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Hospice

Overview

Hospice

Hospice provides comprehensive and interdisciplinary health care to terminally ill patients, as well as bereavement and support services to the patients’ loved ones. Patients receiving hospice care forgo curative treatments. Hospice care is provided through certified hospice programs, and may be delivered in any patient care setting, but is most often provided in the patient's home.

CHA provides state and federal representation and advocacy in the legislative and regulatory arenas to improve access to quality, cost-effective hospice health care services.
 

Hospice provides comprehensive and interdisciplinary health care to terminally ill patients, as well as bereavement and support services to the patients’ loved ones. Patients receiving hospice care forgo curative treatments. Hospice care is provided through certified hospice programs, and may be delivered in any patient care setting, but is most often provided in the patient’s home.

CHA provides state and federal representation and advocacy in the legislative and regulatory arenas to improve access to quality, cost-effective hospice health care services.
 

CHA News Article

CMS Issues FFY 2019 Hospice Wage Index Final Rule

Alyssa Keefe Patricia Blaisdell, FACHE

The Centers for Medicare & Medicaid Services (CMS) has issued its final rule updating the hospice wage index for federal fiscal year (FFY) 2019. CMS finalized a 1.8 percent hospice payment update based on a 2.9 percent inpatient hospital market basket update, reduced by a 0.8 percent productivity adjustment and a 0.3 percentage point adjustment mandated by the Affordable Care Act. The agency estimates the payment update will result in a $340 million increase in hospice payments compared to FFY 2018.

CMS also finalized several changes to the Hospice Quality Reporting Program and, as required by the Bipartisan Budget Act of 2018, expanded the definition of a “hospice attending physician” to include physician assistants in addition to physicians and nurse practitioners. Additional information is available in a CMS fact sheet.

CHA News Article

Post-Acute Care Facilities Notified of Non-Compliance With Quality Reporting

Patricia Blaisdell, FACHE

The Centers for Medicare & Medicaid Services (CMS) has identified inpatient rehabilitation facilities, long-term care hospitals, skilled-nursing facilities and hospices that are not in compliance with quality reporting program requirements for calendar year 2017, and sent those facilities notices of non-compliance on July 9. The non-compliance determination will affect the annual increase factor for fiscal year 2019 reimbursement rates.

The notifications were both mailed to the facilities and placed in their Certification and Survey Provider Enhanced Reports folders in the Quality Improvement and Evaluation System. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 p.m. (PT) on Aug. 7. Instructions for requesting a reconsideration are included in the notification letter.  

CHA News Article

Physician-Assisted Death Law Ruled Unconstitutional

Lois Richardson

A Riverside County Superior Court ruled in May that California’s End of Life Option Act violated the state constitution because it was passed during a special legislative session called to work on other issues. The act, which went into effect in 2016, allows terminally ill individuals to obtain a prescription for a drug to end their life if they meet specified requirements.

The judge’s ruling was limited to this procedural issue; he did not rule on the legality of physician-assisted death. The California attorney general appealed the ruling and requested the appellate court to allow the act to be effective while the appeal is pending. The appellate court responded by ordering the parties to submit briefs on the legal issues involved. In addition, the attorney general filed a motion to vacate the trial court judgment, and a hearing on that motion will be held June 29.

In the meantime, the superior court’s ruling declaring the act void and enjoining the state from recognizing it remains in effect throughout the state. CHA will update its members on the status of the case after the hearing later this month.

CHA News Article

Updates Available for Post-Acute Care Quality Reporting   

Patricia Blaisdell, FACHE Alyssa Keefe

The Centers for Medicare & Medicaid Services (CMS) regularly provides important updates for post-acute care quality reporting programs, including training opportunities, public reporting details and reminders of data submission and review deadlines. The latest updates for inpatient rehabilitation facilities, skilled-nursing facilities, long-term care hospitals, home health and hospice providers are below.

Inpatient Rehabilitation Facilities 
Provider Preview Reports
Inpatient rehabilitation facility (IRF) provider preview reports have been updated and are now available. Providers have until June 30 to review their performance data on quality measures based on data from the fourth quarter of 2016 to the third quarter of 2017, prior to their posting to the IRF Compare website in September. Corrections to the underlying data will not be permitted during this time. However, providers can request a CMS review if they believe their data scores are inaccurate. 

This update of the provider reports includes two additional assessment-based measures and four new claims-based measures, as well as removal of the All-Cause Unplanned Readmission Measure for 30 Days Post-Discharge from Inpatient Rehabilitation Facility measure.  

CHA News Article

CMS Proposes Updates to Payment Rates and Wage Index for Hospices

Patricia Blaisdell, FACHE Alyssa Keefe

On April 27, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update federal fiscal year (FFY) 2019 payment rates and the wage index for hospices.

Under the proposal, CMS estimates payments to hospices would increase by 1.8 percent, or $340 million, compared to FFY 2018. The 1.8 percent update is the result of an estimated 2.9 percent inpatient hospital update, reduced by a 0.8 percent productivity adjustment and a 0.3 percent adjustment mandated by the Affordable Care Act.    

In addition to payment changes, CMS also proposes updates to the Hospice Quality Reporting Program and makes technical changes to regulatory text. Additionally, CMS issues a request for information to solicit comments on ways to achieve interoperability or improved data sharing. 

CHA will provide members with a more detailed summary of the proposed rule in the coming weeks. Comments on the proposed rule are due June 26 by 2 p.m. (PT). A CMS fact sheet is attached.  

CHA News Article

CMS Provides Updates for Post-Acute Care Quality Reporting

Patricia Blaisdell, FACHE

The Centers for Medicare & Medicaid Services (CMS) regularly provides important updates about post-acute care quality reporting programs, including training opportunities, public reporting details and reminders of data submission and review deadlines. Following are the recent updates for inpatient rehabilitation facilities, long-term care hospitals and hospice providers:

Inpatient Rehabilitation Facilities
Provider Preview Reports
Provider preview reports are now available for inpatient rehabilitation facilities (IRFs). IRFs have until April 5, 2018, to review their performance on quality measures based on data from quarter 3 of 2016 to quarter 2 of 2017, prior to their posting to the IRF Compare website in June 2018. Access instructions for the provider reports are available online. Corrections to the underlying data will not be permitted during this time. However, providers can request review by CMS during the preview period if they believe their data are inaccurate. 

CHA News Article

New Law Allows Hospice Providers to Offer Palliative Care to Patients Without Terminal Diagnosis

Patricia Blaisdell, FACHE

The California Department of Public Health has released All Facilities Letter 18-03, notifying providers that a new law established a pilot program that allows licensed hospice providers to provide palliative care to non-terminally but seriously ill patients. Under Senate Bill 294 (Chapter 31, Statutes of 2017), which took effect Jan. 1, providers must notify the department at least 45 days prior to providing palliative care under the pilot program, and must submit required information. At the end of the pilot period, the department will conduct a stakeholder meeting to discuss the results of the reported information and determine the effectiveness of including hospice providers as a means of expanding palliative care for seriously ill patients. More details, including notice and reporting requirements, are available in the attached letter.

CHA News Article

CMS Provides Guides for Post-Acute Care and Hospice Quality Reporting

Patricia Blaisdell, FACHE Alyssa Keefe

The Centers for Medicare & Medicaid Services (CMS) has posted quality reporting program quick reference guides for several post-acute care settings, including long-term care hospitals, inpatient rehabilitation facilities, home health agencies and hospice. The guides include frequently asked questions, information on help desks and links to additional resources. 

CHA News Article

DHCS Releases Guidance to Medi-Cal Managed Care Plans on Providing Palliative Care

Amber Kemp Patricia Blaisdell, FACHE

The California Department of Health Care Services (DHCS) has released the attached All Plan Letter (APL) informing Medi-Cal managed care health plans (MCPs) of their obligation to provide palliative care to Medi-Cal members, pursuant to Senate Bill (SB) 1004 (Chapter 574, Statutes of 2014).To fulfill the bill’s requirement that DHCS establish standards and provide technical assistance to MCPs for the delivery of palliative care, the department outlines its Palliative Care Policy specifying the minimum types of palliative care services MCPs must authorize when medically necessary for a Medi-Cal member who meets eligibility criteria. This APL advises MCPs that, effective Jan. 1, 2018, when a Medi-Cal member meets the minimum eligibility criteria for palliative care, MCPs must authorize palliative care without regard to age.

At a minimum, palliative care must include advance care planning, palliative care assessment and consultation, plan of care, palliative care team, care coordination, pain and symptom management, and mental health and medical social services. The APL further advises MCPs that they must have a process to determine the type of palliative care that is medically necessary or reasonable for eligible beneficiaries, and must have a large enough network of palliative care providers to meet their Medi-Cal members’ needs.

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