The Centers for Medicare & Medicaid Services (“CMS”) recently proposed a rule regarding the hospice wage index for the fiscal year (“FY”) 2012 (“Proposed Rule”). The rule would result in a 2.3 percent increase in Medicare payments to hospices for FY 2012 and implement a new quality reporting system as required by the Affordable Care Act.
In addition, the Proposed Rule includes key changes for the hospice cap calculations (based upon the recent lawsuits successfully challenging the hospice cap calculation methodologies) and revisions to the hospice face-to-face encounter requirements.
Under federal law, CMS must impose limits on the aggregate Medicare payments received yearly by hospice organizations. Beginning with the 2012 cap year, the Proposed Rule would modify how the cap is calculated by changing the way hospice patients are counted. The law would also allow for retroactive calculations under the new methodology in some circumstances. Hospice providers would be permitted to elect to continue using the current counting method under the Proposed Rule. See also Ruling CMS-1355-R, mirroring provisions of the Proposed Rule.
Lastly, the Proposed Rule includes revisions to the hospice face-to-face requirement. Under the Proposed Rule, the hospice physician who performs the face-to-face encounter would not necessarily be the same physician who certifies the patient’s terminal illness.