltimore, MD 21244-1850, or by express/overnight mail to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1692-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

The HEALTHCAREfirst Difference

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fy2019 hospice proposed rule