Hospice 2024 Final Rule and Home Health Update: Preserving Access Legislation

For early August, this is a semi-busy week with health policy stuff and upcoming econ data on inflation. Congress is on recess but that doesn’t mean that there isn’t a fair amount of activity in-play that will impact the health care industry, some positive, some negative. Likewise, this is the start of the presidential election cycle and while it seems all political news is scandal and investigation driven; policy implications remain open for review. As both political party candidate fields concretize (particularly Republican), I will delve into the candidate’s health policy positions and post synopses thereto.

Hospice 2024 Final Rule: Last week, CMS released the Hospice Final Payment Rule for 2024.  As with other provider segment rules (save home health), the payment rate and various policy changes associated with this rule begin October 1, 2023 (Federal Fiscal Year). For those interested, the full published rule is available here: Hospice Final Rule 2024

A quick summary of the important provisions in the rule is as follows.

  • Payment update (rate) for 2024 is 3.1%.  This update percentage also applies to the aggregate cap limit, moving from $32,486.92 (2023) to $33,494.01 (2024).  Rate tables, with full rate which assumes provider QRP reporting is met, are below.

 

  • If a provider does not submit the required quality data (QRP) will see a rate reduction of 4% vs. 2% in prior years.  This means that the rate calculation encompasses a negative 0.9% update (3.1% minus 4% penalty for non-reporting). The illustrative tables are below.

 

  • No new QRP elements were included in the final rule though CMS does comment that progress on the HOPE patient assessment is being made.  This would create for hospice, a similar assessment tool as found in SNFs (MDS) and Home Health (OASIS). There is also discussion but no finalization, of a Special Focus Program (SFP) for poor performing hospices.  Additional information on the SFP proposals is contained in the proposed Home Health Final Rule for 2024. A decent summary of the SFP proposal is available here, from LeadingAge; https://leadingage.org/cms-releases-tep-report-on-hospice-special-focus-program/
  • CMS clarified their position on certifying physicians having to be enrolled and participating in the Medicare program.  The current process for patient certification (meeting the requirement of likely terminal within six months) is: (1) the hospice medical director or the physician member of the hospice interdisciplinary group, and (2) the attending physician (if the patient has one) must initially certify the patient’s terminal condition. For following certification periods (if the patient remains alive), only the hospice physician certification is required.  CMS was proposing that the two categories of physicians be affirmatively enrolled and participating in the Medicare program.  This proposed provision is dropped.

Home Health: Preserving Access Legislation: In their proposed CY 2024 Home Health Final Rule, CMS is applying a 2.2% rate reduction (proposed) due to technical program misses under the change in reimbursement to PDGM.  Recall, in December.  PDGM started in January of 2020, replacing the former Home Health PPS model.  The biggest change involved the elimination of therapy from the payment model as a distinct qualifier and reimbursable service, instead incorporating therapy into patient diagnostic categories.  Like PDPM for SNFs, PDGM focuses on coding and disease states plus comorbidities to generate various categories of rates.  At the end of this post, I will provide a couple of links for readers to get more info. on PDGM. A recap of the rate methodology/reasoning/mechanics CMS is proposing for 2024 is available here: https://wp.me/ptUlY-FS

In concern for the implications of rate reductions, various trade associations and provider groups have lobbied Congress to forestall any cuts in rate.  The primary reasoning centers on staffing concerns netting an inability of agencies to provide services/accept case referrals.  In turn, a bill started in the Senate, is making its way through rule making that would require CMS to negate the proposed cuts.  The legislative summary is here: https://www.congress.gov/bill/117th-congress/senate-bill/4605/all-info

Here are a couple of PDGM resources for anyone interested in what PDGM is and how it works.

 


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