Home Health & Hospice

2014 Hospice Proposed Rule Released

Homecare Insider, May 20, 2013

On April 29, CMS issued a proposed rule that would update 2014 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries.

The proposed hospice payment rule reflects the ongoing efforts of CMS to support beneficiary access to hospice. As proposed, hospices would see an estimated 1.1 percent ($180 million) increase in their payments for fiscal year 2014.

The rule proposes that CMS would update the hospice per diem rates for 2014 and subsequent years through the annual hospice rule or notice, rather than solely through a Change Request, as has been done in prior years.

 Other proposals in the rule include:

  • A phase-out of the BNAF: This proposed rule would implement the fifth year of the seven-year BNAF phase-out, reducing the BNAF by 15 percent, for a total reduction of 70 percent since FY 2010.
  • Coding clarification: The proposed rule solicits comments with the intent of clarifying appropriate diagnosis coding in hospice claims.
  • Hospice quality reporting: Under section 3004 of the Affordable Care Act, hospices that fail to meet quality reporting requirements will receive a two percentage point reduction to their market basket update beginning in 2014. Hospices began reporting quality data in 2013. For the FY 2014 payment determination, hospices reported two measures: the NQF #0209/Pain Management measure and the Structural measure on participation in a /Quality Assessment and Performance Improvement (QAPI) program. The proposed rule solicits comments on the elimination of these two currently reported quality measures beginning with the 2016 payment determination and to replace these two with other measures.
  • Patient experience of care: This proposed rule provides information about CMS’s efforts to develop a Hospice Experience of Care Survey for informal caregivers of hospice patients. The rule also proposes to require use of the survey beginning in 2015. The survey would include questions on hospice provider communications with patients and families; hospice provider care, and overall rating of hospice. CMS proposes to include participation in the survey as a quality-reporting requirement for hospices to receive their full annual payment update beginning in FY 2017.

A link to the proposed rule, which was published in the Federal Register, is available here.