CMS has finalized fiscal year (FY) 2018 Medicare hospice reimbursement rates and other updates to Medicare hospice policies. As mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS is increasing FY 2018 hospice rates by 1% (approximately $180 million) for those hospices that submit required quality data; this update is reduced by 2 percentage points for hospices that fail to report required quality data. Under the final rule, the FY 2018 hospice cap is $28,689.04. The final rule also makes various updates to the Hospice Quality Reporting Program and discusses details of CMS's plans to begin public reporting of hospice quality measures on a Hospice Compare Site (for additional information on Hospice Compare, see the related CMS fact sheet).
In the May 3, 2017 proposed rule, CMS discussed a potential proposal for a regulatory text change at 42 CFR § 418.25 that would clarify that documentation used for the initial certification of a patient's terminal illness must come from the referring physician's or acute/post-acute care facility's medical records. In the final rule, CMS briefly addresses public feedback it received on this issue. CMS reiterates that it is not proposing any regulatory changes at this time. The agency will, however, follow up on commenters' observation that the regulations at 42 CFR 418.22(b) already require that the patient's prognosis and certification of terminal illness be supported by clinical information and other documentation. That is, CMS will work with Medicare Administrative Contractors "to confirm whether they are requesting such information when claims are selected for medical review and, if not, whether such information should be included in any additional documentation requests." Furthermore, CMS "continue[s] to encourage providers to use the full range of clinical documentation when certifying terminal illness in order to ensure physician engagement and accountability."
This article is presented for informational purposes only and is not intended to constitute legal advice.
