On April 24, 2009, CMS published its proposed FY 2010 Medicare hospice wage index rule. The proposed rule would continue the phase-out of the wage index budget neutrality adjustment factor (BNAF), which will conclude in 2011. It also would revise the process for certification and recertification of terminal illness by requiring a brief narrative explanation of the clinical findings that support a life expectancy of 6 months or less. In addition, CMS is requesting comments on requiring recertification visits by physicians or advanced practice nurses (e.g., nurse practitioners), and on issues of payment reform for use in possible future policy development. The proposed rule also would make several technical and clarifying changes to the current hospice regulations. CMS estimates that total Medicare hospice payments for FY 2010 will decrease by $340 million as a result of the application of the reduction in the BNAF and the updated wage data. This estimate does not take into account a hospital market basket update, however, which is currently estimated to be about 2.1% for FY 2010, and which would result in a $240 million increase in payments to hospices. The combined impact of the market basket update, the BNAF reduction, and the updated wage data is expected to decrease Medicare hospice payments by a total of $100 million in FY 2010. CMS will accept comments on the rule until June 22, 2009.