CMS Rebases 2022 Hospices Payments, Updates CoPs

The U.S Centers for Medicare & Medicaid (CMS) has released its final rule for hospice payments in Fiscal Year 2022. Major provisions include a payment rebasing, along with updates to the hospice conditions of participation (CoPs) and new quality measures.

Hospices will see a 2.0% jump in their payments for FY 2022 relative to FY 2021, a result of the 2.7% market basket increase (reduced by a 0.7% point productivity adjustment). The agency also raised the hospice payment cap to $31,297.61, up from the FY 2021 amount of $30,683.93.

The final rule did not make permanent the temporary measure introduced during the COVID-19 pandemic to allow hospices to recertify patients via telehealth rather than a face-to-face encounter.


“At this point, we are still assessing the impact of all waivers and flexibilities on beneficiaries and the delivery of health care services under the [public health emergency],” CMS indicated. “While the impact of some waiver and flexibilities may be more apparent at this time, such as the waivers related to hospice aide supervision, flexibilities associated with other aspects of care are more complex requiring additional time for a complete understanding of their impact.”

CMS did make permanent a waiver related to hospice aide competency evaluations standards. CMS is allowing hospices to use “pseudo patients,” meaning an individual who stands in the role of a patient or a computerized mannequin device, during competency tests for hospice aides, rather than requiring contact with actual patients as typically required under the CoPs.

The final rule rebases labor shares of payments for the four levels of hospice care. The proposed labor share for continuous home care is 74.6%, for routine home care is 64.7%, for inpatient respite care is 60.1%, and for general inpatient care is 62.8%.


Hospice payment rates have a labor share and non-labor share component. Historically, the agency has based the labor share component on costs related to home health and skilled nursing facilities. The revisions will base the labor share portions of all levels of care based on Medicare cost report data for freestanding hospices.

The rule also implements a new measure in the Hospice Quality Reporting Program called the Hospice Care Index. The measure includes 10 quality indicators calculated using claims data, which represent different aspects of hospice care.

According to the final rule, hospice star ratings will be integrated into Care Compare. CMS unveiled its online Care Compare tool last September. It rolled the agency’s eight quality reporting sites into a single resource. Patients, families, referral sources and payers are increasingly paying attention to these data when selecting a hospice provider to work with.

Hospices who fail to comply with quality reporting requirements will incur a 2% point reduction to their annual payment update percentage increase for that year.

Reporter Holly Vossel contributed to this report.