{"abstract":"This final rule updates the hospice wage index, payment rates, and aggregate cap amount for Fiscal Year (FY) 2024. This rule discusses the comments received regarding information related to the provision of higher levels of hospice care; spending patterns for non-hospice services provided during the election of the hospice benefit; ownership transparency; equipping patients and caregivers with information to inform hospice selection; and ways to examine health equity under the hospice benefit. This rule also finalizes conforming regulations text changes related to the expiration of the COVID-19 public health emergency. In addition, this rule updates the Hospice Quality Reporting Program; discusses the Hospice Outcomes and Patient Evaluation tool; provides an update on Health Equity and future quality measures; and provides updates on the Consumer Assessment of Healthcare Providers and Systems, Hospice Survey Mode Experiment. This rule also codifies hospice data submission thresholds and discusses updates to hospice survey and enforcement procedures. Additionally, the rule requires hospice certifying physicians to be Medicare-enrolled or to have validly opted-out.","action":"Final rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2023/08/02/2023-16116.html","cfr_references":[{"chapter":null,"citation_url":null,"part":"418","title":42},{"chapter":null,"citation_url":null,"part":"424","title":42}],"citation":"88 FR 51164","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"These regulations are effective on October 1, 2023. The implementation date for the provider enrollment provisions in this final rule is May 1, 2024.","disposition_notes":null,"docket_ids":["CMS-1787-F"],"dockets":[{"supporting_documents":[],"agency_name":"CMS","documents":[{"comment_count":0,"comment_start_date":"2023-08-02","updated_at":"2023-08-03T16:56:30.413-04:00","comment_url":"https://www.regulations.gov/commenton/CMS-2023-0051-0079","allow_late_comments":null,"id":"CMS-2023-0051-0079","comment_end_date":"2023-08-03","regulations_dot_gov_open_for_comment":false}],"supporting_documents_count":0,"id":"CMS-2023-0051","title":"FY 2024 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, Hospice Quality Reporting Program Requirements, and Hospice Certifying Physician Provider Enrollment Requirements CMS-1787-P"}],"document_number":"2023-16116","effective_on":"2023-10-01","end_page":51199,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2023/08/02/2023-16116.xml","html_url":"https://www.federalregister.gov/documents/2023/08/02/2023-16116/medicare-program-fy-2024-hospice-wage-index-and-payment-rate-update-hospice-conditions-of","images":{"ER02AU23.080":{"large":"https://img.federalregister.gov/ER02AU23.080/ER02AU23.080_large.png","medium":"https://img.federalregister.gov/ER02AU23.080/ER02AU23.080_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.080/ER02AU23.080_original_size.png"},"ER02AU23.091":{"large":"https://img.federalregister.gov/ER02AU23.091/ER02AU23.091_large.png","medium":"https://img.federalregister.gov/ER02AU23.091/ER02AU23.091_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.091/ER02AU23.091_original_size.png"},"ER02AU23.081":{"large":"https://img.federalregister.gov/ER02AU23.081/ER02AU23.081_large.png","medium":"https://img.federalregister.gov/ER02AU23.081/ER02AU23.081_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.081/ER02AU23.081_original_size.png"},"ER02AU23.090":{"large":"https://img.federalregister.gov/ER02AU23.090/ER02AU23.090_large.png","medium":"https://img.federalregister.gov/ER02AU23.090/ER02AU23.090_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.090/ER02AU23.090_original_size.png"},"ER02AU23.079":{"large":"https://img.federalregister.gov/ER02AU23.079/ER02AU23.079_large.png","medium":"https://img.federalregister.gov/ER02AU23.079/ER02AU23.079_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.079/ER02AU23.079_original_size.png"},"ER02AU23.084":{"large":"https://img.federalregister.gov/ER02AU23.084/ER02AU23.084_large.png","medium":"https://img.federalregister.gov/ER02AU23.084/ER02AU23.084_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.084/ER02AU23.084_original_size.png"},"ER02AU23.085":{"large":"https://img.federalregister.gov/ER02AU23.085/ER02AU23.085_large.png","medium":"https://img.federalregister.gov/ER02AU23.085/ER02AU23.085_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.085/ER02AU23.085_original_size.png"},"ER02AU23.082":{"large":"https://img.federalregister.gov/ER02AU23.082/ER02AU23.082_large.png","medium":"https://img.federalregister.gov/ER02AU23.082/ER02AU23.082_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.082/ER02AU23.082_original_size.png"},"ER02AU23.083":{"large":"https://img.federalregister.gov/ER02AU23.083/ER02AU23.083_large.png","medium":"https://img.federalregister.gov/ER02AU23.083/ER02AU23.083_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.083/ER02AU23.083_original_size.png"},"ER02AU23.077":{"large":"https://img.federalregister.gov/ER02AU23.077/ER02AU23.077_large.png","medium":"https://img.federalregister.gov/ER02AU23.077/ER02AU23.077_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.077/ER02AU23.077_original_size.png"},"ER02AU23.088":{"large":"https://img.federalregister.gov/ER02AU23.088/ER02AU23.088_large.png","medium":"https://img.federalregister.gov/ER02AU23.088/ER02AU23.088_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.088/ER02AU23.088_original_size.png"},"ER02AU23.078":{"large":"https://img.federalregister.gov/ER02AU23.078/ER02AU23.078_large.png","medium":"https://img.federalregister.gov/ER02AU23.078/ER02AU23.078_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.078/ER02AU23.078_original_size.png"},"ER02AU23.089":{"large":"https://img.federalregister.gov/ER02AU23.089/ER02AU23.089_large.png","medium":"https://img.federalregister.gov/ER02AU23.089/ER02AU23.089_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.089/ER02AU23.089_original_size.png"},"ER02AU23.086":{"large":"https://img.federalregister.gov/ER02AU23.086/ER02AU23.086_large.png","medium":"https://img.federalregister.gov/ER02AU23.086/ER02AU23.086_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.086/ER02AU23.086_original_size.png"},"ER02AU23.087":{"large":"https://img.federalregister.gov/ER02AU23.087/ER02AU23.087_large.png","medium":"https://img.federalregister.gov/ER02AU23.087/ER02AU23.087_medium.png","original_size":"https://img.federalregister.gov/ER02AU23.087/ER02AU23.087_original_size.png"}},"images_metadata":{"ER02AU23.080":{"large":{"identifier":"ER02AU23.080","content_type":"image/png","size":22761,"width":823,"sha":"50a646519a014105a6521b1d5a12c555","url":"https://img.federalregister.gov/ER02AU23.080/ER02AU23.080_large.png","height":346},"medium":{"identifier":"ER02AU23.080","content_type":"image/png","size":13858,"width":574,"sha":"5ab17828d68c8a99206f4f80029cdf7b","url":"https://img.federalregister.gov/ER02AU23.080/ER02AU23.080_medium.png","height":242},"original_size":{"identifier":"ER02AU23.080","content_type":"image/png","size":41127,"width":4430,"sha":"ea3153e77cf48132c61d0feaf07c18b2","url":"https://img.federalregister.gov/ER02AU23.080/ER02AU23.080_original_size.png","height":1865}},"ER02AU23.091":{"large":{"identifier":"ER02AU23.091","content_type":"image/png","size":53767,"width":823,"sha":"c99475200033f40bd9321e4e522dc106","url":"https://img.federalregister.gov/ER02AU23.091/ER02AU23.091_large.png","height":411},"medium":{"identifier":"ER02AU23.091","content_type":"image/png","size":25621,"width":517,"sha":"bd268a0d176fbf799f0499e5e9eb04dd","url":"https://img.federalregister.gov/ER02AU23.091/ER02AU23.091_medium.png","height":258},"original_size":{"identifier":"ER02AU23.091","content_type":"image/png","size":105348,"width":3900,"sha":"e73203ecb82b10c2e19c8a29454f56a5","url":"https://img.federalregister.gov/ER02AU23.091/ER02AU23.091_original_size.png","height":1946}},"ER02AU23.081":{"large":{"identifier":"ER02AU23.081","content_type":"image/png","size":26780,"width":822,"sha":"74e28bcb54a7fba21d8c18cc89de1e5d","url":"https://img.federalregister.gov/ER02AU23.081/ER02AU23.081_large.png","height":352},"medium":{"identifier":"ER02AU23.081","content_type":"image/png","size":16005,"width":562,"sha":"68e313a11c541b4fcd1f2c1deb331a7b","url":"https://img.federalregister.gov/ER02AU23.081/ER02AU23.081_medium.png","height":241},"original_size":{"identifier":"ER02AU23.081","content_type":"image/png","size":46950,"width":4241,"sha":"1509b15f878892fcbbf1d84859c77c00","url":"https://img.federalregister.gov/ER02AU23.081/ER02AU23.081_original_size.png","height":1817}},"ER02AU23.090":{"large":{"identifier":"ER02AU23.090","content_type":"image/png","size":30613,"width":823,"sha":"cb16fbee41578e8491013073a6c54e4d","url":"https://img.federalregister.gov/ER02AU23.090/ER02AU23.090_large.png","height":329},"medium":{"identifier":"ER02AU23.090","content_type":"image/png","size":14851,"width":491,"sha":"6c7ce7f43aa6bacde9122d8af698ee0b","url":"https://img.federalregister.gov/ER02AU23.090/ER02AU23.090_medium.png","height":196},"original_size":{"identifier":"ER02AU23.090","content_type":"image/png","size":54058,"width":3710,"sha":"fd99ec0f33a400791e4ec29087218ad7","url":"https://img.federalregister.gov/ER02AU23.090/ER02AU23.090_original_size.png","height":1481}},"ER02AU23.079":{"large":{"identifier":"ER02AU23.079","content_type":"image/png","size":21324,"width":823,"sha":"10513cb3f7768e6bc3e88e71b972bd7e","url":"https://img.federalregister.gov/ER02AU23.079/ER02AU23.079_large.png","height":247},"medium":{"identifier":"ER02AU23.079","content_type":"image/png","size":11576,"width":574,"sha":"2ce8356eb9a250254bfa108527a02da3","url":"https://img.federalregister.gov/ER02AU23.079/ER02AU23.079_medium.png","height":172},"original_size":{"identifier":"ER02AU23.079","content_type":"image/png","size":37612,"width":4351,"sha":"45aa9b6ec6c0d898f0bf1f0d2c478d6a","url":"https://img.federalregister.gov/ER02AU23.079/ER02AU23.079_original_size.png","height":1306}},"ER02AU23.084":{"large":{"identifier":"ER02AU23.084","content_type":"image/png","size":62329,"width":822,"sha":"170a5c256d3f1d45edea91e61ac92176","url":"https://img.federalregister.gov/ER02AU23.084/ER02AU23.084_large.png","height":671},"medium":{"identifier":"ER02AU23.084","content_type":"image/png","size":29174,"width":520,"sha":"f7f39f79f6339a19a906302c90bee8be","url":"https://img.federalregister.gov/ER02AU23.084/ER02AU23.084_medium.png","height":424},"original_size":{"identifier":"ER02AU23.084","content_type":"image/png","size":125205,"width":3921,"sha":"b27bedf506e176d484ba2259c99f5942","url":"https://img.federalregister.gov/ER02AU23.084/ER02AU23.084_original_size.png","height":3199}},"ER02AU23.085":{"large":{"identifier":"ER02AU23.085","content_type":"image/png","size":10765,"width":815,"sha":"57c89797d381b23db6f87a1a4b65e87d","url":"https://img.federalregister.gov/ER02AU23.085/ER02AU23.085_large.png","height":112},"medium":{"identifier":"ER02AU23.085","content_type":"image/png","size":5759,"width":539,"sha":"a108b39ab4573787cc0c6edbb680ad8e","url":"https://img.federalregister.gov/ER02AU23.085/ER02AU23.085_medium.png","height":74},"original_size":{"identifier":"ER02AU23.085","content_type":"image/png","size":20027,"width":4090,"sha":"35dc5f7c81c7753b91d33262c264443e","url":"https://img.federalregister.gov/ER02AU23.085/ER02AU23.085_original_size.png","height":562}},"ER02AU23.082":{"large":{"identifier":"ER02AU23.082","content_type":"image/png","size":79204,"width":823,"sha":"df3a58b670dfaf601f8801cf431ea5d8","url":"https://img.federalregister.gov/ER02AU23.082/ER02AU23.082_large.png","height":1001},"medium":{"identifier":"ER02AU23.082","content_type":"image/png","size":29514,"width":464,"sha":"2b7184a25aa8dbbd29fdf5f2c8af2ca2","url":"https://img.federalregister.gov/ER02AU23.082/ER02AU23.082_medium.png","height":565},"original_size":{"identifier":"ER02AU23.082","content_type":"image/png","size":114652,"width":3500,"sha":"9106093175cde71050dcb3eb2274672c","url":"https://img.federalregister.gov/ER02AU23.082/ER02AU23.082_original_size.png","height":4259}},"ER02AU23.083":{"large":{"identifier":"ER02AU23.083","content_type":"image/png","size":21327,"width":823,"sha":"dce1934adf0e897d9442aaf68d8223f8","url":"https://img.federalregister.gov/ER02AU23.083/ER02AU23.083_large.png","height":210},"medium":{"identifier":"ER02AU23.083","content_type":"image/png","size":9728,"width":506,"sha":"8167a96c8436aa9b8bf247750f3f9f04","url":"https://img.federalregister.gov/ER02AU23.083/ER02AU23.083_medium.png","height":129},"original_size":{"identifier":"ER02AU23.083","content_type":"image/png","size":96628,"width":3813,"sha":"b0a6dd052765dae910877ca354a6c672","url":"https://img.federalregister.gov/ER02AU23.083/ER02AU23.083_original_size.png","height":973}},"ER02AU23.077":{"large":{"identifier":"ER02AU23.077","content_type":"image/png","size":45966,"width":823,"sha":"3ab9fd1dd482c5446565622a4992ac90","url":"https://img.federalregister.gov/ER02AU23.077/ER02AU23.077_large.png","height":590},"medium":{"identifier":"ER02AU23.077","content_type":"image/png","size":23377,"width":518,"sha":"be87d7dc586544420a3233b96ffde006","url":"https://img.federalregister.gov/ER02AU23.077/ER02AU23.077_medium.png","height":371},"original_size":{"identifier":"ER02AU23.077","content_type":"image/png","size":326735,"width":3906,"sha":"13ddeec55b49850f39e354e0b362eb7c","url":"https://img.federalregister.gov/ER02AU23.077/ER02AU23.077_original_size.png","height":2799}},"ER02AU23.088":{"large":{"identifier":"ER02AU23.088","content_type":"image/png","size":43115,"width":823,"sha":"a471cd29f7c01b36d09fe2cf9f79dc23","url":"https://img.federalregister.gov/ER02AU23.088/ER02AU23.088_large.png","height":354},"medium":{"identifier":"ER02AU23.088","content_type":"image/png","size":16803,"width":467,"sha":"4aaf6ed43e51c02f73f6c6ee1d475016","url":"https://img.federalregister.gov/ER02AU23.088/ER02AU23.088_medium.png","height":201},"original_size":{"identifier":"ER02AU23.088","content_type":"image/png","size":72834,"width":3521,"sha":"92b1f06603d6921429efa8031f8d01b4","url":"https://img.federalregister.gov/ER02AU23.088/ER02AU23.088_original_size.png","height":1513}},"ER02AU23.078":{"large":{"identifier":"ER02AU23.078","content_type":"image/png","size":17801,"width":823,"sha":"5f301a69ce066b1f5fc6e51b79b6953b","url":"https://img.federalregister.gov/ER02AU23.078/ER02AU23.078_large.png","height":234},"medium":{"identifier":"ER02AU23.078","content_type":"image/png","size":10643,"width":570,"sha":"e3e742e60a8bcebf53f5fc020391ef0a","url":"https://img.federalregister.gov/ER02AU23.078/ER02AU23.078_medium.png","height":162},"original_size":{"identifier":"ER02AU23.078","content_type":"image/png","size":30609,"width":4310,"sha":"7283b2af46aa59908da852d404c2a304","url":"https://img.federalregister.gov/ER02AU23.078/ER02AU23.078_original_size.png","height":1224}},"ER02AU23.089":{"large":{"identifier":"ER02AU23.089","content_type":"image/png","size":14366,"width":823,"sha":"dab91bcd443bb169242eb6595ea3cd09","url":"https://img.federalregister.gov/ER02AU23.089/ER02AU23.089_large.png","height":147},"medium":{"identifier":"ER02AU23.089","content_type":"image/png","size":7588,"width":517,"sha":"7446066f3ece82ef2c55d88ca88893fa","url":"https://img.federalregister.gov/ER02AU23.089/ER02AU23.089_medium.png","height":92},"original_size":{"identifier":"ER02AU23.089","content_type":"image/png","size":23914,"width":3901,"sha":"bbbf73f57c0c1958382615880b793d7c","url":"https://img.federalregister.gov/ER02AU23.089/ER02AU23.089_original_size.png","height":697}},"ER02AU23.086":{"large":{"identifier":"ER02AU23.086","content_type":"image/png","size":45655,"width":823,"sha":"ae1f576c2efcab9675f8c81f384f3a0b","url":"https://img.federalregister.gov/ER02AU23.086/ER02AU23.086_large.png","height":603},"medium":{"identifier":"ER02AU23.086","content_type":"image/png","size":19850,"width":433,"sha":"3a6765f84514e276be0d1fb1a3a02138","url":"https://img.federalregister.gov/ER02AU23.086/ER02AU23.086_medium.png","height":317},"original_size":{"identifier":"ER02AU23.086","content_type":"image/png","size":99803,"width":3267,"sha":"719ba3af28b1a668c77b9789a00eabf3","url":"https://img.federalregister.gov/ER02AU23.086/ER02AU23.086_original_size.png","height":2393}},"ER02AU23.087":{"large":{"identifier":"ER02AU23.087","content_type":"image/png","size":127886,"width":823,"sha":"85876e8b84009c5e16704df4ad105cca","url":"https://img.federalregister.gov/ER02AU23.087/ER02AU23.087_large.png","height":1467},"medium":{"identifier":"ER02AU23.087","content_type":"image/png","size":47202,"width":396,"sha":"ca1fbba9aa233b3f82ac06c9f87bfb1e","url":"https://img.federalregister.gov/ER02AU23.087/ER02AU23.087_medium.png","height":706},"original_size":{"identifier":"ER02AU23.087","content_type":"image/png","size":355523,"width":2992,"sha":"261fb35310cf600df29941f4b2037211","url":"https://img.federalregister.gov/ER02AU23.087/ER02AU23.087_original_size.png","height":5333}}},"json_url":"https://www.federalregister.gov/api/v1/documents/2023-16116?publication_date=2023-08-02","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2023-08-02/2023-16116/mods.xml","not_received_for_publication":null,"page_length":36,"page_views":{"count":12531,"last_updated":"2026-08-26 12:15:06 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2023-08-02/pdf/2023-16116.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2023-16116.pdf?1690575322","publication_date":"2023-08-02","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2023/08/02/2023-16116.txt","regulation_id_number_info":{"0938-AV10":{"issue":"202304","html_url":"https://www.federalregister.gov/regulations/0938-AV10/fy-2024-hospice-wage-index-payment-rate-update-and-quality-reporting-requirements-cms-1787-","title":"FY 2024 Hospice Wage Index, Payment Rate Update, and Quality Reporting Requirements (CMS-1787)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=202304&RIN=0938-AV10&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"}},"regulation_id_numbers":["0938-AV10"],"regulations_dot_gov_info":{"supporting_documents":[],"regulatory_plan":{"html_url":"https://www.federalregister.gov/regulations/0938-AV10/fy-2024-hospice-wage-index-payment-rate-update-and-quality-reporting-requirements-cms-1787-","title":"FY 2024 Hospice Wage Index, Payment Rate Update, and Quality Reporting Requirements (CMS-1787)"},"comments_count":0,"agency_id":"CMS","comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=CMS-2023-0051","supporting_documents_count":0,"docket_id":"CMS-2023-0051","document_id":"CMS-2023-0051-0079","regulation_id_number":"0938-AV10","title":"FY 2024 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, Hospice Quality Reporting Program Requirements, and Hospice Certifying Physician Provider Enrollment Requirements CMS-1787-P","checked_regulationsdotgov_at":"2023-08-04T20:00:14Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":51164,"subtype":null,"title":"Medicare Program; FY 2024 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, Hospice Quality Reporting Program Requirements, and Hospice Certifying Physician Provider Enrollment Requirements","toc_doc":"FY 2024 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, Hospice Quality Reporting Program Requirements, and Hospice Certifying Physician Provider Enrollment Requirements","toc_subject":"Medicare Program","topics":["Health facilities","Health professions","Hospice care","Medicare","Reporting and recordkeeping requirements"],"type":"Rule","volume":88}