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

2. 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

3. 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

4. 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

5. 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.

6. 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.

7. 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, 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Questions and Answers / Contact
Joy M. Cameron
VP, Policy and Innovation