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CMS issues Hospice Payment Rate Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on April 14, 2021 providing routine updates to hospice base payments and the aggregate cap amount for FY 2022 in accordance with existing statutory and regulatory requirements. CMS is also proposing changes to the Hospice Conditions of Participation (CoPs) and Hospice Quality Reporting Program (HQRP).

CMS is proposing a 2.3% ($530 million) increase in payments for FY 2022. However, hospices that fail to meet quality reporting requirements receive a 2% reduction to the annual market basket update for FY 2022. The hospice payment update also includes a statutory aggregate cap that limits the overall payments per patient that is made to a hospice annually. The proposed cap amount for FY 2022 is $31,389.66, a 2.3% increase over the FY 2021 cap amount.

This rule proposes changes to the hospice CoPs regarding hospice aide competency evaluation standards. CMS is proposing to make the waiver for hospice aide competency testing to allow for the use of pseudo-patients issued during the public health emergency permanent. CMS is also proposing that hospices conduct a competency evaluation related to the deficient and related skill(s) noted during a hospice aide supervisory visit instead of assessing multiple areas within the competency evaluation.

CMS is proposing a new measure in the HQRP called the Hospice Care Index to be publicly reported beginning in May 2022. The Hospice Care Index includes 10 indicators of quality that are calculated from claims data. CMS is also proposing to add Consumer Assessment of Healthcare Providers and Systems (CAHPS®), Hospice Survey Star ratings on Care Compare. CMS also intends to add the Hospice Visits in the Last Days of Life (HVLDL) measure for public reporting. CMS is also announced an update on the Hospice Outcome and Patient Evaluation (HOPE) assessment instrument. Within the quality reporting program, CMS is proposing to remove seven individual Hospice Item Set (HIS) measures because a more broadly applicable measure, the Hospice Comprehensive Assessment Measure (NQF # 3235), for those topics is available and already publicly reported.

To meet the January 2022 public reporting refresh cycle for Home Health Facilities, CMS proposes using three quarters rather than four quarters of data for the January 2022 refresh affecting OASIS‑based measures. For some claims-based measures, we are also proposing to use three quarters rather than four quarters of data for refreshes between January 2022 and July 2024.

Additionally, CMS has two requests for information included in the proposed rule. CMS is requesting information on advancing to digital quality measurement and the use of Fast Healthcare Interoperability Resources (FHIR)-based standards to exchange clinical information through application programming interfaces (APIs). CMS is also seeking feedback on ways to attain health equity for all patients through policy solutions that apply to the HQRP and our other quality reporting programs.

Comments will be accepted until June 7, 2021.

The full proposed rule is available here.

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