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Industry Data – Hospiceimage

CMS ISSUES Change Request 9201

SUBJECT: Implementation of the Hospice Payment Reforms
SUMMARY OF CHANGES: The CR implements service intensity add-on payments for hospice social worker and nursing visits provided during the last 7 days of life when provided during routine home care. In addition, this instruction will implement two routine home care rates, paying a higher rate in the first 60 days of a hospice election and a lower rate for days 61 and later.

CR 9201 is available for viewing at the CMS site

Hospice Cost Report:
CMS released the new cost report requirements for freestanding hospice organizations on August 9, 2014. Hospices will be required to report services by the level of care provided.
The final report is available at

CMS Change Request 8877. This request completely replaces CR 8777
” SUMMARY OF CHANGES: This instruction provides a manual update and provider education for new
editing for principal diagnoses that are not appropriate for reporting on hospice claims. It also provides
contractor requirements, a manual update, and provider education for newly required timeframes for filing a
hospice notice of election, and a hospice notice of termination/revocation of election, and for the exceptions
process available when a hospice notice of election is filed late. It also provides a clarification of the
differences between Healthcare Common Procedure Coding System (HCPCS) site of service codes Q5003
and Q5004.”
Self CAP determination reporting

News Update August 5, 2014 CMS issued the final rule for self reporting of own Hospice CAP determinations:
42 CFR §418.308(c) now reads, “The hospice must file its aggregate payment cap determination notice with its Medicare contractor no later than 5 months after the end of the cap year (that is, March 31st) and remit any overpayment due at that time. Hospices shall file the aggregate cap using data no earlier than 3 months after the end of the cap period. The Medicare contractor will notify the hospice of the final determination of program reimbursement in accordance with procedures similar to those described in §405.1803 of this chapter. If a provider fails to file its self-determined cap determination with its Medicare contractor within 5 months after the cap year, payments to the hospice will be suspended in whole or in part, until a self-determined cap determination is filed with the Medicare contractor, in accordance with §405.371(e) of this chapter.

Quality Reporting
Section 3004 of the Affordable Care Act directs the Secretary to establish quality reporting requirements for Hospice Programs. For the actual language in this section of the statute, please see Section 3004 Statute under Related Links below.

Section 3004 requires the Secretary to publish, no later than October 1, 2012 the selected quality measures that must be reported by Hospice Programs. The ACA requires that CMS use nationally endorsed quality measures, but also allows CMS to specify measures that are not already endorsed if a feasible and practical measure in the area determined appropriate by the Secretary has not been endorsed.

Penalties for Failure to Report

For fiscal year 2014, and each subsequent year, failure to submit required quality data shall result in a 2 percentage point reduction to the market basket percentage increase for that fiscal year.

The Hospice Quality Reporting Program (HQRP) is currently “pay-for-reporting,” meaning it is the act of submitting data that determines compliance with HQRP requirements. Performance level is not a consideration when determining market basket updates/Annual Payment Updates (APU).

CMS on their Hospice Education section posted the following information to facilitate and familiarize hospice programs with information about the new Hospice Information Set:

HIS Admission Final 4-8-2014
• HIS Discharge Final 4-8-2014
• HIS Training Slides [PDF, 931KB

Medicare Program; FY 2015 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting Requirements and Process and Appeals for Part D Payment for Drugs for Beneficiaries Enrolled in Hospice

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