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CMS FY2021 Hospice Final Rule

November 3, 2020

 

Michael Criscione
Elizabeth DeRita

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The Centers for Medicare & Medicaid Services (CMS) FY2021 Hospice Final Rule:
Excerpts from Federal Register 8/4/2020
https://www.federalregister.gov/documents/2020/08/04/2020-16991/medicare-program-fy-2021-hospice-wage-index-and-payment-rate-update

CMS FY2021 – Effective 10/1/20

  • As discussed in the September 14, 2018 Office of Management and Budget (OMB) Bulletin 18-04, the OMB has finalized revisions to the delineations of Metropolitan Statistical Areas (MSAs). Furthermore, changes were made to Core-Based Statistical Area (CBSA) geographic designations, such that some urban counties have become rural, some rural counties have been urban, and some existing CBSAs have been split apart.
  • Due to the changes to the OMB delineations, and the resulting changes to the hospice wage index values, CMS has imposed a 5% cap on the overall decrease in a geographic area’s wage index value for FY2021 only for impacted counties.
  • Final hospice wage index tables, including a crosswalk between the current and previous OMB delineations, are available through the Internet. They can be found on the CMS Web site at https://www.cms.gov/medicaremedicare-fee-service-paymenthospicehospice-wage-index/fy-2021-final-hospice-wage-index
  • For FY2021, the growth rate of the 2013-based hospice market basket in the final rule was 2.4% and has taken into consideration macroeconomic data through June 2020, including the  uncertainty  due  to COVID-19. 
    • Hospices that fail to submit the required quality data, as applicable, in accordance with Section 1814(i)(5)(A)(i) of the Social Security Act for a fiscal year, will receive a 2.0 percentage point reduction to their market basket update for the fiscal year involved.
  • The hospice cap amount for FY2021 will be $30,683.93, which is equal to the FY2020 cap amount updated by the FY2021 hospice payment update percentage of 2.4%.
  • No changes to the Hospice Quality Reporting Program were proposed at this time.
  • Overall economic impact of the final rule is an estimated increase of $540 million in aggregate payments to hospices during FY2021.