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Hospice Center

Spotlights
  • On July 18, 2014, the Centers for Medicare & Medicaid Services (CMS) issued, “Part D Payment for Drugs for Beneficiaries Enrolled in Medicare Hospice”, a memorandum to Part D sponsors and Medicare Hospices to modify the March 10, 2014 guidance to Part D sponsors to place a prior authorization for all drugs for hospice beneficiaries.  The revised guidance expects Part D sponsors to use hospice prior authorization only on the four categories of drugs that the Office of Inspector General (http://oig.hhs.gov/oas/reports/region6/61000059.pdf), in consultation with hospice providers, identified as nearly always covered under the hospice benefit.  These categories of drugs will require hospice prior authorization are analgesics, antinauseants, laxatives, and antianxiety drugs.  Hospices may use the “Hospice Information for Medicare Part D” form to provide the necessary information generally requested by Medicare Part D sponsors.
  • On May 2, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update the Medicare hospice wage index and Medicare hospice payment rates for fiscal year (FY) 2015 (CMS-1609-P).  Hospices serving Medicare beneficiaries would see an estimated 1.3 percent increase in their payments for FY 2015, or $230 million. 

    This rule also proposes changes related to hospice elections, proposes self-reporting of payment caps, and proposes updates for the hospice quality reporting program.  In addition, this rule solicits comments on, but does not propose, processes for coordination between hospices and other payers or providers, and definitions of “terminal illness” and “related conditions.” This rule also provides information on the delay in the implementation of ICD-10-CM, and further clarifies diagnosis reporting on hospice claims.  A May 2014 “Medicare Hospice Payment Reform:  Analyses to Support Payment Reform” report by Abt Associates and updated literature review will be available under the “Research and Analyses” section of this hospice center page.

  • On May 1, 2014, CMS issued CR 8727, entitled “Updates and Clarifications to the Hospice Policy Chapter of the Benefit Policy Manual,” which will be effective August 4, 2014. This CR updates the hospice policy chapter of the Internet Only Manual (IOM 100-02, chapter 9) to incorporate policy language from existing regulations, prior rules, an Office of Inspector General Memorandum Report, and two Change Requests, and to clarify existing policy. No changes were made to existing policies.
  • The Centers for Medicare & Medicaid Services recently launched an initiative to develop innovative payment systems to improve care options for beneficiaries by allowing greater beneficiary access to comfort and rehabilitative care in Medicare and Medicaid.  The Medicare Care Choices Model provides a new option for Medicare beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS who meet hospice eligibility requirements under the Medicare hospice benefit, to receive palliative care services from certain hospice providers while concurrently receiving services provided by their curative care providers.  The Medicare Care Choices Model will test improvements to certain Medicare beneficiaries’ quality of life while they are receiving both curative and palliative care.  Eligible hospice organizations interested in participating in this model must submit application materials no later than June 19, 2014. For application materials and additional information, please visit the Medicare Care Choices Model web page.
  • Hospice providers should ensure that their information on the hospice list is current and complete.  Please submit any required changes electronically to PECOS at: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/index.html .

  • CR 8358 entitled “Additional Data Reporting Requirements for Hospice Claims”  was revised on January 31, 2014 to provide clarifying information and examples in the policy section, and to make technical corrections to remove references to legacy contractors in the Business Requirements Table and Funding sections, and to make technical corrections to the manual text. All other information remains the same.  

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