By Kristin Rowan, Editor

On March 28, CMS issued a new proposed rule to update Medicare hospice payments. Here’s what we know.

The new proposed rule:

  • Would change the existing hospice wage index
  • Clarifies current policy related to the hospice “eletion statement” and the “ntoice of election”
  • Adds clarifying language around hospice certification
  • Includes a request for information to get comments on implementing a separate payment mechanism for high-intensity palliative care services
  • Proposes that Hospice Quality Reporting Program (HQRP) measures be collected through the Hospice Outcomes and Patient Evaluation (HOPE), adding two new measures
  • Also proposes changes to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey

The new proposed rule includes a net 2.6% increase in payments over FY 2024. This includes a 3% market-based update, and a 0.4% cut for productivity. Submitting quality data is a requirement of the net pay. Hospices that do not submit quality data will be penalized 4%, netting a 1.4% decrease in payments. The propsed rule for 2025 is .5% lower than the 2024 hospice payment increase.

The National Hospice and Palliative Care Organization (NHPCO) says the rate increase is good, but not high enough. NHPCO COO and Interim CEO, Ben Marcantonio said, “To continue providing the high level of care our patients and their families deserve, hospices require a payment rate that accurately reflects the current economic challenges. We know that hospice care has demonstrated $3.5 billion in annual savings for Medicare, which underscores the critical importance of investing in hospice to ensure continued beneficiary access to quality end-of-life care.”

Palliative Care

CMS is interested in feedback and proposals from hospice agencies for providing complex palliative treatments and high-intensity hospice care when that care negatively impacts hospices financially. CMS aims to care for high-cost patients through palliative care rather than acute care. The NHPCO agrees with the CMS proposal to fund palliative care separately from standard hospice or acute care. CMS will take feedback and proposals through May 28, 2024. Comments can be submitted electronically at, by following the “Submit a Comment” instructions. Comments can also be sent by regular or express mail. Addresses can be found in the full proposed rule. Follow the search instructions at to see all submitted comments.

The proposed rule can be viewed starting April 4, 2024 at the Federal Register at

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Kristin Rowan

Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly or

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