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The Centers for Medicare and Medicaid Services has issued a proposed rule that updates hospice base payments and the aggregate cap amount for 2022.

As proposed, hospices would see a 2.3{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca}, or $530 million increase in their payments for FY 2022. The proposed 2.3{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca} hospice payment update is based on the estimated 2.5{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca} inpatient hospital market basket reduced by the multifactor productivity adjustment of 0.2{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca}. 

Hospices that fail to meet quality reporting requirements receive a two percentage point reduction to the annual market basket update for FY 2022.

The hospice payment update includes a statutory aggregate cap that limits the overall payments per patient that is made to a hospice annually. The proposed cap amount for 2022 is $31,389.66, which is the 2021 cap amount of $30,683.93 increased by 2.3{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca}. 

This proposed rule also includes a comment solicitation regarding hospice utilization and spending patterns that will help inform potential future policy development.

Public comments on the proposal will be accepted until June 7.


The proposed rule affects hospice provider payment and reporting requirements.

CMS also said it is committed to addressing consistent and persistent inequities in health outcomes by improving data collection to measure and analyze disparities across programs and policies that apply to the hospice program.

The agency is working to make quality reporting programs more transparent to consumers and providers. That enables them to make better choices as well as promoting provider accountability around health equity, CMS said. 

In addition, CMS is advancing to digital quality measurement and the use of Fast Healthcare Interoperability Resources in support of the Hospice Quality Reporting Program. FHIR-based standards will allow the exchange of clinical information through application programming interfaces, allowing clinicians to digitally submit quality information once that can then be used in many ways.  


CMS is proposing a new measure called the Hospice Care Index. This single measure includes 10 indicators of quality that are calculated from claims data.

Collectively, the indicators represent different aspects of hospice care and aim to convey a comprehensive characterization of the quality of care furnished by a hospice. If finalized, this measure would be publicly reported no earlier than May 2022.

In addition, this rule proposes to rebase the hospice labor shares for all four levels of care using 2018 Medicare cost reports data for freestanding hospice facilities. The proposed labor share for continuous home care is 74.6{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca}; for routine home care it is 64.7{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca}; for inpatient respite care it is 60.1{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca}; and for general inpatient care it is 62.8{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca}. 

This rule also proposes several clarifying regulation text changes on certain aspects of the hospice-election statement addendum requirements that were finalized for hospice elections beginning on and after October 1, 2020.

Additionally, this rule proposes changes to the conditions of participation regarding hospice aide competency evaluation standards. These proposals would make permanent certain flexibilities allowed during the public health emergency.

CMS is also proposing to add Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospice Survey Star ratings on Care Compare. Star ratings benefit the public in that they can be easier for some to understand than absolute-measure scores, and they make comparisons between hospices more straightforward, CMS said.

Additionally, the rule proposes the addition of the claims-based Hospice Visits in the Last Days of Life measure for public reporting. 

The proposed rule also includes a Home Health Quality Reporting Program proposal to publicly display three quarters of certain outcome and assessment information set data due to the COVID-19 public health emergency exemptions of the 2020 first and second quarter data. 

To meet the January 2022 public reporting refresh cycle for Home Health Facilities, the agency proposes using three quarters rather than four quarters of data for the January 2022 refresh affecting OASIS‑based measures. For some claims-based measures, CMS is also proposing to use three quarters rather than four quarters of data for refreshes between January 2022 and July 2024. 

For Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS), there are no changes. 
Twitter: @SusanJMorse
Email the writer: [email protected]

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