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Proposed Hospice Prospective Payment System rule for FY 2019

The Centers for Medicare & Medicaid Services (CMS) has posted the proposed rule for hospice payment in FY 2019 (starting October 1, 2018).  It will appear in the Federal Register May 8, 2018. The proposed +2.9% market basket update is reduced by a -0.8% productivity adjustment and an additional -0.3% adjustment specific to hospice providers, resulting in the net +1.8% rate update. CMS also proposes increasing the hospice cap amount from $28,689 in FY 2018 to $29,205 in FY 2019, based on the 1.8% increase in payment rates. 

Also in the proposed rule, the definition of “attending physician” is expanded to include physician assistants (PAs) as hospice attending physicians, in addition to physicians and nurse practitioners. If finalized this change would take effect January 1, 2019. The proposed rule defines a PA as a “professional who has graduated from an accredited physician assistant educational program who performs such services as he or she is legally authorized to perform… in accordance with state law…and who meets the training, education, and experience requirements as the Secretary may prescribe.”  

In the proposed hospice rule, Medicare will pay for PA services that are:

medically reasonable and necessary services and would normally be provided by a physician;
provided to a patient who has selected the PA as their attending physician; and, 
NOT related to the certification of terminal illness.

The proposed rule also notes that a PA may not serve as hospice medical directors, may not lead a hospice interdisciplinary team, certify a beneficiary’s terminal illness, nor conduct the hospice face-to-face encounter.  
The CMS also requests comment on several issues related to hospice quality measures, as well as input on interoperability of clinical information. 

This is an important proposed regulation for your review and comment through 5 PM on June 26, 2018.  Instructions about submitting comments can be found with the proposed rule at proposed FY2019 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements

 

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