The U.S. Centers for Medicare & Medicaid Services (CMS) has issued its 2025 proposed rule for hospice payment, which if finalized would include a 2.6% increase in the per diem base rate.
The proposal is a likely signal that CMS will not adopt a recent recommendation by the Medicare Payment Advisory Commission (MedPAC) to freeze rates beginning next year. The proposed hospice cap amount for Fiscal Year 2025 is $34,364.85, up from $33,494.01 this year.
In addition to setting reimbursement rates, the rule indicated that CMS in 2025 will implement a new model for how it uses the wage index to inform payment rates for the coming years.
Initially mandated through the agency’s 2023 final hospice rule, the agency is changing the data sources it uses to adjust hospice payment amounts to account for differences in wage rates among markets. The implementation strategy is designed to minimize disruption as well as the monetary impact on providers by placing a 5% limit on the dollar amounts hospices could lose due to the adjustments.
“This proposed rule proposes to adopt the most recent OMB statistical area delineations, which revises the existing core-based statistical areas based on data collected during the 2020 Decennial Census,” CMS indicated in a fact sheet. “Hospices affected by the change to their geographic wage index will be eligible for applying a 5% cap on any decrease to the wage index from the prior year. This permanent cap, finalized in the FY 2023 Hospice Final Rule, would prevent a geographic area’s wage index from falling below 95% of its wage index calculated in the prior [fiscal year].”
The proposal also puts forth two new potential process measures for the Hospice Quality Reporting Program — Timely Reassessment of Pain Impact and Timely Reassessment of Non-Pain Symptom Impact. If finalized, these measures would be implemented for Fiscal Year 2028.
These process measures would reflect whether a follow-up visit occurred within 48 hours of an initial assessment where there was an impact of moderate or severe symptoms with and without pain, according to CMS.
Beginning in 2025, CMS expects to adopt the Hospice Outcomes & Patient Evaluation (HOPE) tool, which has been in development for several years. Upon implementation, this tool will replace the Hospice Item Set.
“HOPE will collect data at multiple time points across the hospice stay, including admission, the HOPE Update Visit (HUV), and discharge,” the agency indicated. “Compared to the HIS (which only collected data at hospice admission and discharge), HOPE will enable CMS to gather patient level data during their hospice stay to support quality measures.”
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