MSA shuffle is preview for coming home health agency changes. Some hospices will be jumping for joy while others will be tightening their belts in response to wage index changes hitting hospices for the first time.
The changes to the metropolitan statistical areas used to calculate the labor portion of the Medicare hospice payment rate are finally taking effect Oct. 1 for hospices. Home health agencies are expected to follow with Jan. 1 implementation.
The Centers for Medicare & Medicaid Services will adopt the MSA changes the Office of Management and Budget announced in 2003 based on the 2000 U.S. census (see Eli's HCW, Vol. XII, No. 23, p. 182). OMB recommended implementing them last year, but CMS held off until fiscal year 2006.
Instead of just using Metropolitan Statistical Areas (MSAs) as in the past, OMB and now CMS have adopted Core-Based Statistical Areas (CBSAs) that include MSAs and Micropolitan Areas, CMS notes in a proposed rule published in the April 29 Federal Register. OMB reassigned many counties to new MSAs or Micropolitan areas.
There are 1,090 counties in the new CBSA designation, while there were 848 counties under the old MSAs. That means significant payment increases for hospices bumped up to CBSAs from rural areas, notes Judi Lund Person with the National Hospice and Palliative Care Association.
But it also means payment decreases for hospices bumped down from a higher-paying MSA to a lower-paying MSA or Micropolitan Area.
For example, counties around Atlanta, GA are seeing sizable increases while counties in the Northeast and some parts of the West are facing striking decreases, Person tells Eli.
Nationwide, rural hospices will see a 0.8 percent increase to payments while urban hospices will see a 0.2 percent decrease, CMS says in the rule.
NHPCO wants CMS to grant hospices a phase-in period to adjust to the sometimes drastic wage index swings, seeing as hospitals have received such a phase-in. And the last time hospices saw major wage index changes, in 1997, CMS granted a three-year phase-in, Person adds.
"We are urging members to look up their new wage index and run the numbers," Person says. Then they should submit their own comments on the proposed rule to CMS. Comments are due June 28.
Regulation change: In addition to the wage index changes, CMS sets out in the regulation the hospice-related provisions from the Medicare Moderniza-tion Act. The changes, which have already taken effect, include allowing nurse practitioners to act as attending physicians for hospice services, a new hospice consultation service and allowing hospices to furnish core services under arrangement.
Editor's Note: The proposed rule is at
www.access.gpo.gov/su_docs/fedreg/a050429c.html.
