Medicare Program; FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements ting errors due to other changes in the forecasted impact time-period. The nature of the Medicare program is such that the changes may interact, and the complexity of the interaction of these changes could make it difficult to predict accurately the full scope of the impact upon hospices. 2. Hospice Quality Reporting Program There were no new proposals related to the Hospice Quality Reporting Program for FY 2026; accordingly, there are no impacts. C. Detailed Economic Analysis 1. Final Hospice Payment Update for FY 2026 The FY 2026 hospice payment impacts appear in Table 9. We tabulate the resulting payments according to the classifications (for example, provider type, geographic region, facility size), and compare the difference between current and future payments to determine the overall impact. The first column shows the breakdown of all hospices by provider type and control (non-profit, for-profit, government, other), facility location, and facility size. The second column shows the number of hospices in each of the categories in the first column. The third column shows the effect of using the FY 2026 updated wage index data with a 5 percent cap on wage index decreases. The agg e number of hospices in each of the categories in the first column. The third column shows the effect of using the FY 2026 updated wage index data with a 5 percent cap on wage index decreases. The aggregate impact of the change in column three is zero percent, due to the hospice wage index standardization factors. However, there are distributional effects of using the FY 2026 hospice wage index. The fourth column shows the effect of the hospice payment update percentage as mandated by section 1814(i)(1)(C) of the Act and is consistent for all providers. The hospice payment update percentage of 2.6 percent is based on the final 3.3 percent inpatient hospital market basket percentage increase reduced by a 0.7 percentage point productivity adjustment. The fifth column shows the total effect of the updated wage data and the hospice payment update percentage on FY 2026 hospice payments. As illustrated in Table 9, the combined effects vary by specific types of providers and by location. We note that simulated payments are based on utilization in FY 2024 as seen on Medicare hospice claims (accessed from the CCW on May 9, 2025) and only include payments related to the level of care and do ote that simulated payments are based on utilization in FY 2024 as seen on Medicare hospice claims (accessed from the CCW on May 9, 2025) and only include payments related to the level of care and do not include payments related to the service intensity add-on. As illustrated in Table 9, the combined effects vary by specific types of providers and by location. TABLE 9—IMPACT TO HOSPICES FOR FY 2026 Hospice subgroup Hospices FY 2026 updated wage data (%) FY 2026 hospice payment update (2.6%) Overall total impact for FY 2026 (%) All Hospices ............................................................................. Hospice Type and Control: Freestanding/Non-Profit .................................................... Freestanding/For-Profit ..................................................... Freestanding/Government ................................................ Freestanding/Other ........................................................... ......................................... Facility/HHA Based/Non-Profit Facility/HHA Based/For-Profit ........................................... Facility/HHA Based/Government ...................................... Facility/HHA Based/Other ... acility/HHA Based/Non-Profit Facility/HHA Based/For-Profit ........................................... Facility/HHA Based/Government ...................................... Facility/HHA Based/Other ........................................................ Subtotal: Freestanding Facility Type ......................... Subtotal: Facility/HHA Based Facility Type .............. Subtotal: Non-Profit ............................................ Subtotal: For Profit ............................................. Subtotal: Government ........................................ Subtotal: Other ................................................... Hospice Type and Control: Rural: Freestanding/Non-Profit .................................................... Freestanding/For-Profit ..................................................... Freestanding/Government ................................................ Freestanding/Other ........................................................... Facility/HHA Based/Non-Profit ......................................... Facility/HHA Based/For-Profit ........................................... Facility/HHA Based/Government ...................................... Facilit -Profit ......................................... Facility/HHA Based/For-Profit ........................................... Facility/HHA Based/Government ...................................... Facility/HHA Based/Other ................................................. Hospice Type and Control: Urban: Freestanding/Non-Profit .................................................... Freestanding/For-Profit ..................................................... Freestanding/Government ................................................ 6,735 791 4,654 34 0 266 4 97 0 5,479 367 1,067 5,131 132 12 206 392 24 0 112 0 71 0 585 4,262 10 0.0 0.2 ¥0.1 0.9 0.0 0.6 0.3 0.5 0.0 0.0 0.6 0.3 ¥0.1 0.7 0.6 0.5 0.3 0.8 0.0 1.2 0.0 0.1 0.0 0.2 ¥0.2 1.0 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 VerDate Sep 2014 15:44 Aug 04, 2025 Jkt 265001 PO 00000 Frm 00055 Fmt 4700 Sfmt 4700 E:\FR\FM\05AUR1.SGM 05AUR1 1 S E L U R h t i w D O R P 3 2 N Q X 1 1 K S D n o r e t t o l 2.6 2.8 2.5 3.5 2.6 3.2 2.9 3.1 2.6 2.6 3.2 2.9 2.5 3.3 3.2 3.1 2.9 3.4 2.6 3.8 2.6 2.7 2.6 2.8 2.4 3.6 37428 Federal Register / Vol. 90, No. 148 / Tuesday, August 5, 2025 / Rules and Re o r e t t o l 2.6 2.8 2.5 3.5 2.6 3.2 2.9 3.1 2.6 2.6 3.2 2.9 2.5 3.3 3.2 3.1 2.9 3.4 2.6 3.8 2.6 2.7 2.6 2.8 2.4 3.6 37428 Federal Register / Vol. 90, No. 148 / Tuesday, August 5, 2025 / Rules and Regulations TABLE 9—IMPACT TO HOSPICES FOR FY 2026—Continued Hospice subgroup Hospices FY 2026 updated wage data (%) FY 2026 hospice payment update (2.6%) Overall total impact for FY 2026 (%) Freestanding/Other ........................................................... ......................................... Facility/HHA Based/Non-Profit Facility/HHA Based/For-Profit ........................................... Facility/HHA Based/Government ...................................... Facility/HHA Based/Other ................................................. Hospice Location: Urban or Rural: Rural ................................................................................. Urban ................................................................................ Hospice Location: Region of the Country (Census Division): New England .................................................................... Middle Atlantic .................................................................. South Atl Country (Census Division): New England .................................................................... Middle Atlantic .................................................................. South Atlantic ................................................................... East North Central ............................................................ East South Central ........................................................... West North Central ........................................................... West South Central .......................................................... Mountain ........................................................................... Pacific ............................................................................... Outlying ............................................................................. Hospice Size (RHC Days): 0–3,499 RHC Days .......................................................... 3,500–19,999 RHC Days ................................................. 20,000+ RHC Days .......................................................... 0 154 4 26 0 849 5,886 159 280 650 654 252 441 1,251 701 2,270 77 1,751 3,014 1,970 0.0 0.5 0.3 0.7 0 ...................... 20,000+ RHC Days .......................................................... 0 154 4 26 0 849 5,886 159 280 650 654 252 441 1,251 701 2,270 77 1,751 3,014 1,970 0.0 0.5 0.3 0.7 0.0 0.4 0.0 1.3 0.1 0.4 0.4 0.3 0.8 ¥0.5 0.2 ¥1.1 ¥0.4 ¥0.8 ¥0.4 0.1 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 3.1 2.9 3.3 2.6 3.0 2.6 3.9 2.7 3.0 3.0 2.9 3.4 2.1 2.8 1.5 2.2 1.8 2.2 2.7 Source: FY 2024 hospice claims data from CCW accessed on May 9, 2025. Note: The overall total impact reflects the addition of the individual impacts, which includes the wage index impact as well as the hospice pay- ment update of 2.6 percent. Due to missing Provider of Services file and Cost Report information (from which hospice characteristics are obtained), some subcategories in the impact tables have fewer agencies represented than the overall total (of 6,735). Subtypes involving ownership only add up to 6,342 while subtypes involving facility type only add up to 5,846. Region Key: New England=Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont. Middle Atlantic=Pennsylvania, New Jersey, New York. South Atlantic=Delaware, District of Colum o 5,846. Region Key: New England=Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont. Middle Atlantic=Pennsylvania, New Jersey, New York. South Atlantic=Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia. East North Central=Illinois, Indiana, Michigan, Ohio, Wisconsin. East South Central=Alabama, Kentucky, Mississippi, Tennessee. West North Central=Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota. West South Central=Arkansas, Louisiana, Oklahoma, Texas. Mountain=Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming. Pacific=Alaska, California, Hawaii, Oregon, Washington. Outlying=Guam, Puerto Rico, Virgin Islands. We received a comment on the detailed economic analysis and impact table. A summary of this comment and our response follows: Comment: A commenter recommended enhanced data transparency regarding the files used to categorize hospice provider types by ownership and facility type in the FY 2026 hospice impact table. This commenter requested further information about the differences in the two files used to source this data and stated that CMS must be tr rship and facility type in the FY 2026 hospice impact table. This commenter requested further information about the differences in the two files used to source this data and stated that CMS must be transparent about this measure. Response: Ownership and facility type have typically been sourced from the provider of services (POS) file (https://data.cms.gov/resources/pos-file- iqies-for-hha-asc-and-hospice-providers- methodology). In recent years, ownership and facility type have increasingly been missing from the POS. Starting with the FY 2026 proposed rule, we also incorporated cost report data. We first assign ownership and facility type using information from the cost reports. Then, if there is missing data, we use the POS data to determine ownership and facility type. This improved our ability to assign ownership and facility type, with 6,305 hospices having ownership type information and 5,788 having facility type information. We encourage all hospices to review their POS and cost report data to ensure information on ownership and facility type are available and accurate. Missing information on ownership or facility type only impacts the rows of the impact table that are assoc report data to ensure information on ownership and facility type are available and accurate. Missing information on ownership or facility type only impacts the rows of the impact table that are associated with ownership or facility type. Other calculations throughout the rule are not impacted by missing data on ownership or facility type. D. Regulatory Review Cost Estimation If regulations impose administrative costs on private entities, such as the time needed to read and interpret this final rule, we should estimate the cost associated with the regulatory review. Due to the uncertainty involved with accurately quantifying the number of entities that will review the rule, we assume that the total number of unique commenters on this year’s proposed rule will be the number of reviewers of this final rule. However, we acknowledge that this assumption may understate or overstate the costs of reviewing this final rule. It is possible that not all commenters reviewed this year’s proposed rule in detail, and it is also possible that some reviewers chose not to comment on the proposed rule. Despite these limitations, we believe that the number of commenters on this year’s proposed rule i ule in detail, and it is also possible that some reviewers chose not to comment on the proposed rule. Despite these limitations, we believe that the number of commenters on this year’s proposed rule is a fair estimate of the number of reviewers of this final rule. We received no comments on the approach to estimating the number of entities that will review this final rule. We also recognize that different types of VerDate Sep 2014 15:44 Aug 04, 2025 Jkt 265001 PO 00000 Frm 00056 Fmt 4700 Sfmt 4700 E:\FR\FM\05AUR1.SGM 05AUR1 1 S E L U R h t i w D O R P 3 2 N Q X 1 1 K S D n o r e t t o l Federal Register / Vol. 90, No. 148 / Tuesday, August 5, 2025 / Rules and Regulations 37429 entities are in many cases affected by mutually exclusive sections of this final rule, and therefore for the purposes of our estimate we assume that each reviewer reads approximately 50 percent of the rule. Using the May 2024 National median hourly wage rate (doubled for benefits and overhead) for medical and health service managers (Code 11–9111); we estimate that the cost of reviewing this rule is $113.42 per hour, including overhead and fringe benefits (https:// www.bls.gov/oes/current/oes_nat.htm). Assumi lth service managers (Code 11–9111); we estimate that the cost of reviewing this rule is $113.42 per hour, including overhead and fringe benefits (https:// www.bls.gov/oes/current/oes_nat.htm). Assuming an average reading speed we estimate that it would take approximately 1.76 hours for staff to review half of this final rule. For each hospice that reviews the rule, the estimated cost is $199.62 (1.76 hours × $113.42). Therefore, we estimate that the total cost of reviewing this regulation is $11,977.20 ($199.62 × 60 reviewers; which is based on the number of comments received for the proposed rule). E. Alternatives Considered 1. Hospice Payment Since the hospice payment update percentage is determined based on statutory requirements, we did not consider alternatives to updating the hospice payment rates by the hospice payment update percentage. The final 2.6 percent hospice payment update percentage for FY 2026 is based on a final 3.3 percent inpatient hospital market basket percentage increase for FY 2026, reduced by a final 0.7 percentage point productivity adjustment. Payment rates since FY 2002 have been updated according to section 1814(i)(1)(C)(ii)(VII) of the Act, which sta e increase for FY 2026, reduced by a final 0.7 percentage point productivity adjustment. Payment rates since FY 2002 have been updated according to section 1814(i)(1)(C)(ii)(VII) of the Act, which states that the update to the payment rates for subsequent years must be the market basket percentage increase for that fiscal year. Section 3401(g) of the Affordable Care Act also mandates that, starting with FY 2013 (and in subsequent years), the hospice payment update percentage will be annually reduced by changes in economy-wide productivity as specified in section 1886(b)(3)(B)(xi)(II) of the Act. For FY 2026, since the hospice payment update percentage is determined based on statutory requirements at section 1814(i)(1)(C) of the Act, we did not consider alternatives for the hospice payment update percentage. F. Accounting Statement and Table Consistent with OMB Circular A–4 (available at https:// trumpwhitehouse.archives.gov/sites/ whitehouse.gov/files/omb/circulars/A4/ a-4.pdf), we have prepared an accounting statement in Table 10 showing the classification of the expenditures associated with the provisions of this final rule. Table 10 provides our best estimate of the possible cha e prepared an accounting statement in Table 10 showing the classification of the expenditures associated with the provisions of this final rule. Table 10 provides our best estimate of the possible changes in Medicare payments under the hospice benefit as a result of the policies in this final rule. This estimate is based on the data for 6,735 hospices in our impact analysis file, which was constructed using FY 2024 claims (accessed from the CCW on May 9, 2025). All expenditures are classified as transfers to hospices. TABLE 10—ACCOUNTING STATEMENT ESTIMATED CLASSIFICATION TRANSFERS TO MEDICARE HOSPICES OF Hospice payment update Category FY 2025 to FY 2026 Transfers Annualized Monetized $750 million *. Transfers. From Whom to Whom?. Federal Government to Medicare Hos- pices. * The increase of $750 million in transfer payments is a result of the 2.6 percent hos- pice payment update compared to payments in FY 2025. G. Regulatory Flexibility Act (RFA) The RFA requires agencies to analyze options for regulatory relief of small entities if a rule has a significant impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit ptions for regulatory relief of small entities if a rule has a significant impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small jurisdictions. We consider all hospices as small entities as that term is used in the RFA. The North American Industry Classification System (NAICS) was adopted in 1997 and is the current standard used by the Federal statistical agencies related to the U.S. business economy. There is no NAICS code specific to hospice services. Therefore, we utilized the NAICS U.S. industry title ‘‘Home Health Care Services’’ and corresponding NAICS code 621610 in determining impacts for small entities. The NAICS code 621610 has a size standard of $19 million.6 Table 11 shows the number of firms, revenue, and estimated impact per home health care service category. TABLE 11—NUMBER OF FIRMS, REVENUE, AND AVERAGE REVENUE PER FIRM OF HOME HEALTH CARE SERVICES FOR NAICS CODE 621610 NAICS NAICS description Enterprise size ($1,000) Number of firms Receipts ($1,000) Average receipts per firm ($1,000) 621610 ......... Home Health Care Services ......................... 621610 ......... S NAICS description Enterprise size ($1,000) Number of firms Receipts ($1,000) Average receipts per firm ($1,000) 621610 ......... Home Health Care Services ......................... 621610 ......... Home Health Care Services ......................... 621610 ......... Home Health Care Services ......................... 621610 ......... Home Health Care Services ......................... 621610 ......... Home Health Care Services ......................... 621610 ......... Home Health Care Services ......................... 621610 ......... Home Health Care Services ......................... 621610 ......... Home Health Care Services ......................... 621610 ......... Home Health Care Services ......................... 621610 ......... Home Health Care Services ......................... 621610 ......... Home Health Care Services ......................... 20,000 Total 6,361 7,099 3,866 5,218 2,560 885 450 466 235 1,058 28,198 232,967 1,869,713 2,829,374 8,370,496 8,833,076 5,275,636 3,789,016 5,256,982 3,621,448 73,271,709 113,350,417 36.62 263.38 731.86 1,604.16 3,450.42 5,961.17 8,420.04 11,281.08 15,410.42 69,254.92 4,019.80 Source: Data obtained from United States Census B 36 3,789,016 5,256,982 3,621,448 73,271,709 113,350,417 36.62 263.38 731.86 1,604.16 3,450.42 5,961.17 8,420.04 11,281.08 15,410.42 69,254.92 4,019.80 Source: Data obtained from United States Census Bureau table ‘‘us_6digitnaics_rcptsize_2022’’ (SOURCE: 2022 SUSB Annual Data Tables by Industry) Release Date: 4/10/2025: https://www2.census.gov/programs-surveys/susb/tables/2022/us_6digitnaics_rcptsize_ Establishment 2022.xlsx. 6 https://www.sba.gov/sites/sbagov/files/2023-03/ Table%20of%20Size%20Standards_Effective %20March%2017%2C%202023%20%281 %29%20%281%29_0.pdf. VerDate Sep 2014 15:44 Aug 04, 2025 Jkt 265001 PO 00000 Frm 00057 Fmt 4700 Sfmt 4700 E:\FR\FM\05AUR1.SGM 05AUR1 1 S E L U R h t i w D O R P 3 2 N Q X 1 1 K S D n o r e t t o l 37430 Federal Register / Vol. 90, No. 148 / Tuesday, August 5, 2025 / Rules and Regulations Notes: The ‘Average Receipts Per Firm’ column is calculated as the Receipts ($1,000)/Number of firms. The ‘Total’ row represents all the home health care services firms under NAICS 621610. Overall receipts (revenue) for the 28,198 firms (NAICS 621610) are approximately $113 billion. The Department of Health and Human In addition, section 1102(b) of the Act K. s firms under NAICS 621610. Overall receipts (revenue) for the 28,198 firms (NAICS 621610) are approximately $113 billion. The Department of Health and Human In addition, section 1102(b) of the Act K. Conclusion Services’ practice in interpreting the RFA is to consider effects economically ‘‘significant’’ only if greater than 5 percent of providers reach a threshold of 3 to 5 percent or more of total revenue or total costs. The majority of hospice visits are Medicare paid visits, and therefore the majority of hospice agency revenue consists of Medicare payments. Based on our analysis, we conclude that the policies finalized in this rule will result in an estimated total impact of 3 to 5 percent or more on Medicare revenue for greater than 5 percent of hospices. Therefore, the Secretary has determined that this hospice final rule will have significant economic impact resulting in a net increase in positive revenue on a substantial number of small entities. We estimate that the net impact of the policies in this rule is 2.6 percent or approximately $750 million in increased revenue to hospices in FY 2026. The 2.6 percent increase in expenditures when comparing FY 2025 payments to est t of the policies in this rule is 2.6 percent or approximately $750 million in increased revenue to hospices in FY 2026. The 2.6 percent increase in expenditures when comparing FY 2025 payments to estimated FY 2026 payments is reflected in the last column of the first row in Table 9 and is driven solely by the impact of the hospice payment update percentage reflected in the fourth column of the impact table. In addition, hospices with less than 3,500 RHC days will experience a lower estimated increase (1.8 percent), compared to hospices with 3,500– 19,999 RHC days (2.2 percent) and hospices with greater than 20,000 RHC days (2.7 percent) due to the final updated wage index. We estimate that in FY 2026, hospices in urban areas would experience, on average, a 2.6 percent increase in estimated payments compared to FY 2025; while hospices in rural areas would experience, on average, a 3.0 percent increase in estimated payments compared to FY 2025. Hospices providing services in the New England region would experience the largest estimated increases in payments of 3.9 percent. Hospices serving patients in the Pacific region will experience, on average, the lowest estimated increase of 1 land region would experience the largest estimated increases in payments of 3.9 percent. Hospices serving patients in the Pacific region will experience, on average, the lowest estimated increase of 1.5 percent in FY 2026 payments. Further detail is presented in Table 9 by hospice type and location. The analysis in this section along with the rest of the regulatory impact analysis in this final rule constitutes our final regulatory flexibility analysis. We did not receive any comments on our proposed cost analysis. requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 604 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of an MSA and has fewer than 100 beds. As this rule will only affect hospices, the Secretary has determined that this rule will not have a significant impact on the operations of a substantial number of small rural hospitals (see Table 9). H. Unfunded Mandates Reform Act (UMRA) Section 202 of the Unfunded Mandates Reform Act of 19 have a significant impact on the operations of a substantial number of small rural hospitals (see Table 9). H. Unfunded Mandates Reform Act (UMRA) Section 202 of the Unfunded Mandates Reform Act of 1995 (UMRA) also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. In 2025, that threshold is approximately $187 million. This rule will not have an unfunded effect on state, local, or tribal governments, in the aggregate, or on the private sector that exceeds this threshold in any 1 year. I. Federalism Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has Federalism implications. We have reviewed this rule under these criteria of Executive Order 13132 and have determined that it will not impose substantial direct costs on State or local governments. J. E.O. 14192, ‘‘Unleashing Prosperity Through Deregulation’’ Executive Order 14192, entit der 13132 and have determined that it will not impose substantial direct costs on State or local governments. J. E.O. 14192, ‘‘Unleashing Prosperity Through Deregulation’’ Executive Order 14192, entitled ‘‘Unleashing Prosperity Through Deregulation’’ was issued on January 31, 2025, and requires that ‘‘any new incremental costs associated with new regulations shall, to the extent permitted by law, be offset by the elimination of existing costs associated with at least 10 prior regulations.’’ Therefore, this final rule is not an E.O. 14192 regulatory action since it does not impose any more than de minimis regulatory costs. We estimate that aggregate payments to hospices in FY 2026 will increase by $750 million as a result of the 2.6 percent final hospice payment update, compared to payments in FY 2025. We estimate that in FY 2026, hospices in urban areas would experience, on average, a 2.6 percent increase in estimated payments compared to FY 2025; while hospices in rural areas would experience, on average, a 3.0 percent increase in estimated payments compared to FY 2025. Hospices providing services in the New England region would experience the largest estimated increases in paymen perience, on average, a 3.0 percent increase in estimated payments compared to FY 2025. Hospices providing services in the New England region would experience the largest estimated increases in payments of 3.9 percent. Hospices serving patients in the Pacific region will experience, on average, the lowest estimated increase of 1.5 percent in FY 2026 payments. In accordance with the provisions of Executive Order 12866, this regulation was reviewed by the Office of Management and Budget. Mehmet Oz Administrator of the Centers for Medicare & Medicaid Services, approved this document on July 21, 2025. List of Subjects in 42 CFR Part 418 Health facilities, Medicare, Reporting and recordkeeping requirements. For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services amends 42 CFR chapter IV, part 418 as set forth below: PART 418—HOSPICE CARE ■ 1. The authority citation for part 418 continues to read as follows: Authority: 42 U.S.C. 1302 and 1395hh. ■ 2. Section 418.22 is amended by revising paragraphs (a)(4)(ii) and (b)(4) to read as follows: § 418.22 Certification of terminal illness. (a) * * * (4) * * * (ii) During a Public Health Emergency, as defined in § 18.22 is amended by revising paragraphs (a)(4)(ii) and (b)(4) to read as follows: § 418.22 Certification of terminal illness. (a) * * * (4) * * * (ii) During a Public Health Emergency, as defined in § 400.200 of this chapter, or through September 30, 2025, whichever is later, if the face-to- face encounter conducted by a hospice physician or hospice nurse practitioner is for the sole purpose of hospice recertification, such encounter may occur via a telecommunications technology and is considered an administrative expense. Telecommunications technology means the use of interactive multimedia communications equipment that VerDate Sep 2014 15:44 Aug 04, 2025 Jkt 265001 PO 00000 Frm 00058 Fmt 4700 Sfmt 4700 E:\FR\FM\05AUR1.SGM 05AUR1 1 S E L U R h t i w D O R P 3 2 N Q X 1 1 K S D n o r e t t o l Federal Register / Vol. 90, No. 148 / Tuesday, August 5, 2025 / Rules and Regulations 37431 includes, at a minimum, the use of audio and video equipment permitting two-way, real-time interactive communication between the patient and the distant site hospice physician or hospice nurse practitioner. (b) * * * (4) The physician or nurse practitioner who performs the face-to- face encounter with communication between the patient and the distant site hospice physician or hospice nurse practitioner. (b) * * * (4) The physician or nurse practitioner who performs the face-to- face encounter with the patient described in paragraph (a)(4) of this section must attest in writing that he or she had a face-to-face encounter with the patient, including the date of that visit. The attestation must include the physician’s or nurse practitioner’s signature and the date it was signed. The attestation could be a separate and distinct section of, or an addendum to, the recertification or a clinical note that indicates the face-to-face encounter occurred, and includes the clinical findings of the face-to-face encounter, the date of the visit, the signature of the physician or nurse practitioner who conducted the face-to-face encounter, and the date of the signature. If the attestation of the nurse practitioner or a non-certifying hospice physician is a separate and distinct section of, or an addendum to, the recertification, the attestation shall state that the clinical findings of that visit were provided to the certifying physician for use in determining continued eligibility for hospice dendum to, the recertification, the attestation shall state that the clinical findings of that visit were provided to the certifying physician for use in determining continued eligibility for hospice care. * * * * ■ 3. Section 418.25 is amended by revising paragraphs (a) and (b) introductory text to read as follows: * § 418.25 Admission to hospice care. (a) The hospice admits a patient only on the recommendation of the medical director (or the physician designee, as defined in § 418.3) or the physician member of the hospice interdisciplinary group, in consultation with, or with input from, the patient’s attending physician (if any). (b) In reaching a decision to certify that the patient is terminally ill, the hospice medical director (or the physician designee, as defined in § 418.3) or the physician member of the hospice interdisciplinary group, must consider at least the following information: * * * * ■ 4. Section 418.312 is amended by revising paragraph (j)(2) to read as follows: * § 418.312 Data submission requirements under the hospice quality reporting program. * * (j) * * * (2) A hospice must meet or exceed the * * * data submission compliance threshold in paragraph (j)(1) o § 418.312 Data submission requirements under the hospice quality reporting program. * * (j) * * * (2) A hospice must meet or exceed the * * * data submission compliance threshold in paragraph (j)(1) of this section to avoid receiving a 4-percentage point reduction to its annual payment update for a given FY as described under § 418.306(b)(2) of this chapter. Robert F. Kennedy, Jr., Secretary, Department of Health and Human Services. [FR Doc. 2025–14782 Filed 8–1–25; 4:15 pm] BILLING CODE 4120–01–P 1 S E L U R h t i w D O R P 3 2 N Q X 1 1 K S D n o r e t t o l VerDate Sep 2014 15:44 Aug 04, 2025 Jkt 265001 PO 00000 Frm 00059 Fmt 4700 Sfmt 9990 E:\FR\FM\05AUR1.SGM 05AUR1