Potential Future Legislative Changes and New Measures following CMS Final Rule CMS-1675-F

August 17, 2017

Following the issuance of Final Rule CMS-1675-F (read our summary here), there are several potential future legislative measures that are anticipated. Some are changes to existing measures and others are new measures. Below is a summary of the anticipated changes/additions.

  • Affordable Care Act Hospice Reform – CMS will be monitoring the changes to payments implemented in 2016, and the change to the hospice cost report.

  • Clinical Information for determining terminal illness – CMS is considering requiring that documentation from the referring physician or facility medical records be used in the hospice determination. They are also considering allowing a face to face visit by the hospice physician to supplement information supplied by the referring physician or facility.

  • Adding Social Risk Factors to HQRP – CMS requested comments on whether to include social risk factors in the HQRP measures.

  • Future New Measures – CMS is considering adding two new measures in future years:
    • Potentially Avoidable Hospice Care Transitions
    • Access to Levels of Hospice Care.

    Live discharges and the lack of providing General Inpatient Care, and Continuous Home Care, could indicate that the required hospice benefits are not being provided, as required under the Conditions of Participation. CMS wishes to compare these factors for all hospice, and determine the nature of any outliers. Based on review of relevant literature, CMS feels that the appropriate use of higher levels of intensity care can result in better outcomes as well as allowing the patient to die in the location of their choice.

  • Hospice Evaluation and Assessment Reporting (HEART) – CMS is developing a new hospice patient assessment system to replace the HIS process. This tool is planned to be used for quality assessment, but could also be used for payment reform. CMS is early in the process on HEART, and is not definite on the full scope of its use.

Again, these future changes and measures are not yet certain, but merely anticipated. We will continue to keep you informed as decisions are made.

Feel free to contact us with any questions about these potential future measures.

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