The Centers for Medicare and Medicaid Services wants to permanently cap annual hospice wage index adjustments so payments never decrease more than 5% from a prior year.
"We are proposing a policy that increases the predictability of hospice payments for providers, and mitigates instability and significant negative impacts to providers resulting from changes to the wage index," says a proposed rule published Wednesday. Medicare adjusts hospice payments using a wage index that reflects geographical differences.
The agency acknowledges in the regulation that external factors, such as the COVID-19 pandemic, can influence annual geographic wage index changes and that these kinds of ups and downs make it difficult for providers to predict their future pay rates.
CMS also proposes a 2.7% increase in hospice payments for fiscal 2023, which would amount $580 million in additional reimbursements. The Medicare Payment Advisory Commission recommended that hospice rate be unchanged for the coming fiscal year.
Hospice providers' reimbursement would be limited to $32,142.65 per patient in 2023 under CMS's proposal. The total aggregate Medicare payment a hospice receives each year is capped under federal law.
Additionally, CMS asks for comments on the regulation that provide information on a variety of subjects related to equity and access.
The agency wants submissions explaining how hospices recruit workers, volunteers and board members from diverse backgrounds and how they attempt to bridge cultural gaps between personnel and clients. CMS further wants to know how hospices measure the effects of these policies on health equity. In addition, CMS wants insight into how hospices identify barriers to access, collect demographic information, and access and use qualitative data collection to measure the impact of health equity initiatives.
The agency is considering, but did not formally propose, a structural composite measure based on data hospices already collected, which could include organizational efforts to improve access to hospice care for underserved populations.
CMS will accept comments on the proposed rule until May 31.