Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
On March 31, 2023, CMS posted FY2024 Hospice Payment Rate Update Proposed Rule Fact Sheet.
On March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1787-P) that would update Medicare hospice payments and the aggregate cap amount for fiscal year (FY) 2024 in accordance with existing statutory and regulatory requirements. This rule includes information on hospice utilization trends and solicits comments regarding information related to the provision of higher levels of hospice care, spending patterns for non-hospice services provided during the election of the hospice benefit, ownership transparency, equipping patients and caregivers with information to inform hospice election decision-making selection, and ways to examine health equity under the hospice benefit. This rule also proposes conforming regulations text changes related to the expiration of the COVID-19 public health emergency (PHE).
This rule proposes to codify the Hospice Quality Reporting Program (HQRP) data submission threshold policy that was adopted in the FY 2016 Hospice final rule at §418.312. The rule discusses the Hospice Outcomes and Patient Evaluation (HOPE) tool; provides an update on future Quality Measures (QM) development and health equity efforts and provides updates on the Consumer Assessment of Healthcare Providers and Systems, Hospice Survey mode experiment.
This rule also proposes that physicians who order or certify hospice services for Medicare beneficiaries must be enrolled in Medicare or validly opted-out as a prerequisite for payment for the hospice period of care in question. CMS is looking closely at the hospice industry, as we have increasing concerns about fraud, waste and abuse in this space. While this rule takes initial steps, this is part of a larger effort by CMS to address hospice fraud, waste and abuse that will continue this year.
Finally, this rule discusses updates on the Consolidated Appropriation Act, 2021 (CAA 2021) hospice special focus program (SFP).
The proposed rule can be viewed at the Federal Register at https://www.federalregister.gov/public-inspection/2023-06769/medicare-program-fiscal-year-2024-hospice-wage-index-and-payment-rate-update-hospice-conditions-of.
Public comments on the proposals will be accepted until May 30, 2023.
For further information, see the hospice webpage here: https://www.cms.gov/Center/Provider-Type/Hospice-Center.
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