‘Terminal Illness’ Definition Stays Alive

In an advance release of its final rule on the 2015 payment rate and wage index for hospices, CMS opted not to adopt changes to the definitions of “terminal illness” and “related conditions” in the context of the Medicare hospice benefit.

As reported last week, the final rule, which is scheduled to be published in the Federal Register on Aug. 22, CMS adopts the payment and wage index adjustments that were disclosed in the May 8 proposed rule and analyzes hospice payment reform.

The proposed rule also invited public comments on the broader definitions of “terminal illness” and “related conditions” it set forth to be adopted in possible future rulemaking.

Organizations Weigh In

Several organizations chimed in with their thoughts and suggestions. For example:

  • In its comment letter to CMS, the Society for Post-Acute Care and Long-Term Medicine (AMDA) expressed its concern about the terminal illness definition’s focus on disease, stressing that “Abnormal and advancing physical, emotional, social and/or intellectual processes” is the same as “disease.” According to AMDA, removing “abnormal” from the phrase would ensure that frailty, a result of the aging process that is linked to depression and mortality, is included in the definition.
  • The National Association for Home Care & Hospice (NAHC) wrote a letter to CMS questioning whether the new definitions are needed. NACH also took issue with the proposed rule’s definition of related conditions as those that “interact or potentially interact with terminal illness; and/or which are contributory to the symptom burden of the terminally ill individual.” The association noted that this might imply hospices are responsible for all of a patient’s conditions.
  • In its letter to CMS, the Visiting Nurse Associations of America (VNAA) noted that the broader definitions in the proposed rule are unnecessary and perhaps too complex. The organization urged CMS to instead retain the existing Social Security Act definitions of the terms and to “convene a panel of interdisciplinary clinical experts, including hospice clinicians practicing in the field, to develop a consensus definition” the terms.
  • Leading Age, an association of not-for-profit organizations, submitted comments on the proposed “related conditions” definition. Specifically, the association asked CMS to clarify that longstanding and/or preexisting conditions are excluded from the definition. It also suggested excluding “comorbidies that do not have a direct causal connection to the illness that contributed to the prognosis that the individual has a life expectancy of six months or less.”

Future Changes Possible

Despite the concerns raised by these and other organizations, CMS has not incorporated any changes to the definitions in the final rule. The agency acknowledged receiving “a significant number of comments representing diverse stakeholder groups” but noted that it will consider them later, for “possible future rulemaking.”