Proposed FY 2025 Hospice Wage Index and Payment Rate Update/Quality Reporting Rule is Posted 

Proposed FY 2025 Hospice Wage Index and Payment Rate Update/Quality Reporting Rule is Posted 

The proposed FY 2025 Hospice Wage Index and Payment Rate Update/Quality Reporting Rule  (CMS-1810-P) was posted on the Federal Register Public Inspection desk on 3/28/2024. The comment period is 60 days from the publish date in the Federal Register. Instructions for submitting comments are included at the beginning of the rule.  Providers are strongly encouraged to submit comments on this proposed rule. 

Here are the highlights of the proposed rule 

Payment update information: 

  • The FY 2025 proposed hospice payment update percentage is 2.6%. 
  • CMS proposes to adopt the most recent OMB statistical area delineations, which revises the existing core-based statistical areas based on data collected during the 2020 Decennial Census. Hospices affected by the change to their geographic wage index will be eligible for applying a 5-percent cap on any decrease to the wage index from the prior year. This permanent cap, finalized in the FY 2023 Hospice Final Rule, would prevent a geographic area’s wage index from falling below 95 percent of its wage index calculated in the prior FY. 
  • The hospice payment update includes a statutory aggregate cap that limits the overall payments per patient that may be made to a hospice annually. The proposed hospice cap amount for the 2025 fiscal year is $34,364.85 (FY 2024 cap amount of $33,494.01 increased by the FY 2025 hospice payment update percentage of 2.6%). 

Proposed FY 2025 Hospice RHC Payment Rates 

Proposed FY 2025 Hospice CHC, IRC, and GIP Payment Rates 

Proposed regulatory text clarifications 

  1. Discrepancy between hospice CoP regulations and payment requirements: CMS has identified language discrepancies in the existing requirements for hospices as it relates to the medical director and physician designee in the Conditions of Participation (CoPs), and physician member of the interdisciplinary group (IDG) in the payment requirements for the certification of the terminal illness and the admission to hospice care.  
    • CMS proposes to align the medical director CoP and the hospice payment requirements for both clarity and consistency, we are proposing technical changes to the CoPs by adding the physician member of the hospice IDG as an individual who may review the clinical information for each patient and provide written certification that it is anticipated that the patient’s life expectancy is six months or less if the illness runs its normal course.  
    • The proposed changes also include an update to the medical director and admission to hospice care CoPs to clarify that if the medical director is unavailable, the physician designee may review the clinical information and certify the terminal illness.  
  1. Confusion between the hospice election statement and the Notice of Election (NOE) 
    • Hospice election – As part of the election required by § 418.24, a beneficiary (or their representative) must file an “election statement” with the hospice, which must include an acknowledgment that they fully understand the palliative, rather than curative, nature of hospice care as it relates to the individual’s terminal illness and related conditions, as well as other requirements as set out at § 418.24(b). 
    • NOE – an NOE must be filed with the hospice Medicare Administrative Contractor (MAC) within five calendar days after the effective date of the hospice election. If the NOE is filed beyond this timeframe, hospice providers are liable for the services furnished during the days from the effective date of hospice election to the date of NOE filing. 
    • CMS is proposing to reorganize the language at § 418.24 to clearly denote the differences between the election statement and the NOE. That is, we are proposing to title § 418.24(b) as “Election Statement” and would include the title “Notice of Election” at § 418.24(e). By clearly titling this section, the requirements for the election statement and the notice of election would be distinguished from one another, mitigating any confusion between the two documents. 
    • CMS invites comments on the clarifying regulation text changes and reorganization. 

Request for Information (RFI) on Payment Mechanism for High-Intensity Palliative Care Services 

CMS states they are seeking to strengthen the notion that to provide the highest level of care for hospice beneficiaries, we must provide ongoing focus to those services that enforce CMS’ definitions of hospice and palliative care and eliminate any barriers to accessing hospice care.  Therefore, As CMS continues to concentrate on improved access and value within the hospice benefit, we are soliciting public comment on six questions focusing on the provision of high-intensity palliative care. 

It is critical that hospice providers read the rule carefully and offer realistic feedback to CMS on this topic as it could inform future regulatory and payment changes.

Proposals to the Hospice Quality Reporting Program (HQRP) 

  1. New quality measures 
    • CMS proposes to add two new process measures to HQRP.  
    • Timely Reassessment of Pain Impact and Timely Reassessment of Non-Pain Symptom Impact are expected to begin collection in FY 2028. 
    • These two measures would use the data from the HOPE assessment tool.  
    • These process measures would reflect whether a follow-up visit occurred within 48 hours of an initial assessment where there was an impact of moderate or severe symptoms with and without pain. 
  1. CMS proposes to adopt and implement the Hospice Outcomes and Patient Evaluation (HOPE) patient-level data collection tool starting October 1, 2025, with public reporting beginning in FY 2027. 
    • Implementation would update § 418.312(a)(b)(1) to require hospices to complete and submit a standardized set of items for each patient to capture patient-level data, regardless of payer or patient age.  
    • The HOPE tool will replace the existing Hospice Item Set (HIS) structure upon implementation.  
    • HOPE will collect data at multiple time points across the hospice stay, including admission, the HOPE Update Visit (HUV), and discharge. Compared to the HIS (which only collected data at hospice admission and discharge), HOPE will enable CMS to gather patient-level data during their hospice stay to support quality measures.  
    • HOPE includes several domains that are new or expanded relative to HIS, including: 
      • Sociodemographic (updated)  
      • Diagnoses (expanded) 
      • Symptom Impact Assessment  
      • Imminent death  
    • RFI – CMS  requests stakeholder input on potential data collection items related to four SDOHs (housing instability, food insecurity, utility, and transportation challenges) that may be relevant to the hospice setting and how they may need to be adapted to be better suited for the hospice setting.  
    • CMS proposes to provide information about upcoming provider training related to HOPE v1.0 that will be posted on the CMS HQRP website on the HQRP Announcement and Spotlight page and announced during Open Door Forums.  
    • The draft HOPE Guidance Manual v1.0 is available for review and the final HOPE Guidance Manual v1.0 will be available after the publication of the final rule. This guidance manual offers hospices direction on the collection and submission of hospice patient stay data to CMS to support the HQRP quality measures. 
    • CMS will provide the HOPE technical date specifications for software developers and vendors on the CMS website. Software developers and vendors should not wait for final technical data specifications to begin the development of their products.  
    • Software developers and vendors are encouraged to thoroughly review the draft technical data specifications and provide feedback to CMS so we may address potential issues adequately and on time.  
    • CMS will conduct a call with software developers and vendors after the draft specifications are posted, during which we will respond to questions, comments, and suggestions. 
    • Hospice providers will need to use vendor software to submit HOPE records to CMS. As with HIS, facilities that fail to submit all required HOPE assessments to CMS for at least 90% of their patients will be subject to a 4% reduction. See the “Submission of Data Requirements” section below for additional information. 
    • CMS will retire the Hospice Abstraction Reporting Tool (HART) on October 1, 2025, hospices will need to select a private vendor to collect and submit HIS data, and subsequently HOPE data, to CMS. 
  1. CMS proposes changes to the Hospice CAHPS Survey based on the results of a mode experiment conducted in 2021. CMS is proposing to implement the revised CAHPS Hospice Survey beginning with January 2025 decedents.  Specifically, the changes being proposed are: 
    • The addition of a web-mail mode (email invitation to a web survey, with mail follow-up to non-responders), 
    • A shortened and simplified survey,  
    • Modifications to survey administration protocols to include a prenotification letter and extended field period, 
    • The addition of a new, two-item Care Preferences measure,  
    • Revisions to the existing Hospice Team Communication measure and the existing Getting Hospice Care Training measure, 
    • The removal of three nursing home items and additional survey items impacted by other proposed changes in this rule.  
    • CMS seeks comments on these proposed changes.
  1. Impact of updated CAHPS survey on the Special Focus Program (SFP) 
    • The Hospice Special Focus Program (SFP) algorithm uses data from four measures related to caregiver experience collected by the CAHPS Hospice Survey, including Help for Pain and Symptoms, Getting Timely Help, Willingness to Recommend this Hospice, and Overall Rating of this Hospice. 
    •  This proposed rule includes changes to the Overall Rating of this Hospice measure that are non-substantive and will not impact the SFP algorithm.  
    • We appreciate commenters’ interest in the Hospice SFP as finalized in the CY 24 Home Health final rule (88 FR 77676). We continue to review comments and consider whether amendments are necessary.   
  1. Impact of updated CAHPS survey on CAHPS Star Ratings 
    • CMS proposes waiting to publicly report the new version of “Getting Hospice Care Training” until it has eight quarters of data. It anticipates that the first Care Compare refresh in which publicly reported measures scores would be updated to include the new measures would be in November 2027, with scores calculated using data from Q1 2025 through Q4 2026. 
    • During the transition period, scores and Star Ratings would be calculated by combining scores from quarters using the current and new survey. As a result of the survey measure changes, we propose that the Family Caregiver Survey Rating Summary Star Rating will be based on seven measures rather than the current eight measures during the interim period until a full eight quarters of data are available for the “Getting Hospice Care Training” measure. The summary Star Rating would be based on nine measures once eight quarters of data are available for the new Care Preference and Getting Hospice Care Training measures. 
View the Proposed Rule

Public comments on the proposals will be accepted until May 28, 2024.

For further information, see the CMS summary of the hospice proposed rule and the hospice webpage.

Questions about the content of this rule? Contact CHAP