The Centers for Medicare & Medicaid Services (CMS) posted the Proposed Fiscal Year (FY) 2025 Hospice Payment Rate Update (CMS-1810-P) on March 28, 2024. The proposed hospice payment rate update includes an increase in the per diem rate of 2.6%. This update is derived from the proposed inpatient hospital market basket update of 3.0%, with…
The Centers for Medicare & Medicaid Services (CMS) posted the Proposed Fiscal Year (FY) 2025 Hospice Payment Rate Update (CMS-1810-P) on March 28, 2024.
The proposed hospice payment rate update includes an increase in the per diem rate of 2.6%. This update is derived from the proposed inpatient hospital market basket update of 3.0%, with a productivity adjustment estimated at 0.4 percentage points. The proposed hospice cap amount for FY 2025 is $34,364.85, up from $33,494.01 for FY 2024. These small increases indicate that CMS will not adopt the recent recommendation by the Medicare Payment Advisory Commission (MedPAC) to freeze rates for hospices beginning in FY2025; however, it’s important to note that these values are preliminary and subject to change pending the issuance of the final hospice payment rule later in the summer.
Please note that hospices that fail to comply with the Hospice Quality Reporting Program (HQRP) reporting requirements are subject to a 4% payment reduction, as enacted in the Consolidated Appropriations Act of 2024.
CMS also issued a Request for Information (RFI) regarding the payment mechanism for high-intensity palliative care services. This initiative aims to address barriers faced by beneficiary populations with complex palliative needs in accessing hospice care. CMS seeks input on various financial challenges and costs associated with providing higher-cost palliative treatments, including obtaining necessary equipment, drugs, or specialized staff. Additionally, CMS is exploring the possibility of defining palliative services specifically for high-cost treatments and considering parameters for when such treatments should qualify for different types of payments.
CMS is also proposing changes to the geographic classification system, implementing new delineations for metropolitan statistical areas (MSAs) and micropolitan statistical areas. Transition plans are proposed to mitigate potential negative impacts of these changes, including the application of the 5% cap on wage index decreases at the county level in addition to the CBSA level.
Moreover, CMS seeks to clarify current policy related to hospice election procedures (the “election statement” and the “notice of election”, as well as to add clarifying language regarding hospice certification by the Medical Director and/or Physician designee.
Finally, CMS is proposing new quality measures for the HQRP, including timely reassessment of pain impact and non-pain symptom impact. If finalized, these measures would be implemented for FY 2028. As expected, CMS also proposes to implement the Hospice Outcomes & Patient Evaluation tool (HOPE) assessment instrument for standardized patient-level data collection, aiming to support future quality measures and improve patient care planning. The HOPE tool would replace the current Hospice Item Set (HIS) data reporting. Additionally, changes are proposed for the CAHPS Hospice Survey, including the addition of a web-mail mode for survey administration and modifications to survey items based on stakeholder feedback and testing results.
Read the full details of the proposed rule here: 2024-06921.pdf (federalregister.gov) Instructions for submitting comments are included at the beginning of the rule and will be accepted until May 28, 2024.
