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FY 2015 Hospice Final Rule

The Centers for Medicare and Medicaid Services (CMS) released the fiscal year 2015 Hospice final rule (CMS-1609-F; RIN 0938-AS10) on Aug. 4, 2014. According to the final rule, payments to hospices serving Medicare beneficiaries will rise 1.4 percent, or $230 million, in Fiscal Year (FY) 2015. The final rule will be published in the Federal Register later this week on Aug. 22, 2014. The rule goes into effect Oct. 1, 2014.

As we previously reported, CMS issued a proposed rule for Medicare Hospice Providers for FY 2015 [CMS-1609-P] that went on display in the Federal Register. LeadingAge had submitted comments on the proposed rule.

Some highlights of the final rule:

  • Update the hospice payment rates and the wage index for FY 2015;
  • Continue the phase-out of the wage index Budget Neutrality Adjustment Factor (BNAF);
  • Provides an update on hospice payment reform analyses;
  • Potential definitions of “terminal illness” and “related conditions;”
  • Information on potential processes and appeals for Part D payment for drugs while beneficiaries are under a hospice election;
  • Specifies timeframes for filing the Notice of Election (NOE) and the Notice of Termination/Revocation (NOTR);
  • Add the attending physician to the hospice election form, and require hospices to document changes to the attending physician;
  • Require hospices to complete their hospice aggregate cap determinations within five months after the cap year ends, and remit any overpayments;  
  • Update the hospice quality reporting program;
  • Provide guidance on determining hospice eligibility; and
  • Information on the delay in the implementation of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM).

On page 27, it is interesting to read the trends in hospice utilization and the top twenty hospice diagnoses in FY 2002, FY 2007, FY 2012 and FY 2013.

Payment rates
•   Update FY 2015 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries that would include an estimated 1.4 percent ($230 million) increase in hospice Medicare payments.

 Notice of Election (NOE)
•   “We are finalizing a requirement that the Notice of Election (NOE) be filed within five calendar days after the effective date of hospice election. When the NOE is filed more than five calendar days after the effective date of election, the hospice would be financially liable for the cost of the beneficiary's care on days between the effective date of hospice election to the date of NOE filing.”

Aggregate cap determination
•   Require providers to complete their cap determination within 150 days after the cap period and remit any over-payments. If a hospice does not complete its cap determination timely, its Medicare payments would be suspended until the cap determination is complete and received by the contractor.

The hospice aggregate cap amount for 2014 cap year will be $26,725.79.

Payment Rates for all four levels of Care:

 

Levels of Care

FY 2014

FY 2015

Routine home care

$156.06

$159.34

General Inpatient Care

$694.19

$708.77

Continuous Home Care

$910.78

$929.91

Inpatient Respite Care

$161.42

$164.81

 

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871