Hospice Payment Rate Update Proposed Rule — Comment by May 31

On March 30, CMS issued their 2023 proposed rule for Hospice (CMS-1773-P), which  would provide routine updates to hospice-based payments and the aggregate cap amount for fiscal year (FY) 2023. “This proposed rule proposes to establish a permanent mitigation policy to smooth the impact of year-to-year changes in the hospice payments related to changes in the hospice wage index.”

National rates, before geographical calculation of the wage component, are as follows:

Routine home care (days 1-60)                    $    209.14

Routine home care (days 61+)                     $    165.25

Continuous home care (daily maximum)    $ 1,505.61

Inpatient respite care                                     $    486.88

General inpatient care                                  $ 1,098.88

The following is from the CMS announcement:  

Proposed Medicare Hospice Payment Policies

This proposed rule proposes a permanent, budget neutral approach to smooth year-to-year changes in the hospice wage index. Specifically, we are proposing a permanent cap on negative wage index changes greater than a 5% decrease from the prior year (regardless of the underlying reason for the decrease) for hospices in the FY 2023 proposed rule.

Routine Annual Rate Setting Changes

As proposed, hospices would see a 2.7% ($580 million) increase in their payments for FY 2023. The proposed 2.7% hospice payment update for FY 2023 is based on the estimated 3.1% inpatient hospital market basket update reduced by the productivity adjustment (0.4 percentage point). Hospices that fail to meet quality reporting requirements receive a 2-percentage point reduction to the annual market basket update for FY 2023.

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 2023 is $32,142.65 (FY 2022 cap amount of $31,297.61 increased by 2.7%.

Hospice Quality Reporting Program

This rule provides an update on the development of a patient assessment instrument, titled HOPE, which would contribute to a patient’s plan of care when adopted. This includes an update on the BETA testing and derivatives that will be achieved during this phase of testing, such as burden estimates and timepoints for collection, as well as additional outreach efforts that will be conducted during and after BETA testing and during our future plans for adoption. 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, which could be based upon multiple sources that include HOPE, claims, and other data sources.

This rule announces a potential future update to the CAHPS Hospice Survey, which is used to collect data on experiences of hospice care from primary caregivers of hospice patients. In particular, CMS is providing an update on a mode experiment whose goal was to test the effect of adding a web-based mode to the CAHPS Hospice Survey. 

In this proposed rule, we are seeking information on our Health Equity Initiative within the HQRP by describing our current assessment of health equity within hospice. We are also seeking input on a potential future structural measure as well as responses to specific questions that would further inform future efforts. 

More Information:

• Proposed rule: We’ll accept public comments until May 31, 2022
• Hospice Center webpage

Provider Relief Fund Payment Reports Past-Due – Consequences Already Being Enforced

As reported previosuly by HHAC to our members, health care providers who received Provider Relief Fund payments exceeding $10,000 total between July 1 and Dec. 31, 2020, should have reported to the Health Resources and Services Administration by March 31 on how they used those funds. The following is an article by Bloomberg Law about providers that are already facing enforcement actions such as repayment or exclusion from receiving or retaining future PRF payments due to not having reported on the use of funds. 

Doctors Asked to Repay $100 Million in Covid Aid Absent Reports                                   

Bloomberg Law

The Department of Health and Human Services is clawing back as much as $100 million in pandemic assistance from health-care providers who didn’t comply with the agency’s reporting requirements.

Physician practices and clinics that received notices from HHS say they didn’t know there were strings attached to the money. Initial tranches of Covid-19 funds were deposited in some providers’ accounts without them asking for it.

Reminder emails about reporting requirements went to some facilities’ spam folders or to staffers who initially accepted the money but ended up leaving their jobs, according to the Medical Group Management Association, which represents health-care practices and providers.

The HHS’s Health Resources and Services Administration sent notices to non-compliant facilities on March 10, giving them 30 days to return the funds.

“If you do not return the funds, HRSA will initiate the recovery of all funds not reported on” during the first reporting period. Those providers will also be excluded from future payments, HRSA said, according to a sample letter obtained by Bloomberg Law. HRSA confirmed that the letters went out.

Roughly 10,000 recipients of the Provider Relief Fund are being asked to return anywhere from $30,000 to $250,000 by April 10, said Claire Ernst, MGMA’s director of government affairs. Meanwhile, they’re dealing with “everything from the highest inflation that we have seen in 40 years and potential variants down the line,” Ernst said.

Read Full Article

Second Booster Shots Authorized for Adults 50 and Older

CNN / By Brenda Goodman

The US Food and Drug Administration has expanded the emergency use authorization of the Pfizer and Moderna Covid-19 vaccines to allow adults 50 and older to get a second booster as early as four months after their first booster dose of any Covid-19 vaccine.

The move extends the availability of additional boosters to healthy older adults. The FDA had previously allowed additional shots for anyone 12 or older who was severely immune-deficient. This group of people can now receive a three-dose primary series and two boosters for a total of five doses.

The US Centers for Disease Control and Prevention followed suit, saying it is updating its vaccine pages to reflect the FDA's expanded eligibility.

"Current evidence suggests some waning of protection over time against serious outcomes from COVID-19 in older and immunocompromised individuals. Based on an analysis of emerging data, a second booster dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine could help increase protection levels for these higher-risk individuals," said Dr. Peter Marks, director of the FDA's Center for Biologics Evaluation and Research, in a news release.

"Additionally, the data show that an initial booster dose is critical in helping to protect all adults from the potentially severe outcomes of COVID-19. So, those who have not received their initial booster dose are strongly encouraged to do so."

The FDA said that in making its decision, it had determined that the known and potential benefits of second boosters outweigh the known and potential risks for these populations.

The CDC also said in its statement that adults who got Johnson & Johnson's vaccine as their primary and first booster shots at least four months prior may now get an additional booster of Pfizer/BioNTech or Moderna's vaccines.

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Home Health Notice of Admission Processing Update

From NAHC

Home health agencies began experiencing problems with Notice of Admission (NOA) submissions in January of this year when the NOA was implemented, due to CMS (Centers for Medicare & Medicaid Services) systems issues and some MAC-specific systems issues. (See this NAHC Report article for information.)

Most of the issues were fixed at the end of January, but an issue with reason code U537F assigning incorrectly on some NOAs still plagues home health agencies. There is no workaround, and without the NOA on file with CMS home health agencies cannot submit the associated final claim.  Therefore, cash flow in some home health agencies experiencing NOAs returned with U537F has been impacted for a few months.

A system fix to correct this issue is being created, and NAHC has learned from CMS that it anticipates April 4 as the implementation date of the fix.

As of the time this article was written, no additional details are available and the Medicare Administrative Contractors (MACs) have not updated their Claims Processing Issues Log(CPIL)/Production Alerts.  Stay tuned to NAHC Report for more information as it becomes available.