Serving the home health, home care and hospice industry since 1999.

CMS Finalizes 2019 Hospice Wage Index and Payment Rates

On August 1, CMS issued a final rule (CMS-1692-F) that updates fiscal year (FY) 2019 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries.  In addition, this final rule updates the hospice quality reporting requirements.

Burden Reduction

This rule enables more efficient use of Hospice Compare data in the Hospice Quality Reporting Program by no longer directly displaying the 7 component measures from which a composite measure is calculated on Hospice Compare. CMS would still provide the public the ability to view these component measures in a manner that avoids confusion on Hospice Compare. CMS plans to achieve this by reformatting the display of the component measures so that they are only viewable in an expandable/collapsible format under the composite measure itself, thus allowing users the opportunity to view the component measure scores that were used to calculate the main composite measure score.  

Improving Transparency for Patients

In addition to the updates to the public reporting of measures on Hospice Compare, this final rule also provides several updates to the quality reporting program for hospices. Specifically, the final rule finalizes several procedural policies, including a review and correction timeframes for data submitted using the Hospice Item Set (HIS), an extension of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey participation requirements as well as several public reporting policies and procedures. Also finalized are specific updates and improvements to Hospice Compare including the public display of the HIS-based Hospice Comprehensive Assessment Measure (NQF #3235) and Hospice Visits when Death is Imminent Measure Pair, reformatting of the public display of the current seven HIS quality measures, and inclusion of data as shown from the CMS Public Use Files (PUFs) to help consumers make an informed decision in their selection of a hospice.

Meaningful Measures

The “Meaningful Measures” initiative is intended to provide a framework for quality measurement and improvement work at CMS.  While this framework serves to focus on those core issues that are most vital to providing high-quality care and improving patient outcomes, it also takes into account opportunities to reduce paperwork and reporting burden on providers associated with quality measurement.

In this rule, we are finalizing a measure removal factor that takes into consideration whether the costs and burden associated with a measure outweighs the benefit of its continued use in the program.  Our goal is to move the program forward in the least costly and burdensome manner possible, while maintaining meaningful quality measures and continuing to incentivize improvement in the quality of care provided to patients. 

Routine Annual Rate Setting Changes

As finalized, hospices will see a 1.8 percent ($340 million) increase in their payments for FY 2019. The 1.8 percent hospice payment update percentage for FY 2019 is based on a 2.9 percent inpatient hospital market basket update, reduced by a 0.8 percentage point multifactor productivity adjustment and reduced by a 0.3 percentage point adjustment required by law. Hospices that fail to meet quality reporting requirements receive a 2.0 percentage point reduction to their payments.

The hospice payment system includes a statutory aggregate cap. The aggregate cap limits the overall payments made to a hospice annually. The cap amount for FY 2019 will be $29,205.44 (2018 cap amount of $28,689.04 increased by 1.8 percent).

Hospice Regulations Text Changes Due to the Bipartisan Budget Act of 2018

Section 51006 of the Bipartisan Budget Act of 2018 amended section 1861(dd)(3)(B) of the Social Security Act such that, effective January 1, 2019, physician assistants are recognized as attending physicians for Medicare hospice beneficiaries.  This statutory change expands the definition of a hospice attending physician to include physician assistants in addition to physicians and nurse practitioners.  We are finalizing changes to the hospice regulations to reflect that change.

The final rule went on display at the Federal Register's Public Inspection Desk and will be available under "Special Filings," at

For further information, see

Medicare Part D premiums continue to decline in 2019

Today, the Centers for Medicare & Medicaid Services (CMS) announced that, for the second year in a row, the average basic premium for a Medicare Part D prescription drug plan in 2019 is projected to decline. At a time when health insurance premiums are rising across-the-board, basic Part D premiums are expected to fall from $33.59 this year to $32.50 next year.

“President Trump and Secretary Azar have made clear that prescription drug costs must come down. The actions that HHS and CMS are taking to increase competition in order to drive down costs for patients are working,” said CMS Administrator Seema Verma. “CMS will continue to strengthen the Part D program and bolster plans’ negotiating power so they can get the best deal for seniors from prescription drug manufacturers.”

In Medicare Part D, beneficiaries choose the prescription drug plan that best meets their needs, and plans have to improve quality and lower costs to attract beneficiaries. This competitive dynamic sets up clear incentives that drive towards value, as determined by beneficiaries. Earlier this year, CMS announced several changes in the Part D program aimed at further empowering Part D plans to drive a hard bargain with drug manufacturers and lower the cost of prescription drugs. Strengthening negotiations is a key pillar of the Administration’s Blueprint to reduce prescription drug costs. CMS has been working to ensure that Medicare Part D plans can leverage all of the tools that are available to commercial plans in negotiations.

Changes that CMS has made to date include:

  • Reducing the maximum amount that low-income beneficiaries pay for certain innovative medicines known as “biosimilars.” 
  • Allowing for certain generic drugs to be substituted onto plan formularies more quickly during the year, so beneficiaries immediately benefit and have lower cost sharing.
  • Increasing competition among plans by removing the requirement that certain Part D plans have to “meaningfully differ” from each other, making more plan options available.
  • Increasing competition among pharmacies by clarifying the “any willing provider” requirement, to increase the number of pharmacy options that beneficiaries have.

The upcoming annual Medicare open enrollment period for 2019 begins on October 15, 2018, and ends on December 7, 2018. During this time, Medicare beneficiaries can choose health and drug plans for 2019 by comparing their current coverage and plan quality ratings to other plan offerings, or they can choose to remain in traditional Medicare. The agency will be continuing to improve the website for Medicare plan selection, so beneficiaries can more easily compare options and choose the plan that best meets their needs. CMS anticipates releasing the premiums and costs for Medicare health and drug plans for the 2019 calendar year in mid-to-late September.

To view the 2019 Part D base beneficiary premium, the Part D national average monthly bid amount, the Part D regional low-income premium subsidy amounts, the de minimis amount, the Part D income-related monthly adjustment amounts, the Medicare Advantage employer group waiver plan regional payment rates, and the Medicare Advantage regional PPO benchmarks, visit: and select “2019.” 

©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.