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Hospice to Receive 1.8% Payment Update

On August 6, 2018 the Centers for Medicare and Medicaid Services (CMS) published the fiscal year (FY) 2019 Hospice Wage Index and Payment Rate Update final rule. The hospice payment update percentage for FY 2019 is 1.8%.S

Payment Update

The hospice payment update percentage for FY 2019 is based on the inpatient hospital market basket update of 2.9% with the multifactor productivity (MFP) adjustment of -0.8% to yield a final update of 1.8% for hospice providers who submit the required quality data. Those hospice providers that did not submit the required data will receive a -0.2% payment update.

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Reporting Drug Data on Claims

The final rule gives hospice providers the ability to submit total, aggregate durable medical equipment (DME) and drug charges on the claim or the option to continue to report infusion pumps and drugs, with corresponding national drug code (NDC) information, on the hospice claim as separate line items. This submission option will no longer be mandatory. Sub-regulatory guidance on this change can be found through change request 10573 and CMS has related educational materials available for review.

Recognition of Physician Assistants as Designated Attending Physicians

Effective for January 1, 2019, CMS is finalizing updates required from the Bipartisan Budget Act of 2018 to expand the definition of attending physician at § 418.3 of the regulations to include physician assistants (PA). They are also finalizing amendments to the regulations at § 418.304 to include the details regarding Medicare payment for designated hospice attending physician services provided by physician assistants. While recognizing comments to allow professionals including PAs to work at the top of their scope, CMS noted that the statute does not allow PAs to perform the face-to-face visit or certify or re-certify terminal illness.

Quality Reporting

Several updates are made to quality reporting including:

  • Data review and correction timeframes for data submitted using the hospice item set (HIS),

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  • Extension of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey participation requirements, including requiring that hospice providers use CMS-approved vendors,
  • Exemption criteria and public reporting policies to future years, including exempting small hospices from data collection for the CAHPS Hospice Survey through FY 2015 and subsequent years and maintaining the newness exemption,
  • Procedures to announce quality measure readiness for public reporting and public reporting timelines through sub-regulatory means,
  • Removal of the 7 HIS component measures as individual measures on Hospice Compare, once the Hospice Comprehensive Assessment measure is displayed, and
  • Public display of public use file data on the Hospice Compare website including information on utilization, payment (Medicare payment and standard payment), submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number (6-digit provider identification number) and state.

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