On June 5, 2008, the Centers for Medicare & Medicaid Services (CMS) published a final rule making extensive revisions to the conditions of participation (CoPs) that hospices must meet to participate in the Medicare and Medicaid programs. Most notably, the rule requires hospices to implement “an effective, ongoing, hospice-wide data-driven quality assessment and performance improvement (QAPI) program.”  Rather than prescribing the precise areas or mechanisms to include in such an assessment, the rule states that “each hospice is free to decide how to implement the QAPI requirement in a manner that reflects its own unique needs and goals."  The rule also revises CoP provisions related to patients’ rights; patient assessments; and interdisciplinary group (IDG), care planning, and coordination of services. In addition, the rule would modify a number of staffing policies, such as by requiring the physician member of the IDG and the medical director to be an employee of or under contract with the hospice, and permitting nurse practitioners to provide services to beneficiaries receiving hospice care if state law permits. Moreover, the rule clarifies a hospice’s responsibility for care furnished to hospice patients who reside in a nursing facility.  The text of the rule is posted here.  The rule is effective December 2, 2008.  In a related development, CMS has announced that the hospice aggregate cap amount for the 2008 cap year is $22,386.15, and it has provided new guidance on signature requirements in the Medicare hospice benefit. Both documents are posted here.