CMS Releases FY 2014 Proposed Rule on Medicare Hospice Payment, Quality Measures and Coding
Tuesday, May 7, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy

On April 29, the Centers for Medicare and Medicaid Services (CMS) posted its proposed rule governing wage index and quality measures provisions for Medicare Hospice for FY 2014 beginning on October 1, 2013. The rule will be formally published in the Federal Register on May 10. Comments on the proposed rule will be due to CMS by June 28 at 5:00 p.m. ET. It is expected that the final rule will be released in early August. You can access the complete proposed rule by clicking here.

VNAA has prepared a detailed summary of key provision in the proposed rule. To review this summary, please click here.

The Hospice Roundtable will have a conference call on May 23 from 3:00-4:00 p.m. ET (12:00-1:00 p.m. PT) to further discuss the proposed rule and to review VNAA’s draft comments and provide input. If you would like to register for this call please click here. If you do not have a VNAA account, but are an employee of a member agency, contact Leah Dawson, Senior Coordinator for Member Services and Corporate Relations, at

The rule includes proposed wage index and market basket changes, impacting payment as well as the actual proposed payment amounts for hospice.

The proposed hospice rates for FY 2014 are as follows:
  • Routine – $156.21
  • Continuous – $911.68
  • IP Respite – $161.58
  • General IP – $694.88

It also tightens claims requirements for reporting primary and secondary diagnoses on claims. CMS notes that there has been an increase in inappropriate use of nonspecific symptom diagnosis and Mental, Behavioral and Neurodevelopmental Disorders codes as primary diagnoses.

In the quality arena, the proposed rule changes and expands the requirements for collecting and reporting quality measures for hospice and includes experience of care measures. CMS proposes two new quality measures on pain and specifically solicits comments on whether these should replace the existing pain measure NQF 0209 or if the current measure should be retained until a better measure is available. In addition to the proposed changes in pain measures CMS proposed using the following measures to begin building the Hospice Item Set, which would eventually be required for admission and discharge. Proposed measures include:

  • NQF 1617 (Patients Treated with Opioid who are Given a Bowel Regimen),
  • NQF 1638 (Dyspnea Treatment),
  • NQF 1639 (Dyspnea Screening),
  • NQF 1641 (Treatment Preferences), and
  • NQF 1647 (Beliefs/Values Addressed - if desired by the patient)

CMS also discussed public reporting, now scheduled for FY 2018 and the development of a Hospice Experience of Care Survey.

Finally, the rule references the progress made to date on home health payment reform. While the rule did not make any specific proposed changes, the rule does discuss different analysis and policy concerns related to payment reform.

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