Hospital Proposed Rule Impacts Hospice, Home Health and SNFs

On April 14, the Centers for Medicare & Medicaid Services (CMS) released a proposed regulation that will have implications for hospice, home health and SNF providers.

The proposed regulation, titled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices [CMS-1677-P] RIN 0938-AS98 was posted on the Federal Register on April 28, 2017. 

CMS proposes to:

• Require that each national accrediting organizations (AOs) applying or reapplying for CMS-approval of its accreditation program agree to post final accreditation survey reports (including statements of deficiency findings) and acceptable Plans of Corrections (PoCs) from that accreditation program on its public-facing websites within 90 days after such information is made available to the facilities for the most recent three years.

• Adopt the Proportion of Patients Who Died from Cancer Admitted to the ICU in the Last 30 Days of Life (NQF #0213) measure for the FY 2020 program year and subsequent years, the Proportion of Patients Who Died from Cancer Not Admitted to Hospice (EOL-Hospice) Measure (NQF #0215) and Proportion of Patients Who Died from Cancer Admitted to Hospice for Less Than Three Days (EOL-3DH) (NQF #0216) measure.

• Adopt the proposed follow-up measure EOL-3DH to assess whether those patients admitted to hospice were admitted in a timely fashion to derive maximum benefit from hospice services.

• Allow cost reports to be signed electronically for cost reporting periods beginning on or after October 1, 2017, for those providers required to submit the cost report electronically. Providers would continue to have the option to continue to send a hard copy certification and settlement page with a signature or the provider could elect the electronic signature filing. The cost report will provide a separate identification that the signature is being submitted electronically. Currently hospitals, skilled nursing facilities, home health agencies, hospices, end-stage renal disease facilities, organ procurement organizations, histocompatibility laboratories, rural health clinics, Federally qualified health centers, and community mental health facilities are required to file Medicare cost reports electronically with a mailed-in separate signed hard-copy certification and settlement summary.

Currently, the Hospital IQR Program measure set does not contain any measure that assesses end-of-life care. The Proportion of Patients Who Died from Cancer Not Admitted to Hospice (EOL-Hospice) (NQF #0215) measure assesses the proportion of patients who died from cancer who were not admitted to hospice and evaluates whether or not patients were admitted to hospice. The Proportion of Patients Who Died from Cancer Admitted to Hospice for Less Than Three Days (EOL-3DH) (NQF #0216) measure evaluates whether patients who were admitted to hospice were admitted to hospice late in the course of their illness, defined as within three days of their death. The proposed measure uses Medicare administrative claims data to derive the numerator and denominator. The numerator in this proposed measure is defined as the proportion of PCH patients not enrolled in hospice. The denominator is defined as patients who died from cancer. The measure specifications contain no denominator exclusions nor any risk adjustment or risk stratification. The proposed measure is calculated by dividing the numerator by the denominator. Measure specifications for the proposed EOL-Hospice measure can be accessed on the NQF’s website.

In the Proposed rule, CMS cites research that showed patients receiving chemotherapy late into the course of a terminal illness tended to be referred to hospice later, resulting in lower quality of life, distress for caregivers, and increased cost.

CMS has requested public comment on this proposal, and LeadingAge will be submitting comments. We welcome comments from members and state affiliates on this proposed rule. The proposed rule will be posted in the Federal register on April 28, and comments are not due until June 13.