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CMS Issues FY 2022 Hospice Payment Update Proposed Rule

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The Centers for Medicare & Medicaid Services (CMS) has released its proposed rule updating payments to hospice facilities for fiscal year (FY) 2022. Comments on the proposed rule are due by 2 p.m. (PT) on June 7.  

CMS proposes a net 2.3% payment update in the proposed rule, which is estimated to increase payments to hospice providers by $530 million. The hospice payment update includes a statutory aggregate cap that limits the overall payments per patient that is made to a hospice annually. The proposed cap amount for FY 2022 is $31,389.66 (FY 2021 cap amount of $30,683.93 increased by 2.3%). 

The rule also proposes to rebase the labor shares for all four levels of care. The table below provides the updated share for each care setting. 

SettingLabor Share
Continuous Home Care 74.6% 
Routine Home Care 64.7% 
Inpatient Respite Care 60.1% 
General Inpatient Care 62.8% 

Based on experience with waivers issued to address the COVID-19 public health emergency (PHE), CMS proposes to change the conditions of participation regarding hospice aide competency evaluation standards. The agency believes that this PHE waiver should be made permanent and is proposing the use of the pseudo-patient for hospice aide competency training. As a complementary change, CMS also proposes that hospices conduct a competency evaluation related to the deficient and related skill(s) noted during a hospice aide supervisory visit. 

The rule also proposes several changes to the hospice quality reporting program and requests information on ways CMS can use policy solutions to address health equity. 

  • Hospice Care Index: CMS proposes a new measure called the Hospice Care Index. It includes 10 indicators of quality calculated from claims data. If finalized, this measure would be publicly reported no earlier than May 2022. 
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS): CMS is also proposing to add CAHPS Hospice Survey Star ratings on Care Compare.  
  • Hospice Visits Last Days of Life (HVLDL): CMS proposes to add the claims-based HVLDL measure for public reporting. 
  • Hospice Items Set (HIS): CMS proposes to remove the seven individual HIS measures because a more broadly applicable measure, the Hospice Comprehensive Assessment Measure, is available and already publicly reported.   
  • Request for Information on Addressing Health Equity: CMS seeks input on ways to attain health equity for all patients. Specifically, CMS requests comments on potential stratification of quality measure results by dual eligibility and other social risk factors in facility-specific reports, ways to improve demographic data collection, and the creation of a facility equity score to synthesize results across multiple measures and social risk factors. 

Additional information is available in a CMS fact sheet.