CMS 2017 Final Rule for Hospice Published
Hospice Final Rule for 2017 Issued
The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1652-F) that will update the Medicare hospice payment rates, hospice wage index, and cap amount for fiscal year (FY) 2017. As finalized, hospices will see an estimated 2.1 percent ($350 million) increase in Medicare payments for FY 2017. In addition, this rule finalizes changes to the hospice quality reporting program, including 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 the middle of 2017, and includes information regarding the Medicare Care Choices Model (MCCM).
Highlights of the 2017 Hospice Final Rule
FY2017 Hospice Wage Index and Rate Update
The final wage index values applicable for FY2017 were publicly posted online at the following site: CMS Hospice.
Hospice base payments will increase by about 2.1%, which is above the projected rate of .1% that was published in the proposed rule:
Note that failure to submit quality data will result in an increase of only .1%
Base payment rates from CMS for FY2017 for agencies that submit quality data
|Code||Description||FY2016 Payment Rates||Service Intensity BNF||Final Wage Index Standardization Factor
FY2017 Proposed Hospice Payment Update Percentage
|FY2017 Final Payment Rates
|651||Routine Home Care (days 1- 60)||$186.84||X 1.0000||X 0.9989||X 1.021||$190.55|
|651||Routine Home Care (days 61+)||$146.83||X 0.9999||X 0.9995||X 1.021||$149.82|
|652||Continuous Home Care
Full rate = 24 hours of care
$40.19=FY2017 hourly rate
|$944.79||N/A||X 1.0000||X 1.021||$964.63|
|655||Inpatient Respite Care||$167.45||N/A||X 1.0000||X 1.021||$170.97|
|656||General Inpatient Care||$720.11||N/A||X 0.9996||X 1.021||$734.94|
Effective for the 2017 Cap year, CMS has moved forward with a transition to the federal fiscal year. This will have an impact starting with the 2017 Cap Report.
The hospice Cap values as calculated by CMS:
2016 Cap: $27,820.75 (2016 Cap year runs from Nov. 1, 2015, through Oct. 31, 2016)
2017 Cap: $28,404.99 (2017 Cap year runs from Oct. 1, 2016, through Sept. 30, 2017)
Much of the final rule spells out new requirements around the Hospice Quality Reporting Program (HQRP). All current measures continue with the addition of the two below. Data collection to begin April 1, 2017.
Two new hospice quality reporting program (HQRP) measures:
- Hospice Visits When Death is Imminent– assessing hospice staff visits to patients and caregivers in the last week of life
Percent of patients receivingat least 1 visit from RN, Physician, NP or PA in last three days of life
Percent of patients receiving at least 2 visits from MSW, chaplains/spiritual counselor, LPN or hospice aides in the last 7 days of life
- Hospice and Palliative Care Composite Process Measure– assessing the percentage of hospice patients who received care processes consistent with existing guidelines
Use current HQRP quality measures as components in this composite measure:Pain Screening, Pain Assessment, Dyspnea Treatment, Patients Treated with an Opioid who are givena bowel Regimen, and Treatment Preferences & Beliefs/Values Addressed if desired by patient
Percent of patients for whom HIS Admission records contain data on all seven current HQRP measuresAssessed for each patient then aggregated into one score for the whole hospice
Hospices must collect CAHPS Hospice Survey data on an ongoing monthly basis from January 2017 through December 2017 . The data must be submitted by the hospice’s authorized approved CMS vendor. If the vendor does not submit the data, the hospice is held responsible.
Hospices that have fewer than 50 survey -eligible decedents/caregivers in the calendar year reporting period are exempt from CAHPS Hospice Survey data collection and reporting requirements for the applicable fiscal payment determination.
Hospices that want to claim the size exemption are required to submit to CMS their total unique patient count for the period of January 1, 2016 through December 31, 2016. The due date for submitting the exemption request form for the FY 2019 APU is August 10, 2017.
Items under consideration:
Hospice data collection mechanism (like OASIS). CMS is considering developing a new data collection mechanism for use by hospices, but is not proposing a hospice patient assessment tool at this time. At this time, it is still in the early stages of development to determine if it would be feasible to implement under the Medicare Hospice Benefit.
Hospice Compare Site and public reporting: CMS confirmed that public reporting will begin in calendar year 2017.
Be sure to work with your Hospice software vendor for more information and to ensure you’re using the tools available to remain compliant with the Final Rule.
More details for the Hospice Final Rule may be viewed HERE