On July 28, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1787-F) that updates Medicare hospice payments and the aggregate CAP amount for fiscal year (FY) 2024 in accordance with existing statutory and regulatory requirements.
Major provisions of the rule include:
- The FY 2024 hospice payment rate update percentage is 3.1%. This represents an increase of 3.3% related to the increase in the inpatient hospital market basket percentage increase which is then adjusted downward by a .2 percentage productivity adjustment. Payments are impacted by the geographical location of the patient. The wage index applicable to FY 2024 payments is located at CMS-1787-F | CMS.
- Hospices that fail to meet hospice quality reporting requirements will have payments reduced by four percent (4%). Currently the payment reduction is two percent (2%).
- The aggregate payment limitation (“CAP”) for the 2024 CAP Year (October 1, 2023, through September 30, 2024), is $33,494.01.
- CMS codified the HQRP data completion threshold policy at §418.312 and provided several updates relative to the development of a patient assessment instrument, titled HOPE, and future quality measures.
- Effective May 1, 2024, physicians certifying the patient as terminally ill must be enrolled in the Medicare program or have a valid opt-out affidavit on file with a Part A and Part B Medicare Administrative Contractor.
- The provision of telehealth services for purposes of routine home care visits and the face-to-face encounter relating to recertification were finalized to extend through December 31, 2024.
The following reflect the final 2024 hospice payment rates, before any geographical adjustment application:
- Routine Home Care (days 1-60) $ 218.33
- Routine Home Care (days 61+) $ 172.35
- Continuous Home Care $ 65.23 per hour
- Inpatient Respite Care $ 507.71
- General Inpatient Care $ 1,145.31
The Final Rule can be viewed here.
The proposed implementation of a Special Focus Program was included in the 2024 Home Health Prospective Payment Update Rule rather than in the Hospice Rule. Many enrollment related provisions impacting hospice providers are included in other proposed rules.
HOSPICE FINANCIAL MANAGEMENT AND ADMINISTRATION CONFERENCE
The Health Group, LLC’s 2023 Hospice Financial Management and Administration Conference is rapidly filling up (attendance limited). The program will be held at the beautiful Lago Mar Beach Resort, Fort Lauderdale, Florida on November 9-10, 2023. Program information, including registration information, is available here. The program provides for a special session on the financial implications of the many hospice integrity initiatives, both implemented and proposed. The final Home Health and Physician Payment Rules are expected to be finalized before the conference. These include many provisions impacting hospices and hospice financial management.
We are encouraging anyone who expects to attend to make room reservations at their earliest opportunity. Many individuals planning on attending the program have already reserved their rooms. The Lago Mar Beach Resort will sell out for the days of our conference. Special rates have been secured with the Lago Mar Beach Resort & Club; however, to secure these rates, call (855) 829-2923 and inform the hotel that you are attending “The Health Group, LLC Hospice Financial Administration Conference” or online at www.lagomar.com.
When making reservations online, go to reservations, click on group code, and enter 2311THEHEA. Select the dates you will be staying, even if the dates are indicated as not available, select them and your room type. All attendees are being offered Executive One Bedroom Suites at $235/night. Resort fees have been waived for our attendees. If you have a problem, please call the hotel. The hotel is making the $235/night available for two (2) days prior and two (2) days after the program dates.
MEDICARE DEMENTIA CARE MODEL
Meeting the healthcare and supporting service needs of patients with dementia has been a continuing concern of both patients and family members for many years. Reimbursement to providers for healthcare and supporting service needs of dementia patients has been equally concerning.
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced its Guiding an Improved Dementia Experience (GUIDE) Model, which aims to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through a package of care coordination and management, caregiver education and support, and respite services. This is to be an eight (8) year demonstration beginning July 1, 2024.
It is the intent of the demonstration to keep people living with dementia in their homes and provide caregiver support, respite services, and improved access to community-based support. CMS plans to release the application for participation in the demonstration later in 2023 and interested organizations are encouraged to submit Letters of Intent to CMS by September 15, 2023.
The demonstration will categorize dementia patients into one of five (5) tiers based on the whether the patient has a caregiver and the severity of the dementia. Interested providers should review the news release at Biden-Harris Administration Announces Medicare Dementia Care Model | CMS, the Model Overview at Guiding an Improved Dementia Experience (GUIDE) Model Overview Factsheet (cms.gov), and the webpage at Guiding an Improved Dementia Experience (GUIDE) Model | CMS Innovation Center.