Final Fiscal Year 2017 Payment and Policy Changes for the Medicare Hospice Benefit (CMS-1652-F)
On July 29, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2017 Medicare payment rates and wage index and the Hospice Quality Reporting Program (QRP) for hospices serving Medicare beneficiaries.
This final rule updates the hospice wage index, payment rates, and cap amount for FY 2017. In addition, this rule finalizes changes to the hospice quality reporting program, including the addition of two new quality measures. The final rule also describes a potential future enhanced data collection instrument, as well as plans to publicly display quality measures and other hospice data beginning in calendar year (CY) 2017.
Updates to Hospice Payment Rates
As finalized, hospices would see a 2.1 percent ($350 million) increase in their payments for FY 2017 (reflecting an estimated 2.7 percent inpatient hospital market basket update, reduced by a 0.3 percentage point productivity adjustment and a 0.3 percentage point adjustment required by law).
As discussed in the FY 2016 Hospice Wage Index and Payment Rate Update final rule (80 FR 47183), CMS implemented changes required by the Improving Medicare Post-Acute Care Transformation Act of 2014 (Pub. L. 113-185) (IMPACT Act). Specifically, for accounting years that end after September 30, 2016 and before October 1, 2025, the hospice cap is updated by the hospice payment update percentage rather than using the consumer price index for urban consumers (CPI–U). As required by section 1814(i)(2)(B)(ii) of the Act, the hospice cap amount for the 2017 cap year will be $28,404.99, which is equal to the 2016 cap amount ($27,820.75) updated by the FY 2017 hospice payment update percentage of 2.1 percent.
As a reminder, in the FY 2016 Hospice Wage Index and Payment Rate Update final rule (80 FR 47142), CMS finalized the alignment of the cap accounting year with the federal fiscal year beginning in 2017. Therefore, the 2017 cap year will start on October 1, 2016 and end on September 30, 2017. Table 26 in the FY 2016 Hospice Wage Index and Payment Rate Update final rule (80 FR 47185) outlines the timeframes for counting beneficiaries and payments during the 2017 transition year.
Changes to the Hospice Quality Reporting Program (QRP)
Hospice CAHPS® Experience of Care Survey
The Hospice CAHPS® Survey is a component of the Hospice QRP. This final rule provides a description of the Hospice CAHPS® Survey, including the model of survey implementation, the survey respondents, eligibility criteria for the sample, and the languages in which the survey is offered, among other details. The final rule also outlines participation requirements for the FY 2019 and FY 2020 annual payment updates (APU). For the FY 2019 APU, hospices must collect survey data on an ongoing basis from January through December of CY 2017. For the FY 2020 APU, hospices must collect survey data on an ongoing basis from January through December of CY 2018. The final rule also includes survey data submission deadlines for the FY 2018, FY 2019, and FY 2020 APU periods. Public display of the survey results will not occur until CMS has collected at least four quarters of data. CMS anticipates that public display of the data will occur during CY 2017. More information can be obtained at the survey website: www.hospicecahpssurvey.org.
New Hospice Quality Measures
This rule also finalizes new quality measures and provides an update on the Hospice QRP. In accordance with section 1814(i)(5)(A) of the Act, starting in FY 2014, hospices that fail to meet quality reporting requirements receive a 2.0 percentage point reduction to their payments.The Hospice QRP is finalizing two new quality measures for FY 2017. The first, Hospice Visits When Death is Imminent, is a measure that will assess hospice staff visits to patients and caregivers in the last three and seven days of life. The second, Hospice and Palliative Care Composite Process Measure, will assess the percentage of hospice patients who received care processes consistent with guidelines. This measure will be based on the seven that are currently being submitted under the Hospice QRP (Pain Screening, Pain Assessment, Dyspnea Screening, Dyspnea Treatment, Patients Treated with an Opioid who are given a Bowel Regimen, Treatment Preferences, and Beliefs/Values Addressed (if desired by patient).
CMS expects to begin public reporting hospice quality measures via a Compare site in CY 2017. CMS began posting hospice demographic data on a public use file at https://data.medicare.gov on June 14, 2016.
Enhanced Data Collection
CMS is considering enhancing the current Hospice Item Set (HIS) data collection instrument to be more in line with other post-acute care settings. This revised data collection instrument would be a comprehensive patient assessment instrument, rather than the current chart abstraction tool. By integrating a core standard data set into a comprehensive assessment system, hospices can use such a data set as the foundation for valid and reliable information for patient assessment, care planning, and service delivery. This will enable greater accuracy in quality reporting; decrease provider burden; help surveyors ensure hospices are meeting Conditions of Participation (CoP) and providing high quality patient care; and, in the future, enable payment determinations.
For More Information
For more information, see http://www.cms.gov/Center/Provider-Type/Hospice-Center.html.
The final rule will publish in the Federal Register on August 5, 2016, and the rule becomes effective on October 1, 2016.
The final rule is available on the Federal Register at https://www.federalregister.gov/public-inspection.