Services furnished voluntarily by physicians are not reimbursable. The documents posted on this site are XML renditions of published Federal Alcona County or Statistical Equivalent Lake Erie Coastline CBSA boundaries and names are as of February 2013. 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. 18-04 that was issued on September 14, 2018. In response to the concerns raised by those opposing the removal of seven HIS process measures, we would like to emphasize that all but one of the seven HIS measures are topped out individually and one HIS measure is almost topped out and shows insignificant variability between hospices. If, in the judgment of the hospice interdisciplinary team, which includes the hospice physician, the patient's symptoms cannot be effectively managed at home, then the patient is eligible for general inpatient care (GIP), a more medically intense level of care. 45. We believe that this will benefit the hospice and the patient by allowing new aide trainees and aides requiring remedial training and competency testing to begin serving patients more quickly while protecting patient health and safety. Comment: We received several comments with a request for CMS to consider quarterly as opposed to annual reporting of claims-based measures to best support continuous quality improvement activities. This interdisciplinary, holistic scope of the HIS Comprehensive Assessment Measure better aligns with the public's expectations for hospice care. We are finalizing the following revisions to the hospice CoPs. A higher value in these scores indicates that HIS Comprehensive Assessment Measure values are relatively consistent for patients admitted to the same hospice and variation in the measure reflects true differences across providers. The HIS Comprehensive Measure, like any given quality measure, is one part of a portfolio of measures intended to provide a holistic view of care. 14. (2) Administrative data, such as Medicare claims data, used for hospice quality measures to capture services throughout the hospice stay, are required and fulfill the HQRP requirements for 418.306(b). PDF Hospice Care (2013). The fourth column shows the effect of the final rebased labor shares. In that memo, which applies to HIS and CAHPS Hospice Survey, CMS granted an exemption to the HQRP reporting requirements for Quarter 4 (Q4) 2019 (October 1, 2019 through December 31, 2019), Quarter 1 (Q1) 2020 (January 1, Start Printed Page 425782020 through March 30, 2020), and Quarter 2 (Q2) 2020 (April 1, 2020 through June 30, 2020). documents in the last year, 422 Star ratings will continue to be calculated and released as we phase in the new survey version. The commenter stated that they never had an opportunity to review the cost report prior to submission to verify the information was accurate and that they believe this is a common occurrence across the country. This site displays a prototype of a Web 2.0 version of the daily GIP is provided to ensure that any new or worsening symptoms are intensively addressed so that the beneficiary can return to his or her home and continue to receive routine home care. 100-04 Medicare Claims Processing Transmittal 10929, Change Request 12354 dated August 4, 2021. Comment: Several commenters stated that the use of pseudo-patients and simulation techniques are common in healthcare and a standard of practice in many formal nursing assistant programs. We solicit comments on current HOPE-based quality measure development and recommendations for future process and outcome measure constructs. This means that when visits by RNs or medical social workers occurred in at least two of the last three days of life, family and caregivers agree or positively correlate that they would recommend the hospice, more often when compared to HVWDII, on average. The Medicaid reimbursement is based on the status of the member's eligibility days and a hospice lock-in span. Other indicators, such as nurse visits (RN and LPN) on weekends or near death, have a criterion of higher than the 10th percentile, identifying hospice care delivery during the most vulnerable periods during a hospice stay. Table 6 lists all quality measures planned for FY 2022 for HQRP. Using fewer quarters of more up-to-date data requires that: (1) A sufficient percentage of HHAs would still likely have enough OASIS data to report quality measures (reportability); and (2) using fewer quarters of data to calculate measures would likely produce similar measure scores for HHAs, and thus not unfairly represent the quality of care HHAs provided during the period reported in a given refresh (reliability). Given the timing of the COVID-19 PHE onset in the U.S., we determined that we would use data that were submitted for Q4 2019. While hospice is not included in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act of 2014) (Pub. With two years of data, 50 percent Start Printed Page 42588of the data come from the more recent year, and hospices should still be able to see their scores change as their performance improves. In the FY2018 Hospice Wage Index & Payment Rate proposed rule (82 FR 20750), we solicited public comment on two high-priority claims-based measure concepts being considered at the time, one which looked at transitions from hospice and another which examined access to higher levels of hospice care. A few of these commenters requested that CMS provide further clarification of the frequency of updates to the labor shares with hospice cost report data. This PDF is https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensions-quality-reporting-and-value-based-purchasing-programs.pdf. Since its implementation on October 1, 2020, CMS has received additional inquiries from stakeholders asking for clarification on certain aspects of the addendum. The MCR data captures detailed labor and non-labor expenses for patient (including but not limited to nursing, physician, therapy and medical supply expenses) and non-patient expenses (such as administrative and general) by level of care. Response: We thank commenters for their support of this proposal on public reporting for refreshes affected by the exceptions. CMS' sub-regulatory Quality Measure Users' Manual on the CMS HQRP Current Measures web page will include specifications for each indicator and scoring for HVLDL, and the HIS Comprehensive Assessment measure (NQF #3235). The literature strongly supported the focus on RNs and medical social workers in the revised measure. We outline our proposed trimming methodology using CHC as an example. We identified selected waivers as appropriate candidates for formal regulatory changes. However, if additional Medicare hospice claims data points become available, we may consider modifying the measure in light of the new data. Additionally, we summarize the comments on the requests for information (RFI) on advancing to digital quality measurement and the use of FHIR and on addressing the White House Executive Order related to health equity in the HQRP. We solicited public comment on the aforementioned HOPE- and claims-based quality measures to distinguish between high- and low-quality hospices, support healthcare providers in quality improvement efforts, and provide support to hospice consumers in helping to select a hospice provider. Our analyses have determined that the optimal balance between these two goals is at 75 completed surveys per hospice. The SIA payment will equal the Continuous Home Care (CHC) hourly payment rate, for a minimum of 15 minutes and up to 4 hours total per day. These costs are multifaceted and include the burden associated with complying with the program. About the Federal Register Under the current HH QRP public display policy, Home Health Compare uses 4 quarters of data to publicly display OASIS-based measures, and 4 or more quarters of data to publicly display claims-based measures. Since we limited our sample for IRC and GIP compensation cost weights to those hospices providing inpatient services in their facility, we conducted sensitivity analysis to test for the representative of this sample by reweighting compensation cost weights using data from the universe of freestanding providers that reported either IRC or GIP total costs. One of the first areas CMS has identified relative to improving our digital strategy is through the use of Fast Healthcare Interoperability Resources (FHIR)-based standards to exchange clinical information through application programming interfaces (APIs), allowing providers to digitally submit quality information one time that can then be used in many ways. Division CC, section 404 of Consolidated Appropriations Act, 2021 (CAA 2021) amended section 1814(i)(2)(B) of the Act and extended the provision that currently mandates the hospice cap be updated by the hospice payment update percentage (hospital market basket update reduced by the productivity adjustment) rather than the CPI-U for accounting years that end after September 30, 2016 and before October 1, 2030. The 2020-2021 MAP 2020 Final Recommendations can be found at: http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=94893. We estimate that aggregate payments to hospices in FY 2022 will increase by $480 million as a result of the market basket update, compared to payments in FY 2021. We also compared the measure scores of the hospices that meet the reporting threshold when we use 2 years of data with hospices that meet the threshold using only 1 year of data. In Table 15, we explore changes in hospices' relative rankings between the SPR and CAR scenarios. Some commenters recommended that CMS align the late penalty for the addendum with the penalty for late submission of the NOE. The second column shows the number of hospices in each of the categories in the first column. documents in the last year, 494 We will monitor the cost report data to determine whether the proposed updated labor shares are still appropriate. This tool is intended to help hospices better understand care needs throughout the patient's dying process and contribute to the patient's plan of care. We also received six comments on the use of the labor share standardization factor including hospices, national industry associations. The AMA is a third party beneficiary to this Agreement. This could increase the speed of performing competency testing and would allow new aides to begin serving patients more quickly while still protecting patient health and safety. Given the importance of structured data and health IT standards for the capture, use, and exchange of relevant health data for improving health equity, the existing challenges providers' encounter for effective capture, use, and exchange of health information, such as data on race, ethnicity, and other social determinants of health, to support care delivery and decision making. Executive Orders 12866 and 13563 direct agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). Specifically, for IRC, we required total IRC costs (Worksheet B, column 18, line 52) and IRC compensation costs to be greater than zero. We believe that updating the data in February 2022 by more than a year relative to the November 2020 freeze data would assist consumers by providing more relevant quality data and allow hospices to demonstrate more recent performance. In addition, we finalized the Hospice Visits When Death is Imminent measure pair (HVWDII, Measure 1 and Measure 2) in the FY 2017 Hospice Wage Index and Payment Rate Update final rule, effective April 1, 2017. PPACA, required, effective January 1, 2011, that a hospice physician or nurse practitioner have a face-to-face encounter with the beneficiary to determine continued eligibility of the beneficiary's hospice care prior to the 180th day recertification and each subsequent recertification, and to attest that such visit took place. The hospice wage index utilizes the wage adjustment factors used by the Secretary for purposes of section 1886(d)(3)(E) of the Act for hospital wage adjustments. MedPAC also recommended wage adjusting the hospice cap amount to make it more equitable across providers. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. Response: We appreciate the support by comments recognizing the value HCI brings to consumers by providing more information not previously available about hospices. Indicator Nine: Skilled Nursing Minutes on Weekends, c. Measure Reportability, Variability, and Validity, e. Form, Manner and Timing of Data Collection and Submission, 4. Using the most recent complete data available at the time of rulemaking, in this case FY 2020 hospice claims data as of January 15, 2021, we apply the current FY 2021 wage index with the current labor shares. Respite Care, per Day, T2044 General Inpatient Care, per Day, T2045 Ohio Counties Federal Fiscal Year 2022 Hospice Rates by Core-Based Statistical Area for Providers in Compliance with Hospice Quality Reporting . hbbd```b``"gH mX,$M0! For each level of care, we proposed to calculate noncapital overhead costs for each level of care to be equal to Worksheet B, column 18, less the sum of Worksheet B, columns 0 through 2, for line 50 (CHC), or line 51 (RHC) or line 52 (IRC) or line 53 (GIP). The final hospice cap amount for FY23 is $32,486.92. In addition to the Preview Report, we will also include claims-based measure scores in the Hospice Agency-Level QM Report in CASPER. L. 105-33) amended section 1814(i)(1)(C)(ii)(VI) of the Act to establish updates to hospice rates for FYs 1998 through 2002. In addition, this rule rebases the labor shares of the hospice payment rates and finalizes clarifying regulations text changes to the election statement addendum requirements finalized in the FY 2020 Hospice Wage Index and Payment Rate Update final rule (84 FR 38484). Once we identified those hospice stays, we examined the timing of the provision of nursing visits within those stays. Under the Paperwork Reduction Act of 1995, we are required to provide 30-day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to OMB for review and approval. Therefore, we proposed to estimate other patient care salaries attributable to CHC, RHC, IRC, and GIP by first calculating the ratio of total facility (reflecting all levels of care) other patient care salaries (Worksheet A, column 1, lines 38 through 46) to total facility other patient care total costs (Worksheet A, column 7, lines 38 through 46). Background: COVID-19 Public Health Emergency Temporary Exemption and Its Impact on the Public Reporting Schedule, (2). Direct patient care is furnished by a registered nurse (RN) or social worker (SW) that day. This distinction is important since it explains why the individual HIS Start Printed Page 42556measures can be topped out but when measured together as a group, or composite, that is required on each patient in order to get credit for the measure, the HIS Comprehensive Assessment Measure shows variability and meets public reporting standards. Chapter 12: Hospice Services. The size exemption is only valid for the year on the size exemption request form. Other PAC settings show similar findings regarding the stability of claims measures compared to assessment scores, which we update quarterly. Hospice Utilization and Spending Patterns, 2. The hospice CoPs at 418.56(b) require hospices to educate each patient and their primary caregivers(s) on services identified on the plan of care and document the patient's (or representative's) level of understanding involvement and agreement with the plan of care. We have used CBSAs for determining hospice payments since FY 2006. The SIA payment is provided for visits of a minimum of 15 minutes and a maximum of 4 hours per day (80 FR 47172). Comment: Some commenters expressed concern that the HCI will become topped out, with 85 percent of hospices scoring a 7 or better, limiting the measure's ability to differentiate between hospices. We would note that Medicare days, in aggregate, account for over 80 percent of total facility days. At this time, it is premature to determine whether the HOPE tool should be used to create star ratings, either separately from CAHPS or in combination with CAHPS. 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. Furthermore, many of these clarifying regulations text changes have been previously addressed in sub-regulatory guidance. For FY 2022, two of the four measures we proposed to add were claims-based measures which do not increase burden to providers. If you are using public inspection listings for legal research, you Response: The star rating approach proposed for CAHPS Hospice Survey measures is similar to what has been used for Medicare Advantage and Part D plan measures and Hospital CAHPS measures successfully for many years.