FY 2021 Wage Index and Payment Rule Comments

CMS published the FY 2021 Hospice Wage Index and Payment Rate Update in April.  Since then, we have been working with the QAPI and the Clinical Leadership Peer Groups to formulate our comments.  They were submitted on June 8th.  We thanked CMS for the 2.6% increase in all levels of care.  But we objected to initiating the Addendum and Updated Benefit Election Form at this time.  We pointed out that the EMR vendors, as of March, have not released their upgrades that would allow us to electronically document and produce the Addendum.  With the pandemic hitting New York so hard, no provider in impacted areas will have the time or staff availability to implement them before the 10/1/2020 deadline.  We requested that this be delayed until a year after the Public Health Emergency has been canceled and we cited an example of a home care regulation that was delayed for that reason.  
Further, we commented on many aspects of the sample addendum and election statement for when they will need to be used.  CMS did not inlcude statutory language in the sample election statement saying  hospice should cover all care related to my terminal illness and related conditions needed under the hospice election.  We corrected that, citing Medicare regulations, to I also understand that services unrelated to my terminal illness and related conditions are exceptional and unusual and hospice should cover virtually all care related to my terminal illness and related conditions needed under the hospice election that are reasonable and necessary for the palliation and management of the terminal illness as well as related conditions and as consistent with and delineated in a specific patient plan of care.  
We suggested deleting the witness requirement which is not statutorily required, putting the name of the hospice on the form, increasing the font, and a few other items to help it read more easily. 
Although we have some faith that this can be moved, hospices will have to continue to work on the implementation until CMS responds.  They generally respond by end of July or early August to the comments.  
 Carla was on the workgroup at NHPCO for their response as well.  Although not identical, we did not disagree with each other in the responses.  HPCANYS was more specific to NY State's experience during the pandemic.