CMS updates hospice payments in proposed rule for 2023


CMS is following a budget-neutral approach by implementing a permanent cap on negative wage index changes to smooth yearly payment impacts.

The Centers for Medicare and Medicaid Services has issued a proposed rule updating hospice-based payments and the aggregate cap amount for fiscal year 2023.

Hospices would see a 2.7%, or $580 million, increase in their payments for 2023. This is based on the estimated 3.1% inpatient hospital market basket update reduced by the productivity adjustment of 0.4%. Hospices that fail to meet quality reporting requirements would receive a 2% reduction to the annual market basket update.

This compares to a 2.3% increase for 2022.

The new hospice payment update includes a statutory aggregate cap that limits the overall payments per patient that are made to a hospice annually. The proposed cap amount for 2023 is $32,142.65, a 2.7% increase from the 2022 cap amount.

Public comments on the proposal will be accepted until May 31.

Quality-measure updates include:

The development of a patient-assessment instrument, titled HOPE, which would contribute to a patient’s plan of care when adopted. This includes an update on the beta testing and derivatives that will be achieved during this phase of testing, such as burden estimates and timepoints for collection, as well as additional outreach efforts that will be conducted during and after beta testing and during our future plans for adoption.

A potential future update to the CAHPS Hospice Survey, which is used to collect data on experiences of hospice care. In particular, CMS is providing an update on a mode experiment whose goal was to test the effect of adding a web-based mode to the CAHPS Hospice Survey.

Updating information on CMS’ Health Equity Initiative within the Hospice Quality Reporting Program by describing its current assessment of health equity. CMS is also seeking input on a potential future structural measure as well as responses to specific questions that would further inform future efforts.


In the proposed rule, CMS is following a budget-neutral approach by implementing a permanent cap on negative wage index changes greater than a 5% decrease from the prior year, regardless of the underlying reason for the decrease.

This establishes a permanent mitigation policy to smooth the impact of year-to-year changes in hospice payments related to changes in the hospice wage index, CMS said.


In April 2021, CMS proposed a 2.3%, or $530 million, increase in hospice payments for 2022. The proposed 2.3% hospice payment update was based on the estimated 2.5% inpatient hospital market basket reduced by the multifactor productivity adjustment of 0.2%.

CMS said it is improving data-collection measures to analyze disparities, to address consistent and persistent inequities in health outcomes.

For More Information: cms updates hospice payments proposed rule 2023