A proposed rule from the Centers for Medicare and Medicaid Services seeks to increase the hospice payment rate by 2.4% – an estimated increase of $695 million in payments from fiscal year 2025.
This results from the proposed 3.2% inpatient hospital market basket percentage increase reduced by a proposed 0.8 percentage point productivity adjustment, as required by law, CMS said.
The proposed FY 2026 rates for hospices that do not submit the required quality data would reflect the proposed FY 2026 hospice payment update percentage of 2.4%, minus four percentage points as required by law, which would result in a 1.6% reduction over the previous year's payment rate.
Hospice payments are subject to a statutory aggregate cap that limits the overall payments made to a hospice annually, CMS said. The proposed hospice cap amount for FY 2026 is $35,292.51, a 2.4% increase over FY 2025.
WHAT'S THE IMPACT
For the Hospice Quality Reporting Program (HQRP), CMS is proposing to change what it calls a "typographical error" in a regulation to reaffirm that the Hospice Outcomes and Patient Evaluation (HOPE) requirements that will be implemented on Oct. 1.
CMS is also soliciting public comments on two RFIs.
One of the RFIs is linked to President Donald Trump's executive order "Unleashing Prosperity Through Deregulation," which states the administration's policy to significantly reduce the private expenditures required to comply with federal regulations.
To comply with the executive order, CMS is including in the proposed rule an RFI seeking public input "on approaches and opportunities to streamline regulations and reduce burdens on those participating in the Medicare program."
THE LARGER TREND
To seek feedback on the adoption of health information technology and standards, including Fast Healthcare Interoperability Resources (FHIR), CMS is seeking feedback on two RFIs: a future measure on the topics of interoperability, nutrition and well-being; and Advancing digital quality measurement.
Last year, CMS proposed a 2.6% increase for 2025 but ended up giving 2.9% in the final rule. The 2.9% increase for hospice providers last year fell short, said Katie Smith Sloan, president and CEO of LeadingAge, at the time.
"Good hospice care is a holistic, patient- and family-centered, compassionate approach to the dying -- and it can be a godsend," she said. "We recognize that a 2.9% is an increase, but given the challenges our mission driven and nonprofit members continue to navigate, particularly a very competitive labor market especially for registered nurses, the final rule falls short of the need."
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.