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CMS Hospice FY2022 – Payment Rules and Other Changes

Jena Weitzer

April 14, 2021

Released on April 8th, the Centers for Medicare & Medicaid Services (CMS) issued a hospice proposed rule that could provide routine updates to hospice base payments and the aggregate cap amount for FY2022.

The proposed rule will rebase and revise the labor shares for all four levels of care using 2018 Medicare cost report data for freestanding hospice facilities. It also proposes several clarifying regulation text changes to certain aspects of the hospice election statement addendum. These requirements were finalized for hospice elections beginning on or after October 1, 2020.

Routine Annual Rate Setting Changes:

For the second year in a row, CMS has proposed an increase to payments at a percentage lower than the prior year. CMS is proposing a 2.3% ($530 million) net increase to payments, compared to FY2021. While the increase in payments is beneficial to agencies, it’s not as high as the 2.6% for the FY2021 proposed rule. This will include a 2.5% inpatient hospital market basket update and a 0.2% cut for hospices that fail to meet quality reporting requirements.

The proposed cap amount for FY2022 is $31,389.66, up 2.3% from FY2021 ($30,683.93).

Key provisions of the proposal:

  • Hospice Labor Shares proposed as 74.6% for continuous home care, 64.7% for routine home care, 60.1% for inpatient respite care, and 62.8% for general inpatient care.
  • Hospice Conditions of Participation is proposing a change to the hospice CoPs regarding hospice aide competency evaluation standards. Considering changes made under the COVID-19 PHE, CMS is proposing the PHE waiver is made permanent.
  • CMS is proposing a new measure in the HQRP called Hospice Care Index. This index would be a single measure that includes 10 indicators of quality, calculated from claims data, to be reported no earlier than May 2022. This proposal will help hospice agencies aim for a comprehensive characterization on the quality of care they provide to patients.
  • In keeping with the alignment of Home Health and Hospice, CMS is proposing using three quarters and not four quarters of data for the January 2022 refresh affecting OASIS-based measures.
  • CMS is looking for feedback and requesting additional information on advancing to digital quality measurement and the use of FHIR, along with ways to attain health equity for all patients that will apply to the HQRP and other quality reporting programs. These are two areas they are looking at to further improve benefiting the hospice agencies greatly.

While it’s still early to see what CMS will bring to their FY2022 Final Rule, public comments and feedback on the proposal will be accepted by CMS until June 7, 2021. Click here to comment.

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