FY 2022 Final Rule: What to Expect in 2022

This month, the Centers for Medicare & Medicaid Services (CMS) finalized the FY 2022 CMS Proposed Rule. On August 4, 2021, the Federal Register made public the official FY 2022 CMS Final Rule. The Hospice Final Rule goes into effect on January 1st, 2022.

Hospice agencies can expect minor changes to the proposed rule that positively impact the quality and transparency of care. In the new year, the CMS will adjust current models, metrics, and figures, solidify changes made during the public health emergency (PHE), and set proposed trajectories for long-term change.


What Changes Can Be Expected to the Hospice Final Rule


Adjusted Routine Annual Rate Settings and Payments

In 2022, hospice agencies can expect a two percent increase in payment compared to 2021. The statutory aggregate cap amount is also subject to this two percent increase, with a new cap amount of $31,297.61 per hospice patient.

Updated Hospice Payment Policies and Labor Shares

The finalized changes rebase and revise labor shares for all levels of hospice care. The labor shares are now calculated as follows:

● Routine Home Care (RHC): 66%
● Continuous Home Care (CHC): 75.2%
● Inpatient Respite Care (IRC): 61%
● General Inpatient Care (GIC): 63.5%

Permanent Changes to the Hospice Conditions of Participation (CoPs)

First, the finalized changes adjust aspects of the current hospice aide competency evaluation standards. Second, the CMS signed off on the continued use of pseudo-patients to support hospice aide competency training. Last, the 2022 finalized changes solidify a new policy that requires a Competency Evaluation during hospice aide supervisory visits. The evaluation will assess competency based on two simplified categories: deficient skills and related skills.

Continued PHE Blanket Waivers

As part of the CoPs, certain waivers used to minimize staff burdens during the public health emergency (PHE) will be continued through FY 2022, such as telehealth services.

Finalized Changes to Hospice Quality Reporting Programs (HQRP)

In 2022, hospice agencies will be required to use four quality measures:

Hospice in the Last Days of Life (HVLDL), a claims-based measure that will be publicly reported.
HIS Comprehensive Assessment Measure (previously known as the Hospice and Palliative Care Composite Process Measure: Hospice Comprehensive Assessment at Admission Measure), which will remove the seven previous individual HIS process measures.
Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey Star Ratings, a standardized ranking that will allow patients to compare care quality across hospice agencies.
– The newly added Hospice Care Index (HCI) measure, which will be publicly reported sometime after May 2022. The HCI is a claims-based quality assessment that leverages 10 quality indicators, each representing a different aspect of quality care.

Going forward, the CMS will continue to provide updates regarding the new assessment instrument, Hospice Outcome, and Patient Evaluation (HOPE).

Request For Information (RFI): HQRP and Fast Healthcare Interoperability Resources (FHIR)

To comply with Executive Order 13985, the RFI serves to help the CMS discover capabilities of regulation in closing the Health Equity Gap. The feedback received from the RFI will inform ongoing policy changes and HQRPs.

The CMS specifies intentions for 2023 once feedback from the RFI is procured. These include:
a) advancing the FHIR standard, b) defining digital quality measures (dQMs) for the HQRP, and
c) using FHIR for dQMs in the HQRP.

The advancement of FHIR standards is intended to provide transparency of clinical information. Specifically, FHIR-based standards will enable clinicians to digitally share information, facilitating continuity of care for all hospice beneficiaries.

Finalized Regulation Language Changes for Hospice Final Rule

Finally, the rule finalized certain language changes for the sake of clarifications, including text changes to the hospice election statement addendum requirements.

To learn more about the FY 2022 Hospice Final Rule, read the official release on the Federal Register.

Ensuring Compliant Care in 2022 with EMR Technology

As always, KanTime continues to support Hospice agency compliance. Our EMR is continuously updated to ensure regulatory compliance in 2022 and facilitate your agency’s internal evaluation of compliance. Request a demo to learn more.