Texas Register

Title 26. Health and Human Services Part 1. Health and Human Services Commission Chapter 266. Medicade Hospice Program the Texas Administrative Code (TAC), Title 26, Part 1, new Chapter 266, Medicaid Hospice Program were adopted.  Medicaid hospice rules were moved under HHSC from 40 TAC Chapter 30 to 26 TAC Chapter 266 as part of the consolidation.

The new rules cover the following:

  • The rules will be consistent with the federal Medicare hospice regulations,
  • Certification periods will be 90,90,60
  • Definitions were added: interdisciplinary team, licensed vocational nurse, period of crisis, registered nurse, service intensity add on and many more
  • Details about utilization review policy requirements, such as describing what the individualized plan of care must include, types of required documentation that a hospice must maintain, and specifics regarding the certification of terminal illness, and update standards to protect the health and safety of individuals receiving hospice care.
  • Incorporate the federal rate changes in Title 42, Code of Federal Regulations (CFR), Chapter IV, Part 418, Subpart G, Payment for Hospice Care, that HHSC implemented on January 1, 2016. These changes allow providers to be paid at a higher rate during the first 60 days of routine home care and during the final seven days. Additionally, the new rules create an annual aggregate cap and align it with the federal fiscal year. The proposed new rules also align hospice election periods to those in 42 CFR, Chapter IV, Part 418, Subpart B, §418.21 Duration of hospice care coverage – Election periods.
  • Hospice documentation requirements,
  • Recoupment of payments, and
  • The option to request an informal review of and appeal proposed recoupment.

If you would like to review the comment and responses in the Texas Register, go to:  https://www.sos.state.tx.us/texreg/archive/July222022/index.html.

You can access the new rules at:  https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=26&pt=1&ch=266.


Federal News and Information

What’s New for Fiscal Year 2023?

CMS issued the Fiscal Year (FY) 2023 Hospice Payment Rate Update final rule to update Medicare hospice payments, wage index, quality reporting programs, and policies. Areas of interest are:

  • Routine annual rate setting changes resulting in a 3.8% increase in payments for FY 2023. The cap amount for FY 2023 is $32,486.92 (FY 2022 cap amount of $31,297.61 increased by 3.8%).
  • Permanent 5% cap on negative wage index changes; and
  • Hospice Quality Reporting Program (HQRP) updates, including the new Hospice Outcomes and Patient Evaluation Tool, the Consumer Assessment of Healthcare Providers and Systems hospice survey, quality measures for FY 2023, and a summary of public comments from the request for information to inform future efforts related to HQRP health equity

Detailed information on the wage index can be found here:  https://www.cms.gov/medicaremedicare-fee-service-paymenthospicehospice-regulations-and-notices/cms-1773-f.

In depth summation on the above areas can be found here:  https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2023-hospice-payment-rate-update-final-rule-cms-1773-f.




New and seasoned hospice providers, please be aware of the following HQRP requirements and know you will lose money if you do NOT comply!  You will also learn about documentation, audits, Palmetto’s expectations of the provider etc.  Great reasons to make plans to attend MACTOBER Fest November 9-10!

Hospice Quality Reporting Program (HQRP) Compliance

  • Most new hospices are not aware that all Medicare-certified hospice providers must comply with the individual submission requirements of Hospice Quality Reporting Program (HQRP) or be subject to a percentage point reduction in their annual payment update (APU). The payment reduction is currently two percent of the APU for existing hospices but is increasing to four percent of their APU beginning in FY 2024 for all 2022 non-compliance hospices. Payment reductions are based on individual fiscal year reporting. To assist and support new and existing hospices, the CMS Hospice Quality Reporting Program (HQRP) webpage provides detailed information and training a hospice may use to ensure HQRP compliance. More detailed information on HQRP can be accessed at:  https://www.palmettogba.com/palmetto/jmhhh.nsf/DID/5EM7CLHSLO#ls.

Hospice Visits in the Last Days of Life

  • On July 26, 2022, the National Quality Forum (NQF) endorsed the claims-based measure, Hospice Visits in the Last Days of Life (HVLDL) as NQF #3645. NQF is a not-for-profit, nonpartisan, membership-based organization that facilitates an evidence- and consensus-based approach to endorsing quality measures. HVLDL reflects the proportion of hospice patients who received in-person visits from a registered nurse or a medical social worker on at least 2 of the final 3 days of life. HVLDL is the re-specified measure replacing the HIS-based Hospice Visits When Death is Imminent (HVWDII). Public reporting for HVLDL will begin in August 2022 and will replace public reporting of HVWDII.
  • More information, including a link to the NQF website, can be found on the HQRP Quality Measure Development webpage:  https://www.cms.gov/medicare/hospice-quality-reporting-program/quality-measure-development.

HQRP: Hospice Care Index Measure (HCI) Informational Video

  • CMS is proud to introduce a video describing the Hospice Care Index (HCI) measure. This video provides an overview of the new HCI claims-based measure, which combines several quality indicators into a single index score that patients and families can readily use to compare their hospice options. With the inclusion of this measure, the Medicare Hospice Quality Reporting Program offers patients, families, and caregivers a more comprehensive and holistic view when making decisions about hospice care.
  • You can access the video here: https://youtu.be/qFeo2OMRXDk

HQRP Explanatory Video

  • CMS has released a new video resource providing an overview of the HQRP. The video introduces the purpose of the HQRP, how data is collected for use in HQRP, and the quality measures included in HQRP. You can access the video on the CMS YouTube channel here: https://youtu.be/nfcq80J6csw.


Hospices: Volunteer to Test Hospice Outcomes & Patient Evaluation Instrument

CMS is looking for additional Medicare-certified hospice providers to test the Hospice Outcomes & Patient Evaluation assessment instrument. We plan to collect data from August through this fall. Visit the Updates section of the Provider and Stakeholder Engagement webpage for more details:  https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-QRP-Provider-Engagement-Opportunities.


Texas News and Information

Health and Human Services Commission (HHSC)

How Should a Hospice Handle Comfort Kits for a Patient?

As a hospice provider, you are aware that you are responsible for the pain management of your patients regardless of where they are living.  Comfort kits are allowed in the NF and ICFIID if the NF agrees, and it is part of your agreement with the provider.   Comfort kits contain the drugs and pharmaceuticals need for that hospice patient.  They CANNOT be used for multiple patients!!   You may find that these providers do not want comfort kits within their facility, as is within their rights.  But remember, you, the hospice provider are responsible for the management of pain, on call 24/7 and are required to remind and educate the provider that you are to be called about pain management!!

If the provider agrees to the comfort kits, in writing, the hospice medical director would place orders on the chart for each medication, its route etc.  The patient determines at the beginning and throughout their care how they want their pain managed by the hospice provider!  It must be documented and addressed in the patient’s plan of care.

Medicaid Hospice Provider Webinar Slated for Aug. 17


HHSC Issues New Regional Boundaries for Long-term Care Providers (PL 2022-18)

HHSC has published Provider Letter 2022-18 – New Regional Boundaries for Long-term Care Providers (PDF).

The letter indicates that HHSC Long-term Care Regulation has redrawn regional boundaries for survey and investigation purposes effective August 1, 2022.  All LTC providers are affected by the new regional boundaries. Please see the map for the new regional boundaries that go into effect on August 1, 2022. The new boundaries separate former Region 7 into two new regions: Region 8 and 11.  You can access the letter which does have the link to the regional map at:  https://www.hhs.texas.gov/sites/default/files/documents/pl2022-18.pdf.



Disclaimer:  The Texas and New Mexico Hospice Organization publishes the Regulatory Update as an information only item.  TNMHO has no attorneys nor does it represent the state and federal governments.  All legal questions or concerns should be directed to your attorney or the governments involved.