Over the last few weeks, there have been final rules sent out by CMS that impact hospice care.
November 1, CMS released the final Home Health Prospective Payment Rule for CY2024. Included in this rule was a “-2.89% cut, offset by a slight increase to the market basket rate in the initial proposed rule to 3.3% for an overall .8% increase to the payments for CY2024” according to a summary by LeadingAge. They express concern for the methodology, however.
Also included are the Hospice Special Focus Program Algorithm designed to identify poor hospice performers. Survey reports with Condition-Level Deficiencies (CLDs) and complaints with substantiated allegations, CMS Medicare Data source from the Hospice Quality Reporting Program (HQRP) CAHPS will be used in the algorithm along with hospices’ performance on certain Conditions of Participation that directly contribute to the quality of care for patients, their caregivers, and families. LeadingAge along with other industry leaders- National Partnership for Healthcare and Hospice Innovation (NHPI), the National Association for Home Care a& Hospice (NAHC), and the National Hospice and Palliative Care Organization (NHPCO) all expressed concern about the algorithm.
As a result of hospice integrity following the November 2022 New Yorker article exposing fraud in the hospice industry in 5 western states, the final rule also included a “36-month” rule for hospice agencies that mirrors regulations that home health has followed for several years. This rule” forbids the change in majority ownership during the 36 months after initial Medicare enrollment including acquisitions, stock transactions or mergers” according to Hospice News brief from November 1, 2023.
On November 2, 2023, CMS released the CY2024 Medicare Physician Fee Schedule Final rule that includes many improved billing opportunities for hospice and palliative care (See the November 13, 2023 Unified Voice for details). According to LeadingAge CMS “has decided not to finalize the requirement that Social worker, Marriage and Family Therapist, or Mental Health Counselor be a member of the IDG based on the needs and preferences of the patient.”
Hospice News reports that Leading Age, NHPCO, National Association for Home Care & Hospice, and the National Partnership for Healthcare and Hospice Innovation have been in contact with lawmakers in hopes of keeping nearly $1 Billion dollars in the hospice program rather than reallocating it to pharmacy and behavioral health, and other programs. This money is being “freed up” through amendments to the Social Security act, making adjustments to the hospice payment cap for 2023.
Finally, in the November Partnership News & Best Practices South Dakota Department of Health newsletter, there are reminders about administrative rules of South Dakota (ARSD) that relate to hospice services and residents in Assisted Living Centers (ALC). The article discuss the ARSD, licensure requirements and staffing requirements to provide hospice services in ALCs. See pages 5-7 of the article.
Visit our hospice webpage for more news and resources.