CMS Releases FY 2016 Hospice Payment Rule with Significant Changes to Routine Home Care Rate
Tuesday, May 5, 2015
by: Visiting Nurse Associations of America

Section: Breaking News

On Thursday, May 1, 2015, the Centers for Medicare and Medicaid Services (CMS) issued the Fiscal Year 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements proposed rule. The rule proposes a number of changes to the way in which hospice payment rates are calculated and updated. The most significant changes are to propose two routine home care day rates to account for more costly days at the beginning of a hospice stay and a supplemental payment at the end of the stay. It also proposes changes to the Hospice Quality Reporting Program (HQRP) and would implement new coding requirements to better enable CMS to track and monitor Medicare spending outside of the hospice benefit for individuals enrolled in hospice.

The overall economic impact of this proposed rule is estimated to be $200 million. This represents a 1.3 percent payment increase to hospices in FY 2016. Payment to non-profit hospices in the aggregate is expected to increase by 2.7 percent. In comparison, payment to for-profit hospices is anticipated to increase by 0.3 percent. The difference between aggregate payments to non-profit and for-profit hospices is due to the proposed change to the routine home care rate.

VNAA President and CEO Tracey Moorhead commented in response to the rule: "VNAA has long supported the move to a hospice payment model that better aligns reimbursement to how and when resources are deployed across a patient's stay. Patients often need the greatest intensity of services at the beginning and very end of their stay. By reflecting this in the payment model, CMS can help ensure that patients get the right amount of care when they need it. VNAA continues to examine the specific elements of CMS' model but applauds the overall direction in the proposed rule."

A more detailed summary of the major provisions of the rule can be found here (link to VNAA summary). Comments to the rule are due on June 29, 2015.

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