On August 1, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1692-F) that updates fiscal year (FY) 2019 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries. In addition, this final rule updates the hospice quality reporting requirements.

Summary

This final rule updates the hospice wage index, payment rates, and cap amount for FY 2019. This rule also finalizes changes to the Hospice Quality Reporting Program (Hospice QRP).

Burden Reduction

This rule enables more efficient use of Hospice Compare data in the Hospice Quality Reporting Program by no longer directly displaying the 7 component measures from which a composite measure is calculated on Hospice Compare. CMS would still provide the public the ability to view these component measures in a manner that avoids confusion on Hospice Compare. CMS plans to achieve this by reformatting the display of the component measures so that they are only viewable in an expandable/collapsible format under the composite measure itself, thus allowing users the opportunity to view the component measure scores that were used to calculate the main composite measure score.

Improving Transparency for Patients

In addition to the updates to the public reporting of measures on Hospice Compare, this final rule also provides several updates to the quality reporting program for hospices. Specifically, the final rule finalizes several procedural policies, including a review and correction timeframes for data submitted using the Hospice Item Set (HIS), an extension of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey participation requirements as well as several public reporting policies and procedures. Also finalized are specific updates and improvements to Hospice Compare including the public display of the HIS-based Hospice Comprehensive Assessment Measure (NQF #3235) and Hospice Visits when Death is Imminent Measure Pair, reformatting of the public display of the current seven HIS quality measures, and inclusion of data as shown from the CMS Public Use Files (PUFs) to help consumers make an informed decision in their selection of a hospice.

Meaningful Measures

The “Meaningful Measures” initiative is intended to provide a framework for quality measurement and improvement work at CMS. While this framework serves to focus on those core issues that are most vital to providing high-quality care and improving patient outcomes, it also takes into account opportunities to reduce paperwork and reporting burden on providers associated with quality measurement.

In this rule, we are finalizing a measure removal factor that takes into consideration whether the costs and burden associated with a measure outweighs the benefit of its continued use in the program. Our goal is to move the program forward in the least costly and burdensome manner possible, while maintaining meaningful quality measures and continuing to incentivize improvement in the quality of care provided to patients.

Routine Annual Rate Setting Changes

As finalized, hospices will see a 1.8 percent ($340 million) increase in their payments for FY 2019. The 1.8 percent hospice payment update percentage for FY 2019 is based on a 2.9 percent inpatient hospital market basket update, reduced by a 0.8 percentage point multifactor productivity adjustment and reduced by a 0.3 percentage point adjustment required by law. Hospices that fail to meet quality reporting requirements receive a 2.0 percentage point reduction to their payments.

The hospice payment system includes a statutory aggregate cap. The aggregate cap limits the overall payments made to a hospice annually. The cap amount for FY 2019 will be $29,205.44 (2018 cap amount of $28,689.04 increased by 1.8 percent).

Hospice Regulations Text Changes Due to the Bipartisan Budget Act of 2018

Section 51006 of the Bipartisan Budget Act of 2018 amended section 1861(dd)(3)(B) of the Social Security Act such that, effective January 1, 2019, physician assistants are recognized as attending physicians for Medicare hospice beneficiaries. This statutory change expands the definition of a hospice attending physician to include physician assistants in addition to physicians and nurse practitioners. We are finalizing changes to the hospice regulations to reflect that change.

The final rule went on display at the Federal Register’s Public Inspection Desk and will be available under “Special Filings,” at https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-16539.pdf .

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