Healthcare professional pushing an elderly person in a wheelchair

In July 2022, CMS released the 2023 Hospice Final Rule (CMS-1773-F). Included in the final rule are the updated hospice payment rates and cap amount for FY 2023, including updates to the Hospice Quality Reporting Program (HQRP), as well as discussion on Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey Mode Experiment. Regulations from the rule were effective beginning on October 1, 2022.

Hospice Payment Rates

The FY 2023 hospice payment rate update was an increase of 3.8%, which is made up of a 4.1% market basket increase, less a 0.3% productivity adjustment, as shown in the table. The total estimated increase in Medicare hospice payments compared to the prior year is expected to be $825 million.

Hospices that do not meet quality reporting requirements will incur a 2% payment reduction from these rates for the year. The updated hospice payment rates for each geographic area are available by request. Complete the form below to receive the payment rates for your area.

Effective FY 2023 and beyond, a permanent cap on wage index decreases was finalized, whereby the decrease to geographic area wage index from the previous year is capped at 5%.
 

Type of Hospice Care FY 2023 Payment Rates
Routine (Days 1–60) $211.34
Routine (Days 61+) $167.00
Continuous $1,522.04
Inpatient Respite $492.10
General Inpatient $1,110.76

Hospice Aggregate Cap Amount

The hospice cap amount for the 2023 cap year was finalized at $32,486.92, which is an increase consistent with the payment update percentage of 3.8% from the 2022 cap amount. Comments received from the proposed rule included recommendation from MedPAC that the hospice cap be wage index adjusted and reduced by 20%; however, CMS responded in the final rule that they do not have statutory authority to reduce the cap amount nor to adjust for wage index.

Hospice Quality Reporting Program

The final rule included an update on the development of Hospice Outcomes and Patient Evaluation (HOPE), which is a patient assessment instrument that would be completed by the hospice care staff in an effort to provide quality data for the requirements of HQRP. Currently, this program is undergoing national beta field testing to gather information on reliability, validity, and feasibility of the data from using this instrument. CMS intends to introduce hospice quality measure concepts based on the future implementation of HOPE.

The FY 2023 final rule does not introduce any new quality measures but does include tables illustrating the Quality Measures finalized in the FY 2022 final rule that are in effect for FY 2023 for the HQRP.

CAHPS Hospice Survey Mode Experiment

CMS recently conducted testing for the CAHPS Hospice Survey to determine the impact on response rates and scores from adding a web-based mode. The survey currently allows for only mail and telephone-based modes without any web-based component. Results are being evaluated and any changes to the survey will be proposed at a later date.

There were no changes to the ability for hospices to apply for a volume-based exemption from the CAHPS Hospice Survey Data Collection and Reporting requirements.

Hospice agencies should review the final rule and evaluate impacts from these changes. A link to the full final rule can be found here

If you have any questions or need assistance, reach out to a professional at FORVIS or submit the Contact Us form below.

Download the Hospice Payment Rates for Your Area

 

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