Medicare Hospice Payments to Rise in 2020 for Some Services

The U.S. Centers for Medicare & Medicaid Services (CMS) intends to raise hospice payment rates for certain levels of care by 2.7 percent for Fiscal Year 2020, according to a proposed rule that outlines the agency’s regulatory priorities for hospice in the coming year.

The increases apply to continuous home care, inpatient care, and inpatient respite care. Under the Affordable Care Act, such increases must be budget neutral. To facilitate these increases, CMS also proposed a 2.7 percent cut for routine home care.

The change represents a $540 million raise in hospice payments for FY 2020. CMS based the update on a market basket increase of 3.2 percent, less a 0.5 percent multifactor productivity adjustment.

The agency is also requesting public comments on applying alternative payment and care delivery models to the hospice benefit, including Medicare Advantage (MA), Accountable Care Organizations (ACOs), other future models designed to change the incentives in providing care under traditional fee-for-service Medicare, as well as “lessons learned any lessons learned that CMS should consider for future enhancements of the Medicare hospice benefit.”

If the proposed rule becomes final, CMS would also raise the annual payment cap for hospice by 2.7 percent to $22,993.99. However, hospices that do not comply with quality reporting requirements receive a 2 percentage point reduction to the annual market basket update for the year.

The agency will continue collecting data on the current 10 Hospice Quality Reporting System measures and did not introduce any new measures for FY 2020.

The agency will collect but not publicly report data on the measure “Hospice Visits over the Last 7 Days,” which indicates whether patients received at least one visit from a medical social worker, chaplain or spiritual counselor, licensed practical nurse, or aide during their final seven days of life. The measure requires more testing, according to the agency.

“Quality measures must meet readiness standards for public reporting before CMS adds them to Hospice Compare,” a CMS spokesperson told Hospice News. “Testing to date indicates the seven-day measure does not meet the readiness standards for public reporting at this time. While we conduct additional testing to determine what changes may be needed, the decision not to publicly display it at this time will have no impact on the public reporting of other hospice measures.”

To date, CMS has not submitted the measure for consideration by the National Quality Forum, raising questions among some stakeholders.

“Our concerns are heightened by the fact that the measure hasn’t been submitted to or considered by the National Quality Forum [NQF] since hospices began collecting and submitting the data to CMS in April 2017,” a spokesperson for the National Association of Home Care & Hospice said.

In response, a CMS spokesperson said that while the agency has not yet sought NQF endorsement for the measure, the agency is working to ensure it demonstrates scientific acceptability, including reliability and validity, and meets the goals of the Hospice Quality Reporting Program.

“While it will not be publicly reported at this time, we believe this seven-day measure focuses on an important aspect of quality care for imminently dying patients, and we will continue the appropriate testing to inform next steps,” the spokesperson said.

CMS also proposes a change to an exemption from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey participation requirements.

Hospices that received their CMS Certification Number after January 1, 2017 for the FY 2019 Annual Payment Update (APU) and January 1, 2018 for the FY 2020 update will be exempted from CAHPS requirements for one year.