CMS has published a proposed rule to establish fiscal year (FY) 2018 Medicare hospice reimbursement rates, update hospice quality programs, and request public input on ways to improve the Medicare hospice program.

The proposed rule would increase FY 2018 hospice rates by 1% (approximately $180 million), as mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); CMS estimates that in the absence of MACRA, the market basket update would have been 2.2%. Note that the annual update is reduced by 2 percentage points for hospices that fail to report required quality data. CMS also proposes updating the FY 2018 hospice cap to $28,689.04, an increase of 1%.

CMS proposes various updates to the Hospice CAHPS® Experience of Care Survey measures, and discusses the potential use of a new “Hospice Evaluation & Assessment Reporting Tool” (HEART) patient assessment instrument. Furthermore, CMS requests comments on potential future hospice quality measure “concepts” addressing potentially avoidable hospice care transitions and access to levels of hospice care. The proposed rule also discusses details of CMS’s plans to begin public reporting of hospice quality measures on a Hospice Compare Site.

In addition, CMS solicits comments regarding possible future rulemaking to specify that:

  1. the referring physician’s and/or the acute/post-acute care facility’s medical record would serve as the basis for initial hospice eligibility determinations; and
  2. documentation of an in-person visit from the hospice Medical Director or the hospice physician member of the interdisciplinary group could be used as documentation to support initial hospice eligibility determinations, if needed to augment the clinical information from the referring physician/facility’s medical records.

As with other proposed Medicare payment rules issued by the Trump Administration, CMS requests information on ways the agency could “increase quality of care, lower costs, improve program integrity, and make the health care system more effective, simple and accessible.” CMS will not respond to comments in the final rule, but it intends to “actively consider all input as we develop future regulatory proposals or future subregulatory policy guidance.”

The proposed rule was published on May 3, 2017. Comments on the proposal will be accepted until June 26, 2017.