CMS Releases Final Rule on FY 2014 Hospice Payment
Tuesday, August 6, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy

On Aug. 2, the Centers for Medicare and Medicaid Services (CMS) released the final rule for FY 2014 hospice payment.  Hospices will see a payment update of 1.7 percent and CMS provides an overview of hospice payment reform progress. The final rule also discusses a number of issues related to coding and quality measures.   

CMS created a fact sheet that discusses the final rule, please click here to access.

Until Aug. 7, the final rule may be found here. On Aug. 7, the final rule will be posted in the Federal Register.
Here are highlights from the Final Hospice Rule:
Payment Reform
CMS is required to reform hospice payments no earlier than October 2013 and is authorized to collect additional data that may be used to revise the hospice payment system. In the final rule, CMS provided updates on Medicare hospice payment reform efforts, including 1) a discussion of reform model options; 2) highlights from recent reform research and; 3) an update on data collection efforts. To read the technical report on hospice payment reform efforts with details on reform research methods and findings, please click here.
The rule clarifies that hospice providers should use ICD-9-CM coding guidelines and refrain from using certain non-specific diagnosis or diagnoses coding that are not principal diagnoses. Specifically, hospices should code the principal diagnosis using the underlying condition that is the main focus of the patient's care. CMS will delay returning claims to providers for this coding issue until Oct. 1, 2014.

Hospice Experience of Care
The rule details CMS’ effort to develop a Hospice Experience of Care Survey which hospices will be required to use in 2015. Participation in the survey will be used as a quality-reporting requirement for hospices to receive their annual payment update beginning in FY 2017. It is anticipated that final requirements will be published in the FY 2015 rulemaking.
Hospice Information Set (HIS)  
For FY 2014, CMS will finalize the implementation of a standardized patient-level data collection instrument called the Hospice Item Set (HIS). CMS notes that the HIS is not a patient assessment and will not be administered to the patient and/or family or caregivers during the initial assessment visit.  HIS is not intended to replace a hospice’s current initial patient assessment.  Prior to implementation, CMS will provide guidance and training materials.
Quality Measures
CMS has eliminated two currently reported quality measures beginning in fiscal year 2014: the NQF #0209 Pain Management measure and the Structural measure on participation in a Quality Assessment and Performance Improvement (QAPI) program.
The seven quality measures listed below will be collected through the use and submission of the HIS proposed to begin July 2014. 
NQF #1617 Patients Treated with an Opioid who are Given a Bowel Regimen
NQF #1634 Pain Screening
NQF #1637 Pain Assessment
NQF #1638 Dyspnea Treatment
NQF #1639 Dyspnea Screening
NQF #1641 Treatment Preferences
NQF #1647 Beliefs/Values Addressed (if desired by the patient)
  • The data will be submitted electronically for all patients admitted on or after July 1, 2014 for all payers.
  • Hospices will be required to complete and submit an admission HIS and a discharge HIS for each patient.
  • Hospices failing to report quality data via the HIS in 2014 will have their market basket update reduced by 2 percentage points in FY 2016. Hospice programs will be evaluated for purposes of the quality reporting program based on whether or not they submit data, not on their performance level on required measures.
CMS acknowledged that the 7-day length of stay exclusion effectively excludes an important segment of hospice patients from the measures. The rule notes that CMS plans to analyze HIS data to continue to assess the scientific acceptability of the measures and are willing to work with measure developers and stewards to make modifications to measures where needed. Prior to implementation of the HIS, CMS will provide guidance and training materials, including a detailed user guide to hospices.

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