Given the timing of the COVID-19 PHE onset, we determined that we would not use HH QRP OASIS, claims, or HH CAHPS data from Q1 and Q2 of 2020 for public reporting, and that we would assess the impact of the COVID-19 PHE on HH QRP data from Q4 2019. However, providers with substantially higher percent of live discharge than their peers could signal a potential concern with quality of care or program integrity. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. In addition to the hospice payment reform changes discussed, the FY 2016 Hospice Wage Index and Rate Update final rule implemented changes mandated by the IMPACT Act, in which the cap amount for accounting years that end after September 30, 2016 and before October 1, 2025 would be updated by the hospice payment update percentage rather than using the CPI-U (80 FR 47186). We solicited comments on these proposals for CAHPS Star Ratings and the public reporting of star ratings no sooner than FY 2022.Start Printed Page 42573. CAHPS Hospice Survey to examine alignment between the survey outcomes and the HCI. of delivery would work best in furnishing the addendum. Those hospices that fail to submit their aggregate cap determinations on a timely basis will have their payments suspended until the determination is completed and received by the Medicare contractor (79 FR 50503). The provision of care would proportionately escalate to meet the increased clinical, emotional, and other needs of the patient and family. We stated that when the request is within 5 days from the date of a hospice election, and the patient elects hospice on December 1st and requests the addendum on December 3rd, the hospice would have until December 8th to furnish the addendum (86 FR 19724), making December 1st as day zero in this example. Comment: Many commenters expressed concern about the timeframe for implementing CAHPS Hospice Survey star ratings. As MedPAC noted,[22] All regulations will take effect on October 1, 2021. This publicly reported information currently includes diagnoses, location of care, and levels of care provided. We previously finalized the participation requirements for the CAHPS Hospice Survey, (84 FR 38484). As noted previously, we used Q4 2019 data for public reporting in November 2020 and froze that data for the February, May, August, and November 2021 refreshes. Therefore, under the CAR scenario we excluded data for OASIS-based measures for HHA patient stays with admission dates in Q1 and Q2 2019. The Office of Management and Budget (OMB) approved the collection of information to remove Section O of the HIS expiring on February 29, 2024, (OMB Control Number: 0938-1153, CMS-10390). CMS proposed a CAHPS-only star rating since other portions of Care Compare also display a CAHPS-only star rating (for example, Hospital CAHPS and Home Health CAHPS). (4) If the individual dies, revokes, or is discharged within the required timeframe for furnishing the addendum (as outlined in paragraphs (d)(1) and (2) of this section, and before the hospice has furnished the addendum, the addendum would not be required to be furnished to the individual (or representative). d. What additional resources or tools would post-acute care settings, including but not limited to hospices and health IT vendors find helpful to support testing, implementation, collection, and reporting of all measures using FHIR standards via secure APIs to reinforce the sharing of patient health information between care settings? CMS will continue to monitor for any aberrant behavior in regard to HCI and the care provided by hospices. The productivity adjustment for FY 2022, based on IGI's second quarter 2021 forecast, is 0.7 percent. The third column shows the effect of using the FY 2022 updated wage index data. Providers are required to report detailed patient costs (including but not limited to nursing, physician, therapy, and medical supplies) and non-patient costs for each level of care. In addition, as stated previously, providers must certify the cost report that to the best of [their] knowledge and believe, [the] report and statement are true, correct, complete and prepared from the books and records of the provider in accordance with applicable instructions, except as noted. Nonetheless, we recognize that data can be misreported at times and, therefore, our proposal for revising the labor shares included applying several edits to remove possible outlier dataa common statistical practice. The Centers for Medicare and Medicaid Services (CMS) notifies intermediaries through a Program Memorandum of the hospice rates for the coming year. These commenters believed that the existing process measures provide more valuable and transparent information about hospice performance than the HIS Comprehensive Assessment composite measure. documents in the last year, 1008 24. Because 0.8556 is greater than 0.8, County B's hospice wage index would be 0.8. Response: We agree that communicating widely is critically important, to ensure as many hospices as possible are aware not only of the increase in penalty, but also clearly understand the HQRP reporting requirements and the APU process. The CAHPS Hospice Survey is a component of the CMS HQRP, which is used to collect data on the experiences of hospice patients and their family caregivers listed in their hospice records. (7) Collection or public reporting of a measure leads to negative unintended consequences other than patient harm. Rather, the HCI will serve as a useful measure to add value to the HQRP by providing more information to patients and family caregivers and better empowering them to make informed health care decisions. Currently, only Medicare-certified hospices with more than 20 patient stays each year have quality measure results publicly available on Care Compare. Office of Analytics and Program Improvement, Medicaid Promoting Interoperability Program. Comment: A commenter stated that the preview report timeframe is too short and that hospices should receive preview data at least 1 year prior to its publication in order to analyze performance and implement quality improvement. The candidate measure Reduction in Pain Severity reports the percentage of patients who had a reduction in reported pain severity. The specifications for Indicator One, CHC or GIP services provided, are as follows: The OIG has found instances of infrequent visits by nurses to hospice patients. We previously finalized survey participation requirements for FY 2022 through FY 2025 as stated in the FY 2018 and FY 2019 Hospice Wage Index and Payment Rate Update final rules (82 FR 36670 and 83 FR 38642 through 38643). Section 418.306 is amended by revising paragraph (b)(2) to read as follows: (2) For fiscal years 2014 and through 2023, in accordance with section 1814(i)(5)(A)(i) of the Act, in the case of a Medicare-certified hospice that does not submit hospice quality data, as specified by the Secretary, the payment rates are equal to the rates for the previous fiscal year increased by the applicable hospice payment update percentage increase, minus 2 percentage points. For more details, see section (3). Rolling up eight quarters of data instead of four ensures that measure scores are available for many more hospices, which improves the usefulness of the Compare web tools for hospice consumers. This final rule makes changes to the hospice CoPs regarding hospice aide competency evaluation standards. For example, if the hospice discharge occurred on a Sunday, the hospitalization had to occur on Sunday, Monday, or Tuesday to be counted. [FR Doc. We proposed to require that the date furnished be within the required timeframe, rather than the signature date, to mitigate any undue strain on the beneficiary or representative in returning the addendum to the hospice by a specified date. We view the HCI as an opportunity to add value to the HQRP, augmenting the current measure set with an index of indicators compiled from currently available claims data. Nelson, R., Should Medical Aid in Dying Be Part of Hospice Care? 45. A commenter stated that as currently structured, the penalty is a negative incentive to furnish the addendum in a timely manner if a hospice misses the initial required timeframe. Instead, they included all these days on line 23 and 33 of Worksheet S-1 but failed to report contracted days on line 40 and 41 of Worksheet S-1. This rule takes effect October 1, 2021. Previously, local wage index values were applied based on the geographic location of the hospice provider, regardless of where the hospice care was furnished. 37. For example, for the Home Health QRP, we finalized the Potentially Preventable 30-Day Post-Discharge Readmission Measure in the CY 2017 Home Health QRP Rule (81 FR 76770 through 76775) for reporting with three consecutive years of claims data beginning with the CY 2018 Home Health QRP. Response: Section 1814(i)(5)(E) of the Act requires that the Secretary establish procedures for making HQRP data available to the public and ensure that hospices have the opportunity to review HQRP data before their release to the public. We agree there are benefits to telehealth visits that supplement, not replace, in-person visits. Response: CMS acknowledges that patients have the right to refuse hospice services, and that some refusals are expected and appropriate. This does not constitute a change to the requirements of the CoPs. Those excepted quarters cannot be publicly displayed and resulted in the freezing of the public display using Q1 2019 through Q4 2019 data for the refreshes that would have occurred from October 2020 through October 2021, as shown in Table 24. If the beneficiary (or representative) refuses to sign the addendum, the hospice must document on the addendum the reason the addendum was not signed and the addendum would become part of the patient's medical record. These process measures may support or complement the outcome measures. We make that assumption instead of looking at the visits directly because Medicare does not require hospices to record all visits on the claim for the GIP level of care. Therefore, in general, using CAR scenario for the OASIS and claims-based measures would achieve acceptable reportability for the HH QRP measures. Several comments suggest CMS explore statewide or regional approaches to measure quality rather than using national analysis and perform rigorous data validation by hospice providers for claims-based measures. In addition, we finalized a policy to use the current year's pre-floor, pre-reclassified hospital inpatient wage index as the wage adjustment to the labor portion of the hospice rates. Typically, the wage index standardization factor is calculated using the most recent, complete hospice claims data available. Azar, A. M. (2020 March 15). Go tohttps://www.mmis.georgia.gov/portal/to access the Hospice Manual. March 2011 Report to the Congress: Medicare Payment Policy, Chapter 11: Hospice. March 15, 2011. in recent years noted that the HIS Comprehensive Assessment Measure differentiates the hospice's overall ability to address care processes better than the seven individual HIS process measures. Our testing indicates that claims data from the COVID-19 PHE are generally stable. While we did not propose any of these recommendations we could consider them for future rulemaking. Instead, we will continue to post state and national averages for HH QRP measures. We will consider these comments and suggestions for ongoing monitoring analyses, program integrity efforts, and for potential future rulemaking. In that final rule, we noted that the procedures for HHAs to review and correct their data on a quarterly basis is performed through CASPER along with our procedure to post the data for the public on our Care Compare website. Response: We also believe in the importance of using simple language on Care Compare to ensure consumers can easily use and appropriately interpret quality information that we provide for their decision-making. NQF #1617 Patients Treated with an Opioid who are Given a Bowel Regimen, NQF #1647 Beliefs/Values Addressed (if desired by the patient). The FY 2019 Hospice Wage Index and Payment Rate Update final rule (83 FR 38622) introduced the Meaningful Measure Initiative to hospice providers to identify high priority areas for quality measurement and improvement. L. 104-4), Executive Order 13132 on Federalism (August 4, 1999), and the Congressional Review Act (5 U.S.C. Section 1814(i)(5) of the Act requires the Secretary to establish and maintain a quality reporting program for hospices. We count skilled nursing visits where the corresponding revenue center date overlaps with one of the days of RHC previously identified. Therefore, hospice providers with larger costs (reflecting larger utilization) would have a larger weight in the proposed labor shares. The Medicaid reimbursement is based on the status of the member's eligibility days and a hospice lock-in span. In particular, we will continue to host HQRP Forums to allow hospices and other interested parties to engage with us on the latest updates and ask questions on the development of HOPE and related quality measures. We received many comments about the use of standardized patient assessment data in the hospice setting to assess health equity and social determinants of health (SDOH). Since the HIS Comprehensive Assessment Measure captures all seven processes collectively, we believe that public display of the individual component measures is not necessary. Reimbursement for physician services is included in the amount subject to the hospice payment cap described in Section 1007 of the Hospice Services Manual. Section 418.309 is amended by revising paragraphs (a)(1) and (2) to read as follows: (1) For accounting years that end on or before September 30, 2016 and end on or after October 1, 2030, the cap amount is adjusted for inflation by using the percentage change in the medical care expenditure category of the Consumer Price Index (CPI) for urban consumers that is published by the Bureau of Labor Statistics. A summary of these comments and our responses to those comments appear below: Comment: A few commenters requested more information regarding the labor share standardization factor; specifically, its purpose, and any anticipated future use of the factor. We also proposed to use the CAR scenario for refreshes for January 2022 for OASIS and for refreshes from January 2022 through July 2024 for some claims-based measures. The Hospice Item Set V3.00 PRA Submission replaced the HVWDII measure with a more robust version: The claims-based measure HVLDL. Index Earned Point Criterion: Hospices earn a point towards the HCI if their individual hospice score for percentage of decedents receiving a visit by a skilled nurse or social worker in the last 3 days of life falls above the 10th percentile ranking among hospices nationally. The HOPE tool is now under development. IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. Therefore, while we proposed to adopt the updates set forth in OMB Bulletin No. Together with other measures already publicly reported in the HQRP, HCI scores will help patients and family caregivers choose between hospice providers based on the factors that matter most to them. [1617] However, a 2013 OIG report[18] FY 2020 Hospice Wage Index and Payment Rate Update Final Rule, 12. For these analyses, we exclude claims from hospices with 19 or fewer discharges[14] Specifically, we will refresh claims-based measure scores on Care Compare, in preview reports, and in the confidential CASPER QM preview reports annually. Accessible via: https://oig.hhs.gov/oei/reports/oei-02-10-00490.asp. Similarly, we proposed to clarify at 418.24(d)(5) that in the event that a beneficiary requests the addendum and the hospice furnishes the addendum within 3 or 5 days (depending upon when the request for the addendum was made), but the beneficiary dies, revokes, or is discharged prior to signing the addendum, a signature from the individual (or representative) is no longer required. HOPE will include key items from the HIS and demographics like gender and race. A pseudo-patient must be capable of responding to and interacting with the hospice aide trainee, and must demonstrate the general characteristics of the primary patient population served by the hospice in key areas such as age, frailty, functional status, cognitive status and care goals. We propose no changes to this exemption. (8) The costs associated with a measure outweigh the benefit of its continued use in the program. Information defining the last three days has been included in the HIS Manuals since 2017. Hospice Utilization and Spending Patterns, 2. Several hospice providers expressed support for the measure's ability to demonstrate greater variation in hospice performance than the component indicators taken individually. Response: We agree that hospice care is interdisciplinary care delivered by clinical and non-clinical staff supporting the patient's plan of care. L. 79-404), 5 U.S.C. The signed addendum is only acknowledgement of the beneficiary's (or representative's) receipt of the addendum (or its updates) and the payment requirement is considered met if there is a signed addendum (and any signed updates) in the requesting beneficiary's medical record with the hospice. In fact, on weekends, patients' caregivers are more likely to be around and could prefer privacy from hospice staff. We note that simulated payments are based on utilization in FY 2020 as seen on Medicare hospice claims (accessed from the CCW in May 2021) and only include payments related to the level of care and do not include payments related to the service intensity add-on. Response: We appreciate the opportunity to provide clarification. Index Earned Point Criterion: Hospices earn a point towards the HCI if their average Medicare spending per beneficiary falls below the 90th percentile ranking among hospices nationally. We are finalizing our proposal to remove the seven HIS process measures from the HQRP as individual measures, and no longer applying them to the FY 2024 APU and thereafter. Readers who want more information about the development of the survey, originally called the Hospice Experience of Care Survey, may refer to 79 FR 50452 and 78 FR 48261. Table 22 and Table 23 summarize the comparison between the original schedule for public reporting with the revised schedule (that is, frozen data) and also with the proposed public display schedule under the CAR scenario (that is, using 3 quarters in the January 2022 refresh), for OASIS- and claims-based measures respectively. The aggregate impact of the changes in column three and four is zero percent, due to the hospice wage index standardization factor and the Start Printed Page 42602labor share standardization factor. The first worksheet would represent costs associated with freestanding units operated by the hospice and the second worksheet would be for costs associated with contracted services. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Another commenter stated it was appropriate that the hospice labor shares be based on data for hospice providers, rather than home health agencies and skilled nursing facilities. Some commenters suggested that CMS formulate a methodology that would include smaller hospices in star ratings. The Reporting Year (HIS)/Data Collection Year (CAHPS). Other PAC settings show similar findings regarding the stability of claims measures compared to assessment scores, which we update quarterly. hereafter referred to as the March 27, 2020 CMS Guidance Memorandum. Specifically, for CHC, we proposed that total CHC costs (Worksheet B, column 18, line 50) and CHC compensation costs to be greater than zero. Commenters encouraged CMS to stratify quality measures by demographic data, social risk factors, and social determinants of health. https://www.phe.gov/emergency/news/healthactions/section1135/Pages/covid19-13March20.aspx. While CMS and other stakeholders have explored potential alternatives to the current CBSA-based labor market system, no consensus has been achieved regarding how best to implement a replacement system. Response: The labor share standardization factor is applied to the FY 2022 hospice payment rates so that the aggregate payments do not increase or decrease due to changes in the labor share values. We have examined the impacts of this rule as required by Executive Order 12866 on Regulatory Planning and Review (September 30, 1993), Executive Order 13563 on Improving Regulation and Regulatory Review (January 18, 2011), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. Comment: Some commenters raised questions about using 75 completed surveys as the threshold for public reporting of stars. An official website of the United States government. We purposely made no updates or proposals in the FY 2021 final rule during the COVID-19 PHE. Response: On the questionnaire, the respondent is asked if their family member experienced the symptom. This single measure differentiates hospices and holds them accountable for completing all seven process measures to ensure core services of the hospice comprehensive assessment are completed for all hospice patients. The addendum must be titled Patient Notification of Hospice Non-Covered Items, Services, and Drugs; 3. From there, we found all beneficiaries that ended their hospitalization and were readmitted back to hospice no more than 2 days after the last date of the hospitalization. FY 2015 Hospice Wage Index and Payment Rate Update Final Rule, 9.
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