“Placing HOME at the center of health care delivery” Proposed FY18 Hospice Rate & Rule Joy M. Cameron May 31, 2017

FY 2018 Hospice Proposed Rule: Key Sections Potential Impacts of ACA Hospice Payment Reform – Research and Analysis Length of Stay and Live Discharges Skilled Visits in the Last Days of Life Non-Hospice Spending Proposed FY2018 Hospice Wage Index and Rate Update Proposed FY2018 Hospice Wage Index Proposed FY2018 Payment Update Percentage Proposed FY2018 Hospice Payment Rates Hospice Cap for FY2018 2017 cap amount + 1 percent payment update

FY 2018 Hospice Proposed Rule: Key Sections CMS soliciting comments regarding clinical certification of a six-month or less life expectancy. Proposed Updates to the Hospice Quality Reporting Program Proposed removal of previously adopted measures Measures Concepts Under Consideration for Future Years Quality Data Submission Previously adopted APU Determination and Compliance Criteria for the HQRP HQRP Submission Exemption and Extension Requirement for the FY19 Payment determination and subsequent years 2017 cap amount + 1 percent payment update

FY 2018 Hospice Proposed Rule: Key Sections CAHPS Hospice Survey Participation Requirements HQRP Reconsideration and Appeals Procedures for the FY18 Payment Determination and Subsequent years Public Display of Quality Measures and other Hospice Data for the HQRP Request for Information on CMS Flexibilities and Efficiencies 2017 cap amount + 1 percent payment update

FY 2018 Proposed Hospice Rule: Reminder CMS posted a reminder from the proposed rule: Hospices must report all diagnoses related or unrelated to the terminal prognosis. A likely guidepost of things to come. Previously, CMS posted reminders to visit counts. We believe that this is an indication of them once again looking at Hospice / Non-hospice care, consistency of diagnosis across the end of life an area that they are considering for greater scrutiny.

FY 2018 Proposed Hospice Rule: Research and Analysis Hospice Length of Stay FY2015 & FY2016 length of stay virtually the same Chronic progressive neurological – longest lengths of stay Live Discharges FY2016 – 17% were discharged alive Decreased since FY2014 Skilled Visits in the Last Days of Life Incremental improvement Non-Hospice Spending Rate has declines, but still a concern A likely guidepost of things to come. Previously, CMS posted reminders to visit counts. We believe that this is an indication of them once again looking at Hospice / Non-hospice care, consistency of diagnosis across the end of life an area that they are considering for greater scrutiny.

FY 2018 Hospice Proposed Rule: Rate Proposed Hospice Payment Update Percentage for FY 2018 is 1% increase Hospice Cap Amount for FY 2018 is $28,689.04. This is equal to the FY 2017 rate plus the proposed 1% increase. CMS soliciting comments regarding clinical certification of a six-month or less life expectancy. 2017 cap amount + 1 percent payment update

FY 2018 Hospice Proposed Rule: Six month life expectancy CMS soliciting comments regarding clinical certification of a six-month or less life expectancy. 2017 cap amount + 1 percent payment update

FY 2018 Proposed Hospice Rule: HQRP Proposed Updates to the Hospice Quality Reporting Program Proposed removal of previously adopted measures None proposed Measures Concepts Under Consideration for Future Years Potentially avoidable hospice care transitions Access to levels of hospice care CMS solicits comments regarding additional ideas fr future measure development Quality Data Submission HEART tool under consideration NM

FY 2018 Proposed Hospice Rule: HEART Tool New data collection mechanism under consideration - Hospice Evaluation & Assessment Reporting Tool (HEART) HEART will provide the quality data necessary for the Hospice Quality Reporting Program (HQRP) and Hospice Item Set (HIS), as well as the clinical data. NM

FY 2018 Proposed Hospice Rule: HQRP Previously adopted APU Determination and Compliance Criteria for the HQRP Month data collection 1/19 – 12/19 for FY21 HQRP Submission Exemption and Extension Requirement for the FY19 Payment determination and subsequent years 90 days from the qualifying extraordinary circumstance to request NM

FY 2018 Proposed Hospice Rule: CAHPS Measures CAHPS Hospice Survey Participation Requirements Eight survey-based measures for the CY18 Six composite Hospice team communication Getting timely care Treating Family Member with Respect Getting Emotional and Religious support Getting help for symptoms Getting hospice care training Two global survey Rating of Hospice Willingness to Recommend hospice NM

FY 2018 Proposed Hospice Rule: HQRP HQRP Reconsideration and Appeals Procedures for the FY18 Payment Determination and Subsequent years Public Display of Quality Measures and other Hospice Data for the HQRP NM

FY 2018 Proposed Hospice Rule: Hospice Compare Hospice Compare website will become active in 2017 Hospice star ratings (between one and five stars) will be determined through methods yet to be announced. Public comments regarding how the rating system will determine star ratings; methods for calculations; and timeline for implementation. The Hospice Item Set (HIS) will be used for the Hospice Compare set until the Hospice Evaluation & Assessment Reporting Tool (HEART) is developed and implemented. NM

FY 2018 Hospice Proposed Rule: CMS RFI CMS is soliciting ideas on regulatory, sub-regulatory, policy, practice, and procedural changes in hospice care in order to: improve the health care delivery system how to making the delivery system less bureaucratic and complex, how CMS can reduce burden for clinicians, providers and patients, while: increasing quality of care, decreasing costs , maintaining program integrity, and preventing fraud. Basically – effective (cost and services), simple and accessible (and fraud free) invitation on next slide to provide input

Questions and Answers / Contact Joy M. Cameron VP, Policy and Innovation jcameron@vnaa.org 571-527-1536