CMS issued the anticipated fiscal year 2024 proposed rule in the April 4, 2023 Federal Register. As expected, the 36-page rule included hospice wage index and payment rate updates that are proposed to increase 2.8% overall. This is generally good news for the industry, although the increase would not be enough to offset some of the wages and business expenses experienced by many providers in the current economic landscape.
Also of note in the rule is the increase from a 2% to a 4% penalty for organizations that do not meet the submission requirements for Hospice Quality Reporting Program data. The biggest reason cited for organizations not meeting the requirements is Hospice Item Set (HIS) late submissions, which can lead to organizations falling below the 90% threshold for admission and discharge records to be submitted within 30 days of the triggering event. These submissions are handled by internal agency operations and must be closely monitored. It will be critical for organizations to have solid processes and monitoring to confirm that HIS submission requirements are met as required and that they are participating in required Consumer Assessment of Healthcare Providers and Systems monthly surveys through a CMS-approved, third-party vendor to prevent the 4% penalty.
CMS also is proposing to require physicians who order or certify hospice services for Medicare beneficiaries to be enrolled in or validly opted out of Medicare as a prerequisite for the payment of hospice services. While this would be a new requirement for hospices, this same requirement exists in other programs where Medicare services are ordered.
CMS hints at closer scrutiny of the hospice benefit through future program integrity actions, stating in the proposed rule’s accompanying fact sheet that: “CMS is looking closely at the hospice industry, as we have increasing concerns about fraud, waste and abuse in this space. While this rule takes initial steps, this is part of a larger effort by CMS to address hospice fraud, waste and abuse that will continue this year.”
With this publicly announced scrutiny, it’s exceptionally noteworthy that the proposed rule is data rich and covers topics such as hospice utilization and spending patterns related to diagnosis, levels of care, lengths of stay, live discharges, and non-hospice spending during election for Medicare Part D drugs and other services like end-stage renal disease and higher-level palliative treatments like chemotherapy, radiation, and blood transfusions. Ownership transparency, with the growth in for-profit providers, and hospice election decision making also are areas of interest for CMS based on the data in the proposed rule.
These topics and data points should compel hospices to sit up and take notice, as CMS has issued multiple requests for information (RFIs) from hospice providers and industry stakeholders to understand the factors driving the data points. It’s advisable that providers review these RFIs and consider these specific requests and how they relate to their operation. Social determinants of health also are referenced, indicating that 80% of hospice beneficiaries are white with Black and Hispanic populations less likely to use the benefit. CMS presented seven different questions for comment to providers surrounding their approaches to health inequities in the proposed rule.
We encourage all providers and interested parties to review this proposed rule. With this much data and RFIs in this proposed rule, the signals for coming changes to the hospice benefit are strong. If you have any questions or need assistance, please reach out to a professional at FORVIS.