2017 Hospice Rule is Now Final

2017 Hospice Rule is Now Final

It's final!

On Friday, CMS released the FY 2017 Hospice Final Rule.

Download your PDF version at https://www.federalregister.gov/public-inspection

Two New Hospice Process Measures

This final rule implements two new measures.

The first measure is the Hospice and Palliative Care Composite Process MeasureComprehensive Assessment at Admission. This measure captures seven individual care processes gathered from current hospice item set (HIS) items currently used to calculate the seven component measures, requiring no new data collection beginning April 1, 2017 to calculate this measure using existing data items. The data from patient admissions on and after April 1, 2017 will be included in the composite measure calculation.

Table 18. Summary of Burden Hours and Costs

Regulation Section(s)

OMB Control No.

Number of Respondents

Number Of Responses

Burden per Response (hours)

Total Annual Burden (hours)

Hourly Labor Cost of Reporting ($)

Total Cost ($)

Hospice Item Set Admission Assessment

0938- 1153

4,259

1,248,419 per year

0.233 clinician hours; 0.083 clerical hours

395,333 hours

Clinician at $67.10 per hour; Clerical staff at $32.24 per hour

$22,900,166

Hospice Item Set Discharge Assessment

0938- 1153

4,259

1,248,419 per year

0.150 clinician hours; 0.083 clerical hours

291,298 hours

Clinician at $67.10 per hour; Clerical staff at $32.24 per hour

$15,919,423

3-year total

0938- 1153

4,259

7,490,514

0.55 hours

2,059,891 hours

Clinician at $67.10 per hour; Clerical staff at $32.24 per hour

$116,458,766

Hospice payment rates implemented as proposed

Hospices that receive their CCN after January 1, 2017 for the FY 2019 APU and
January 1, 2018 for the FY 2020 APU are exempted from the Hospice CAHPS® requirements due to newness.

As proposed, CMS finalized its proposal to use the pre-floor, pre-reclassified hospital inpatient wage index as the wage adjustment to the labor portion of the hospice rates. For FY 2017, the updated wage data are for hospital cost reporting periods beginning on or after October 1, 2011 and before October 1, 2012 (FY 2012 cost report data).

After considering public comments on the proposed rule, CMS codified its policy that once a quality measure is adopted, it be retained for use in the subsequent fiscal year payment determinations until otherwise stated, as proposed.

Medicare Choices Model

The Medicare Care Choices Model (MCCM) tests a new option for Medicare and dual- eligible beneficiaries with certain advanced diseases who meet the model’s other eligibility criteria to receive hospice-like support services from MCCM participating hospices while receiving care from other Medicare providers for their terminal illness. This model is designed to:

(1) increase access to supportive care services provided by hospice;

(2) improve quality of life and patient/family/caregiver satisfaction; and

(3) inform new payment systems for the Medicare and Medicaid programs.

 Hospice Cap 2016

As proposed, for accounting years that end after September 30, 2016 and before October 1, 2025, the hospice cap is updated by the hospice payment update percentage rather than using the consumer price index for urban consumers (CPIU). The 2016 cap amount is $27,820.75.

 Hospice Claims Data Updates

Top Twenty Principal Hospice Diagnoses for FY 2015

1

331.0 Alzheimer's disease

196,705

13%

2

428.0 Congestive heart failure, unspecified

115,111

8%

3

162.9 Lung Cancer

88,404

6%

4

496 COPD

80,655

6%

5

331.2 Senile degeneration of brain

46,843

3%

6

332.0 Parkinson’s Disease

34,957

2%

7

429.9 Heart disease, unspecified

31,906

2%

8

436 CVA/Stroke

29,172

2%

9

437.0 Cerebral atherosclerosis

26,887

2%

10

174.9 Breast Cancer

23,969

2%

11

153.9 Colon Cancer

23,844

2%

12

185 Prostate Cancer

23,293

2%

13

157.9 Pancreatic Cancer

23,127

2%

14

585.6 End stage renal disease

22,990

2%

15

491.21 Obstructive chronic bronchitis with (acute) exacerbation

21,493

1%

16

518.81 Acute respiratory failure

20,214

1%

17

429.2 Cardiovascular disease, unspecified

16,937

1%

18

434.91 Cerebral artery occlusion, unspecified with cerebral infarction

15,841

1%

19

414.00 Coronary atherosclerosis of unspecified type of vessel

15,689

1%

20

188.9 Bladder Cancer

11,648

1%

Note(s): The frequencies shown represent beneficiaries that had a least one claim with the specific ICD-9-CM code reported as the principal diagnosis. Beneficiaries could be represented multiple times in the results if they have multiple claims during that time period with different principal diagnoses.

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