FR 2025-06317

Summary of the Document

The document is a proposed rule issued by the Centers for Medicare & Medicaid Services (CMS) that aims to update the hospice wage index, payment rates, and aggregate cap amount for Fiscal Year 2026. In addition to financial updates, the rule proposes changes to hospice admission regulations and face-to-face attestation requirements. It also includes corrections to past regulatory text and seeks updates to the Hospice Quality Reporting Program (HQRP). CMS is actively seeking public comments on these proposed changes, particularly concerning future hospice quality measures that focus on digital quality measurement, interoperability, well-being, and nutrition.

Significant Issues and Concerns

One major concern is the length and complexity of the document. It contains dense technical language and extensive use of acronyms, which could be difficult for stakeholders without specialized knowledge of Medicare regulations to navigate and fully understand. This complexity is compounded by a lack of immediate explanations for some acronyms.

Another issue is the intricate section on the impact analysis. The assumptions and methodologies used to derive figures are not fully transparent, making it challenging for stakeholders to comprehend the economic implications. Additionally, the transition details from the current Hospice Item Set (HIS) to the Hospice Outcomes and Patient Evaluation (HOPE) system require more clarity regarding implementation timelines and processes.

The document also includes a Request for Information (RFI) on digital quality measurement. While this is an attempt to gather public input, it may delay decision-making processes, affecting the timely implementation of necessary updates.

Impact on the Public

For the broader public, this proposed rule signifies an anticipated increase in hospice payments, amounting to approximately $695 million in FY 2026. This financial boost could translate into improved hospice services, benefiting patients and families who require end-of-life care. However, understanding the rule's complexities might be challenging for the general public, potentially limiting their engagement with the public commenting process that CMS encourages.

Impact on Specific Stakeholders

Specific stakeholders, particularly hospice providers, are likely to be affected both positively and negatively. On the positive side, providers can expect increased payments due to the payment update percentage. However, smaller or rural hospices may face challenges, as the document's economic assessments do not clearly differentiate the impact on urban versus rural providers.

Moreover, there is potential favoring of technology vendors certified under the Office of the National Coordinator (ONC) Health IT Certification Program, which could disadvantage smaller vendors who do not possess such certifications. This could lead to increased costs or challenges for hospices that utilize non-certified products, thereby impacting their operations and the services they provide.

In conclusion, while the proposed rule aims to enhance the regulatory framework for hospice care, its complexity, and language might limit public understanding and engagement. The potential economic implications, particularly for smaller or rural hospices, need further exploration and clarity to ensure equitable outcomes across all hospice providers.

The proposed rule outlines several key financial allocations and updates concerning hospice payments and regulations for Fiscal Year (FY) 2026 under the Medicare program. Throughout the document, there are multiple references to financial impacts, primarily focusing on increased payments to hospices and updated spending caps.

Financial Allocations and Spending Increases

The document states an overall economic impact of $695 million in increased payments to hospices for FY 2026. This figure reflects the proposed hospice payment update percentage, which is 2.4 percent. The update aims to adjust the payment rates for hospice care categories, resulting in a significant financial impact on hospices across the country. This increase is consistent with statutory requirements that payments under the hospice benefit must be updated annually to reflect changes in economic conditions.

Additionally, the proposed hospice cap amount for the FY 2026 cap year is $35,292.51. This cap indicates the maximum payment a hospice can receive per patient and is updated from the FY 2025 cap amount of $34,465.34 by the proposed payment update percentage of 2.4 percent.

Review Cost Estimation

The document also assesses the cost of reviewing the proposed rule. It estimates the review cost to be $106.42 per hour for medical and health service managers, leading to an estimated total reviewing cost of $18,355.40 for approximately 98 reviewers. This estimate assumes an average reading time of 1.76 hours per reviewer, highlighting potential simplification in evaluating the true cost and time burden on stakeholders.

Relation to Identified Issues

The financial references within the document raise several issues. Firstly, the estimation of increased payments assumes certain economic behaviors that may not be fully transparent or detailed, potentially leading to a lack of clarity around the assumptions affecting the payment updates. This could particularly impact smaller, rural hospices more significantly, given the possibly different economic conditions they face compared to urban hospices.

Moreover, the document's analysis of financial impacts seems to be somewhat simplistic and may not account for the nuanced financial positions of various stakeholders. For instance, the cost estimate for reviewing the proposed rule may not consider the full scope of engagement needed from various professionals who would be impacted by these financial updates.

Overall, these financial references and updates are central to the proposed rule, aiming to ensure that hospice services are adequately funded while also maintaining compliance with regulatory standards. However, clarity in financial assumptions and a more in-depth exploration of regional impacts could further enhance understanding and preparedness among stakeholders.