Press release



The Centers for Medicare & Medicaid Services (CMS) announced today it will propose a new rule that would improve the quality of care provided to more than 700,000 Medicare beneficiaries receiving hospice care each year.


The proposed conditions of participation (CoP) for hospices would ease the regulatory burden for hospice providers and improve the quality of care for all hospice patients, including the expanding population of Medicare patients choosing this benefit.


“Terminally ill patients choosing the hospice option are a high priority in our quality improvement efforts,” said CMS Administrator Mark B. McClellan, M.D., Ph.D.  “This proposal will move us closer to our overall goal of high quality for all Medicare beneficiaries”


Hospice care is a combination of health care services, ranging from nursing to medications, which give care and comfort to individuals who are terminally ill.


Under the proposed rule, the hospice conditions of participation would provide more attention to meeting the specific needs of individual patients. Changes and additions to the current rule, originally published in 1983, would include:


  • Adding a patient assessment requirement to ensure that all patient needs are identified on a timely basis;
  • Replacing the quality assurance requirement with a more comprehensive quality assessment and performance improvement (QAPI) CoP that enables hospices to take tailored proactive steps to ensure quality care;
  • Allowing hospices to contract for core services in certain situations;
  • Removing the requirement that a registered nurse provide patient care in an inpatient facility on a 24-hour basis, as recommended by the Secretary’s Advisory Committee on Regulatory Reform. CMS is proposing to remove this prescriptive, process-oriented requirement, contained in the current hospice conditions of participation, and replace it with an alternative outcome-oriented requirement that focuses on the results of care provided to patients and their families; and
  • Adding guidance for hospices that care for residents of nursing facilities.


    Under Medicare law, the Secretary of HHS establishes minimum health and safety quality standards that must be met by providers and suppliers participating in the Medicare and Medicaid programs. The hospice CoPs ensure that this particularly vulnerable patient population receives high quality care during the dying process.


    CMS believes that high quality care has helped to increase the number of service days per patient, indicating that patients are benefiting from hospice services earlier in the disease process and for a longer period of time. This increase is a positive development for patients and providers alike, and one that would be reinforced by the new CoPs.


    The rule proposed today would adopt contemporary standards of practice in the hospice community, and would incorporate recommendations made by the Secretary’s Advisory Committee on Regulatory Reform, the Office of the Inspector General, the Office of Disability, Aging and Long-Term Care Policy, and Operation Restore Trust, as well as those from the public.


    The proposed rule will go on display at the Office of the Federal Register on May 26, 2005 and will be published in the May 27, 2005 Federal Register. Public comments will be accepted until July 27, 2005.