Hospice FY 2020 Proposed and Final Rule Crosswalk

Hospice FY 2020 Proposed and Final Rule Crosswalk

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Section FY 2020 Hospice Proposed Rule Starting Page

Number

FY 2020 Hospice Final Rule Starting Page

Number

Resources

Issued: April 19, 2019 N/A Issued: July 31, 2019 N/A

FY 2020 Hospice Proposed Rule Link (CMS-1714-P) N/A FY 2020 Hospice Final Rule Link (CMS-1714-F) N/A

FY 2020 Hospice Proposed Rule Fact Sheet Link N/A FY 2020 Hospice Final Rule Fact Sheet Link N/A

Hospice FY 2020 Proposed Provider-Level Impacts and Wage Index Files N/A Hospice FY 2020 Final Provider-Level Impacts and Wage Index Files N/A

Hospice FY 2020 Proposed Rule Submitted Comments N/A CMS Hospice Center Webpage N/A

CR11411: Hospice FY 2020 Final Rate Update Transmittal N/A

Rates

Section III.B.4: Proposed FY 2020 Hospice Update Percentage:

• Estimated increase of $540 million in payments in FY 2020

• Resulting from the hospice payment update percentage of 2.7 percent (3.2% market basket increase offset by 0.5% productivity reduction)

17587

Section III.B.3: Final FY 2020 Hospice Update Percentage:

• Estimated increase of $520 million in payments in FY 2020 • Resulting from the hospice payment update percentage of 2.6 percent

(3.0% market basket increase offset by 0.4% productivity reduction) 38501

Section III.A: Rebase and increase to continuous home care (CHC), Inpatient respite care (IRC) and general inpatient (GIP) levels of care to account for provider costs exceeding provider payments.

17574

Section III.A: Finalized as proposed with modified rebased FY 2019 and final FY 2020 rates.

38487

Section III.A: Reduction of routine home care (RHC) by -2.71% to maintain overall budget neutrality. 17583

Section III.A: Reduction of routine home care (RHC) by -2.72% to maintain overall budget neutrality. 38492

Section III.B.4, Tables 12 and 13: Proposed FY 2020 RHC, CC, IRC, GIP Rates for agencies that have met HQRP requirements without the one-year lag in wage index.

17588

Section III.B.4, Tables 10 and 11: Final FY 2020 RHC, IRC, GIP Rates for agencies that met HQRP requirements without the one-year lag in wage index. 38503

Hospice FY 2020 Proposed and Final Rule Crosswalk

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Level of Care

FY 2019 Per Diem Payment

Rate

Proposed FY 2019 Budget-

Neutral Payment

Rates

SIA Budget Neutrality

Adjustment Factor

Wage Index Standardization

Factor

Proposed FY 2020 Payment Update

Proposed FY 2020 Payment

Rates

RHC 1-60 $196.25 $190.93 X 0.9924 X 1.0054 X 1.027 $195.65

RHC 61+ $154.21 $150.03 X 0.9982 X 1.0054 X 1.027 $154.63

CHC

$997.38 (per diem)$41.56 (hourly)

$1,363.26$56.80 N/A X 1.0041 X 1.027 $1,405.81

$58.57

GIP $758.07 $994.45 N/A X 1.0060 X 1.027 $1,027.43

IRC*Includes 5% co-insurance reduction

$176.01 $435.82* N/A X 1.0049 X 1.027 $449.78

Level of Care

FY 2019 Per Diem Payment

Rate

FY 2019 Rebased Payment

Rates

SIA Budget Neutrality

Adjustment Factor

Wage Index Standardization

Factor

Final FY 2020

Payment Update

Final FY 2020

Payment Rates

Difference between FY 2019 and FY

2020 Rates

RHC 1-60 $196.25 $190.93 X 0.9924 X 1.0006 X 1.026 $194.50 -$1.75

RHC 61+ $154.21 $150.03 X 0.9982 X 1.0005 X 1.026 $153.72 -$0.49

CHC

$997.38 (per diem)$41.56 (hourly)

$1,363.26$56.80 N/A X .9978 X 1.026 $1,395.63

$58.15+$398.25+$16.59

GIP $758.07 $992.99 N/A X 1.0024 X 1.026 $1,021.25 +$263.18

IRC*Includes 5% co-insurance reduction

$176.01 $437.86* N/A X 1.0019 X 1.026 $450.10 +$274.09

FY 2020 Hospice FINAL RuleFY 2020 Hospice PROPOSED Rule

Section FY 2020 Hospice Proposed Rule Starting Page

Number

FY 2020 Hospice Final Rule Starting Page

Number

Wage Index

Sections III.B.1 and III.B.2: Proposal for elimination of one-year lag. 17584 Sections III.B.1 and III.B.2: Finalized as proposed with the elimination

of one-year lag. 38496

Hospice FY 2020 Proposed Provider-Level Impacts and Wage Index Files N/A Hospice FY 2020 Final Provider-Level Impacts and Wage Index Files N/A

Labor Portion: Same as prior year • RHC/CHC: 68.71%• GIP: 64.01%• IRC: 54.13%

17587

Labor Portion: Same as prior year • RHC/CHC: 68.71% • GIP: 64.01%• IRC: 54.13%

38502

Hospice Cap

Section III.B.6: Proposed FY 2020 Hospice Cap: $29.993.99 17589 Section III.B.5: Final FY 2020 Hospice Cap: $29,964.78 38505

Hospice FY 2020 Proposed and Final Rule Crosswalk

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Section FY 2020 Hospice Proposed Rule Starting Page

Number

FY 2020 Hospice Final Rule Starting Page

Number

RFI

Section III.D: Request for Information Regarding the Role of Hospice and Coordination of Care at End-of-Life CMS sought information on:

• The interaction of the hospice benefit and various alternative care delivery models (including MA, ACOs and other models designed to change the incentives of providing care under the current fee for service model).

• The impact of the alternative delivery and payment models on the provision of hospice care.

• Any lessons learned that CMS should consider for the future design of the Medicare hospice benefit.

17598

Section III.D: CMS expressed appreciation for the input and suggestions provided by commenters in response to this request for information (RFI) but stated they generally do not summarize or respond to comments in the final rule for requests for information as the purpose of such requests is to help CMS for future rulemaking or the development of models through CMS’ Innovation Center. However, as CMS continues to review the comments received, they believe that the information gathered under this RFI will help inform: (1) Future CMS payment models; (2) the role of hospice with respect to ACOs; and (3) their general understanding of the traditional FFS hospice environment in relation to the increasing penetration of managed care through the MA program.

38521

Hospice Election

Statement Content Changes

Section III.C: Proposed changes to the content of the Hospice Election Statement effective FY 2020 (10/1/19):

• Information about the holistic comprehensive nature of the hospice benefit.

• A statement that, although it would be rare, there could be some necessary items, drugs, or services that will not be covered by the hospice because the hospice has determined that these items, drugs or services are to treat conditions that are unrelated to the terminal illness.

• Information about beneficiary cost-sharing for hospice services

• Notification of the beneficiary’s (or representative’s) right to request an election statement addendum that includes a written list and the rationale for the conditions, items, drugs or services that the hospice has determined are unrelated to the terminal illness and related conditions and that immediate advocacy is available through the BFCC-QIO if the beneficiary (or representative) disagrees with the hospice’s determination.

17589Section III.C: Proposed changes to the content of the Hospice Election Statement were finalized as proposed but with an updated effective implementation date of FY 2021 (10/1/20).

38505

Hospice FY 2020 Proposed and Final Rule Crosswalk

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Section FY 2020 Hospice Proposed Rule Starting Page

Number

FY 2020 Hospice Final Rule Starting Page

Number

Hospice Election

Statement New

Addendum

Section III.C: Proposal to add a new Hospice Election Addendum effective FY 2020 (10/1/19):

• The addendum would contain a list along with the rationale for the conditions, items, services and drugs that the hospice has determined to be unrelated to the terminal illness and related conditions.

• The addendum would be provided upon request of the beneficiary or representative; other non-hospice providers that are treating such conditions; and/or Medicare Contractors.

• This would be a new Condition of Payment for Medicare Hospice services that if it were requested during medical review, the signed addendum must exist in the beneficiary hospice medical record

• If requested at time of hospice election, the addendum must be provided to the individual (or representative) within 48 hours of the request (unless patient dies).

• If requested during the course of hospice care, the information is to be provided immediately and in writing

• If there are changes to the PoC that result in new and/or changed items to the addendum that occur after election, hospices would be required to issue an updated addendum for signature to the patient (or representative).

• The addendum would be titled Patient Notification of Hospice Non-Covered Items, Services, and Drug’’ and the content would contain 8 items as specified on pages 17594 and 17595 of the proposed rule.

17589

Section III.C: Proposal to add a new Election statement Addendum was finalized as proposed with the following modifications:

• Effective date: With elections FY 2021 (10/1/20) and later. • If the addendum is requested at time of hospice election, information

must be provided to the individual (or representative) within 5 days after the start of hospice care instead of the 48 hours that was originally proposed.

• If requested during the course of hospice care, the information is to be provided in writing within 72 hours of the date of the request versus the original proposal to provide immediately.

38505

Hospice FY 2020 Proposed and Final Rule Crosswalk

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Section FY 2020 Hospice Proposed Rule Starting Page

Number

FY 2020 Hospice Final Rule Starting Page

Number

HQRP

Section III.E.2a: Updates to Quality Measure Development in Future Years:

• No new measures were proposed but CMS sought public comments and suggestions related to ideas for future claims-based and outcome measure concepts and quality measures in the HQRP that could also be tied to the goals of the Meaningful Measures initiative.

17599

Section III.E.2a: Updates to Quality Measure Development in Future Years:

• CMS will take comments into consideration (pages 38522-38523) as they continue to address the high priority areas of identifying gaps in care and reducing regulatory burden as they explore the development of other claims-based and outcome measures for the HQRP.

38521

HQRP

Section III.E.2b: Update on Claims Based Measure Development: • CMS has identified two ‘‘high priority’’ areas that will

be addressed by claims-based measure development: Potentially avoidable hospice care transitions and access to levels of hospice care. CMS is seeking public comment on ways to further develop these two measure concepts and different measure concepts that fall under these high priority areas.

17600

Section III.E.2b: Update on Claims Based Measure Development:

• CMS will take the submitted comments under advisement as they continue exploring options for measuring these constructs and reiterate their commitment to working with NQF and the MAP. With respect to potentially avoidable transitions, CMS is carefully considering stakeholder and MAP feedback, and are looking at multiple ways to measure this construct, including separating out the components to reduce the measure’s complexity. In their ongoing development efforts, they are examining the potential impact of these measures, including any unintended consequences.

38523

Section III.E.2c: Update on the Hospice Assessment Tool:

• CMS emphasized commitment to the development of a Hospice Assessment Tool to replace HIS and due to confusion with the current name, HEART, with HART (Hospice Abstraction Reporting Tool), CMS sought public comment on a new name for the hospice assessment tool.

17600

Section III.E.2c: Update on the Hospice Assessment Tool: • After reviewing submissions, CMS finalized to call the hospice

assessment tool the Hospice Outcomes & Patient Evaluation (HOPE).

38523

Hospice FY 2020 Proposed and Final Rule Crosswalk

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Section FY 2020 Hospice Proposed Rule Starting Page

Number

FY 2020 Hospice Final Rule Starting Page

Number

HQRP

Section III.E.3b: Update on the CMS System for Reporting Quality Measures and Standardized Patient Assessment Data and Associated Procedural Proposals:

• CMS will be migrating to a new internet Quality Improvement and Evaluation System (iQIES) as soon as FY 2020 that will enable CMS to make real-time upgrades, and CMS is designating that system as the data submission system for the Hospice QRP. Effective October 1, 2019, CMS is proposing to notify the public of any changes to the CMS designated system in the future using sub-regulatory mechanisms such as web page postings, listserv messaging, and webinars. CMS invited public comment on this proposal.

17601

Section III.E.3b: Update on the CMS System for Reporting Quality Measures and Standardized Patient Assessment Data and Associated Procedural Proposals:

• For the reasons discussed in the proposed rule, CMS will be migrating to the iQIES system as soon as FY 2020 and will provide further information regarding the migration and any future system of record changes via sub-regulatory mechanisms to make this transition as smooth as possible.

38525

Section III.E.4c and g: CAHPS® Hospice Survey Participation Requirements for the FY 2023 APU and Subsequent Years:

• As part of the Patients Over Paperwork initiative, CMS solicits comments about the CAHPS Hospice Survey questionnaire. CMS seeks comments regarding suggested changes, additions or deletions to the instrument that would improve its value to hospices for quality improvement and consumers for selecting a hospice.

17601

Section III.E.4c and g: CAHPS® Hospice Survey Participation Requirements for the FY 2023 APU and Subsequent Years:

• CMS appreciates the feedback on potential changes to the CAHPS® Hospice Survey and will take these comments into consideration as they consider changes. Any potential changes will be proposed through future rulemaking.

38525

Hospice FY 2020 Proposed and Final Rule Crosswalk

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Section FY 2020 Hospice Proposed Rule Starting Page

Number

FY 2020 Hospice Final Rule Starting Page

Number

HQRP

Section III.E.4e: Volume-Based Exemption for CAHPS® Hospice Survey Data Collection and Reporting Requirements:

• CMS proposes to continue their policy for a volume-based exemption for CAHPS® Hospice Survey Data Collection for FY 2021 and every year thereafter.

• Starting with FY 2022 CMS proposes to provide an automatic exemption to any hospice that (1) is an active agency and(2) according to CMS data sources has served less than a total of 50 unique decedents/caregivers in the reference year.

The automatic exemption is good for 1 year and will be reassessed in subsequent years. Hospices with fewer than 50 unique decedents/caregivers in the reference year would not be required to submit an exemption request form.

17601

Section III.E.4e: Volume-Based Exemption for CAHPS® Hospice Survey Data Collection and Reporting Requirements:

• CMS finalized their proposal to continue their policy for a volume-based exemption for CAHPS® Hospice Survey Data Collection for FY 2021 and every year thereafter.

• Starting with FY 2022 CMS finalized their proposal to provide an automatic exemption to any hospice that:

(1) is an active agency and (2) according to CMS data sources has served less than a total of 50

unique decedents/caregivers in the reference year. The automatic exemption is good for 1 year and will be reassessed in subsequent years. Hospices with fewer than 50 unique decedents/caregivers in the reference year would not be required to submit an exemption request form.

38526

HQRP

III.E.5.b.2: Update to Public Reporting of the ‘‘Hospice Visits When Death Is Imminent’’ Measure Pair:

• CMS reiterated in the proposed rule that the Hospice Visits when Death is Imminent Measure 1, will be publicly reported on Hospice Compare beginning in FY 2019. However, CMS proposes continued collection of data to complete additional testing and to make a determination about the public reporting of Measure 2 of the ‘‘Hospice Visits when Death is Imminent’’ measure pair. CMS expects to complete their analysis by the end of FY 2020, and determine next steps for public reporting based on meeting established standards for reliability, validity, and reportability. CMS is cognizant and respectful of the time and effort that hospices take to complete the HIS V2.00.0 items used to calculate and test Measure 2. CMS will continually evaluate the volume and robustness of the resulting data to determine when data collection is no longer required.

17603

III.E.5.b.2: Update to Public Reporting of the ‘‘Hospice Visits When Death Is Imminent’’ Measure Pair:

• The Hospice Visits When Death is Imminent measure 1 of pair will be publicly reported in the August, 2019 refresh.

• After considering the comments received in response to the proposed rule and for the reasons discussed in the final rule, CMS is finalizing their proposal to continue collection of this data to complete additional testing and to make a determination about the public reporting of Measure 2 of the ‘‘Hospice Visits when Death is Imminent measure pair. CMS expects to complete their analysis by the end of FY 2020, and determine next steps for public reporting based on meeting established standards for reliability, validity, and reportability. CMS will continue to use a variety of sub-regulatory channels and regular HQRP communication strategies, such as Open-Door Forums, Medicare Learning Network, MS.gov website announcements, listserv messaging, and other opportunities, to provide ongoing updates of testing results and their plans for modifying and reporting this measure.

38527

Hospice FY 2020 Proposed and Final Rule Crosswalk

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Section FY 2020 Hospice Proposed Rule Starting Page

Number

FY 2020 Hospice Final Rule Starting Page

Number

HQRP

III.E.5c.1: Display of Publicly Available Government Data on the Hospice Compare Website (Update):

• PUF data, along with clear text explaining the purpose and uses of this information and suggesting consumers discuss this information with their healthcare provider, will be displayed under a new ‘‘General information’’ section on Hospice Compare in summer 2019. This new section will precede the existing ‘‘Family Experience of Care’’ section on the Hospice Compare website. Tables 17 through 19 in the proposed rule show how this data will be displayed on Hospice Compare.

17604

III.E.5c.1: Display of Publicly Available Government Data on the Hospice Compare Website (Update):

• This PUF data, along with clear text explaining the purpose and uses of this information and suggesting consumers discuss this information with their healthcare provider, displayed under a new section on Hospice Compare in May 2019. This new section precedes the existing ‘‘Family Experience of Care’’ section on the Hospice Compare website. Tables 16 through 18 show how this data is displayed on Hospice Compare.

38529

III.E.5c.2: Proposal to Post Information From Government Data Sources to the Hospice Compare Website:

• CMS sought public comments on their proposal to post information from publicly available government sources to the Hospice Compare website in the future.

17606

III.E.5c.2: Proposal to Post Information from Government Data Sources to the Hospice Compare Website:

• After considering the comments received in response to the proposed rule and for the reasons discussed in the final rule, CMS finalized their proposal to post information from other publicly available U.S. government sources to publicly report in the future and as soon as FY 2020 on Hospice Compare or other CMS website.

38531

This “Hospice FY 2020 Proposed to Final Rule Crosswalk” document was developed using the published CMS Hospice FY 2020 Proposed (CMS-1714-P) and CMS Hospice FY 2020 Final (CMS-1714-F) rules. The information in this document is aimed to help your agency obtain a high level overview of the proposed rule provisions compared to the final rule provisions, and is to be used for informational purposes only, as the information provided should be individually verified by the recipient. Recipient should seek as appropriate, regulatory and legal advice on impact of the foregoing CMS rules.

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