FY2022 Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

CMS issued Transmittal 10929 … Change Request 12354 on August 4, 2021.

I. SUMMARY OF CHANGES: This Change Request (CR) updates the hospice payment rates, hospice wage index, and Pricer for FY 2022. The CR also updates the FY 2022 hospice aggregate cap amount. These updates apply to Pub 100-04, Chapter 11, section 30.2.

EFFECTIVE DATE: October 1, 2021

*Unless otherwise specified, the effective date is the date of service.

IMPLEMENTATION DATE: October 4, 2021

This is an 8-page CR with 2 Tables (found on pages 7 and 8)

And…

Highlights include:

  • The hospice payment update percentage for Fiscal Year (FY) 2022 is based on the inpatient hospital market basket update of 2.7 percent. Due to the requirements at sections 1886(b)(3)(B)(xi)(II) and 1814(i)(1)(C)(v) of the Act, the inpatient hospital market basket update for FY 2022 of 2.7 percent must be reduced by an MFP adjustment as mandated by Affordable Care Act (currently estimated to be 0.7 percentage point for FY 2022).  In effect, the hospice payment update percentage for FY 2022 is 2.0 percent. The FY 2022 hospice payment rates are effective for care and services furnished on or after October 1, 2021, through September 30, 2022.
  • In the FY 2016 Hospice Wage Index and Payment Rate Update final rule (80 FR 47142), we finalized aligning the cap accounting year, for both the inpatient cap and the hospice aggregate cap, with the federal FY beginning in 2017. Therefore, the 2022 cap year will start on October 1, 2021 and end on September 30, 2022.

For the inpatient cap for the 2022 cap year, we will calculate the percentage of all hospice days that were provided as inpatient days (GIP care and Respite care) from October 1, 2021 through September 30, 2022.

The hospice cap amount for the 2022 cap year is equal to the FY 2021 cap amount ($30,683.93) updated by the FY 2022 hospice payment update percentage of 2.0 percent. As such, the FY 2022 cap amount is $31,297.61.

  • The revised payment rates and wage index will be incorporated in the Hospice Pricer and forwarded to the Medicare contractors. The wage index will not be published in the Federal Register but will be available on the CMS website at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/index.html
  • The FY 2022 Hospice final rule revised the labor shares used to wage-adjust hospice payments for each level of care. The revised labor share for Routine Home Care is 66.00 percent and corresponding the non-labor share is 34.00 percent. The revised labor share for Continuous Home Care is 75.20 percent and the corresponding nonlabor share is 24.80 percent. The revised labor share for Inpatient Respite Care is 61.00 percent and the corresponding non-labor share is 39.00 percent. The revised labor share for General Inpatient Care is 63.50 percent and the corresponding non-labor share is 36.50 percent.