CMS Posts FY23 Hospice Wage Index Final Rule

From NHPCO

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) posted for public inspection the Fiscal Year 2023 (FY23) Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Final Rule. The final rule includes a payment increase of 3.8% for FY23 and the final hospice cap amount of $32,486.92. The CMS Fact Sheet describes additional details of the rule. Final Wage Index values were also posted. NHPCO will have the FY23 Final State/County Rate Charts ready in the coming days.

Summary at a Glance

In the 4:15 p.m. posting of the Federal Register for July 27,2022 the Fiscal Year 2023 (FY23) Hospice Wage Index and Quality Reporting final rule was posted to the public inspection part of the Federal Register.

Rate Information and Cap

Final Rate increase: 3.8% which is a 1.1% increase from the proposed 2.7%.

Cap amount: The final hospice cap amount for the FY23 cap year is $32,486.92, which is equal to the FY22 cap amount ($31,297.61) updated by the proposed FY23 hospice payment update percentage of 3.8 %. This is an increase from the $32,142.65 in the proposed rule.

Quality Reporting Information

Update on the Hospice Outcomes and Patient Evaluation (HOPE) tool: CMS provided an update on the beta testing, burden estimates and timepoints for collection, along with additional outreach efforts.

Future quality measures: CMS also discusses potential future quality measures within the HQRP based on HOPE and administrative data, including HOPE-based process measures and hybrid quality measures.

Testing for CAHPS Hospice Survey: CMS provided an update on a survey-mode experiment whose goal was to test the effect of adding a web-based mode to the CAHPS Hospice Survey. 

Request for Information on Health Equity in Hospice

CMS expressed appreciation for the many public comments on improving health equity in hospice and on a future structural measure under consideration for HQRP.

The CMS Fact Sheet on the final rule describes additional details of the rule. Final Wage Index values were also posted. NHPCO will have the FY23 Final State/County Rate Charts ready in the coming days.

NHPCO has begun the review of the final rule and will release a detailed analysis of the final rule and its components. Look for a Regulatory Alert in the coming days.

Any questions can be directed to [email protected] with “FY23 Final Rule” in the subject line.

PMHC HCBS Funding Alert

From Partnership for Medicaid Home-Based Care (PMHC)

Senate Majority Leader Chuck Schumer (D-NY) and Sen. Joe Manchin (D-WV) announced an agreement on a reconciliation package that includes tax and energy provisions in addition to drug pricing reforms and additional ACA subsidies.  As currently written, The legislation – the Inflation Reduction Act of 2022 – does not include funding for Medicaid HCBS. This is a narrowly crafted compromise approach and other things were also dropped.

Senate Democrats who have championed permanent Medicaid HCBS funding indicated to PMHC as recently as this week that the parameters of a reconciliation bill would be determined by Leader Schumer and Sen. Manchin.  It is unlikely that the Inflation Reduction Act of 2022 will be modified to include HCBS funding.  However, PMHC weighed in with Leader Schumer’s policy director in support of including Medicaid HCBS investments in the reconciliation bill.  We encourage PMHC members to use the VoterVoice grassroots campaign to urge Members of Congress to support these critical investments. 

The legislative text and summaries of the Inflation Reduction Act are available here.  The bill is expected to be considered by the Senate next week.  

[HHAC is a member of PMHC through the Council of States]

House Votes to Extend Hospice Telehealth Flexibilities Through 2024

From NHPCO

The Coronavirus Aid, Relief and Economic Security (CARES) Act (Public Law 116-136) expanded the ability for hospice providers to use telehealth with patients, including the face-to-face visit required for recertification of hospice eligibility, for the duration of the COVID-19 Public Health Emergency (PHE). The Consolidated Appropriations Act, 2022 (Public Law 117-103) extended this flexibility for an additional 151 days after the end of the PHE.

Last night, the House of Representatives passed the Advancing Telehealth Beyond COVID-19 Act of 2021 (H.R. 4040) which further extends these telehealth flexibilities through December 31, 2024. The legislation passed by a vote of 416 – 12 and advances to the Senate.

The NHPCO and HAN teams are closely monitoring the progress of this bill and remain engaged with key Members of Congress and partner organizations on telehealth issues.

CMS Announces Unprecedented Quality Measure Set for Home- and Community-Based Services

Home Health Care News | By Andrew Donlan

The Centers for Medicare & Medicaid Services (CMS) released its first ever home- and community-based services (HCBS) quality measures Thursday.

The agency said the measures will promote “consistent quality measurement within and across state Medicaid HCBS programs” and are a “critical step to promoting health equity among the millions of older adults and people with disabilities who need LTSS.”

The measures are built around three pillars: access, a rebalancing of HCBS spend versus institutional care spend and community integration. For now, the measures are voluntary – with one caveat. 

“While use of this measure set is voluntary at this time, CMS plans to incorporate use of the measure set into the reporting requirements for specific authorities and programs, including the Money Follows the Person (MFP) program and future section 1115 demonstrations that include HCBS,” a state Medicaid director letter read.

The MFP program is a CMS-directed way to get individuals out of institutional-based care and back into their homes and communities to receive HCBS. As recently as March, CMS put forward $110 million to boost MFP, and therefore HCBS services, across the country.

In other words, following the measure set is strongly encouraged for states.

“CMS is using every lever available to protect and expand coverage for all people eligible for Medicaid,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “We are working to expand their access to care across settings – including in the setting of their choice.”

While the home health industry is highly – and very consistently – regulated across the country, the personal home care industry has not been historically.

Strictly private-pay providers will still not be affected necessarily by the CMS quality measure set, but it is a sizable step to industry standardization, particularly among Medicaid-focused, HCBS providers.

“Today’s announcement provides states with tools to better understand and compare health outcomes across groups receiving home- and community-based services,” Brooks-LaSure continued. “The use of consistent quality measures across the country is another step toward reducing health disparities and ensuring that people with disabilities, and older adults enrolled in Medicaid, have access to and receive high-quality services in the community.”

The measures are aiming to obtain the aforementioned three goals:

• Increased access, defined as beneficiary and caregiver awareness of resources that support overall well being and HCBS.

• A rebalancing, which is aimed at finding a more equitable balance between spending on institutional care and HCBS care in communities

• Community integration, which is focused on “ensuring the self-determination, independence, empowerment and full inclusion” of children, adults and older adults in the Medicaid program receiving HCBS 

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