Live discharges occur when the patient discharge status code does not equal a value from the following list: 30, 40, 41, 42, 50, 51. However, we will remain open to reconsidering the frequency of reporting claims across all PAC settings in the future, should data after implementation indicate that such change is warranted. Response: CMS does not believe that the public display of the individual process measures on Care Compare will add value for consumers. Before proceeding with the October 2020 refresh, we conducted testing to ensure that publicly displaying Q4 2019 data would still meet our standards despite granting an exception to HH QRP reporting requirements for Q4 2019. The seven individual components address care processes around hospice admission that are clinically recommended or required in the hospice CoPs. We believe the information provided in the proposed and final rule allows for commenters to replicate, with their own claims data, the indicators, thresholds, and points earned. Hospice Care In 2019, we added the Hospice Visits When Death is Imminent (Measure 1) to the website. Furthermore, commenters noted that interoperability challenges lead to complications when sharing health information with other providers. HQRP Compliance requires understanding three timeframes for both HIS and CAHPS. This adjustment is made using the change in the CPI from March 1984 to the fifth month of the cap year. We disagree with commenters that notices should be posted on Care Compare regarding the inclusion of data from the COVID-19 PHE as such notice would not help consumers distinguish between hospices in their region. 19. Star ratings benefit the public in that they can be easier for some to understand than absolute measure scores, and they make comparisons between hospices more straightforward. Specifically, a hospice's HCI score is based on its collective performance for the ten performance indicators detailed earlier, all of which must be included to calculate the score and meaningfully distinguish between hospices' relative performance. 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. Open for Comment, Applications for New Awards-American History and Civics Education National Activities Program, Economic Sanctions & Foreign Assets Control, National Oceanic and Atmospheric Administration, Salmonella in Not-Ready-To-Eat Breaded Stuffed Chicken Products, Authority To Order the Ready Reserve of the Armed Forces to Active Duty To Address International Drug Trafficking, Revitalizing Our Nation's Commitment to Environmental Justice for All, B. offers a preview of documents scheduled to appear in the next day's 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. A summary of the comments we received on this proposal and our responses to those comments appear below: Comment: Many commenters requested clarification on the reporting period for initial reporting. Part 418, subpart G, provides for a per diem payment based on one of four prospectively-determined rate categories of hospice care (routine home care (RHC), CHC, IRC, and GIP), based on each day a qualified Medicare beneficiary is under hospice care (once the individual has elected). In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. We acknowledge that this assumption may understate or overstate the costs of reviewing this rule. One commenter stated that it is difficult to attract nurses to their geographic area because of the increase in the median home price between January 2021 and May 2021. We stated that in such a case, although the beneficiary has refused to sign the addendum, the date furnished must still be within the required timeframe (that is, within 3 or 5 days of the beneficiary or representative request, depending on when such request was made), and noted in the chart and on the addendum itself (86 FR 19725). Subject areas specified under paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide's performance of the task with a patient or pseudo-patient. Final Rule Action: We are finalizing as proposed at 418.76(c)(1) our policy that hospices may conduct competency testing by observing an aide's Start Printed Page 42552performance of the task with a patient or pseudo-patient. However, section 1814(i)(1)(C)(iii) of the Act requires the Secretary, for years subsequent to the first fiscal year in which payment revisions described in paragraph (6)(D) are implemented, to update the payment rates by the market basket percentage increase (as defined in section 1886(b)(3)(B)(iii)) of the Act for the Start Printed Page 42543fiscal year; section 1814(i)(1)(C)(iv)(I) of the Act requires that subsequent to such increase, the payment rates be reduced by the productivity adjustment described in section 1886(b)(3)(B)(xi)(II) of the Act. Other commenters recommended using a code to indicate billed but not covered hospice days when the addendum is furnished late. We recognize that the HIS Comprehensive Assessment Measure reflects high scores and is improving over time, which may cause the measure to also become topped out in the future. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. (2) The APU is subsequently applied to FY payments based on compliance in the corresponding Reporting Year/Data Collection Year. Items, Services, and Drugs Related and Unrelated to the Terminal Illness and Related Conditions, 2. This approach aligns with what we are doing for the other PAC setting Quality Reporting Programs, including home health (see section III.G). Obtaining the required signatures on the election statement has been a longstanding regulatory requirement. 37. The day occurs during the last sevendays of the patient's life, and the patient is discharged. Several commenters indicated that the changes will facilitate a more time-efficient process in the evaluation of aide skills. documents in the last year, 825 These visits can be made by either the RN, the medical social worker, or both. HQRP Compliance Checklist illustrates the APU and timeliness threshold requirements. Although this a smaller sample of providers than used for the other proposed labor shares for RHC (2,919 providers) and CHC (1,240 providers), we believe this is a technical improvement to the current labor shares that were primarily based on skilled nursing facility costs from the early 1980s. An unusually high rate of live discharges could indicate that a hospice provider is not meeting the needs of patients and families or is admitting patients who do not meet the eligibility criteria., Our live discharge indicators included in the HCI, like MedPAC's, comprise discharges for all reasons. Hospice care offers holistic support and relief from pain and other symptoms of the terminal illness. Public Reporting of HIS-based Measures With Fewer Than Standard Numbers of Quarters Due to COVID-19 PHE Exemption in February 2022, (4). As with the NOE, the claims processing system must be notified of a beneficiary's discharge from hospice or hospice benefit revocation within 5 calendar days after the effective date of the discharge/revocation (unless the hospice has already filed a final claim) through the submission of a final claim or a Notice of Termination or Revocation (NOTR). Consistent with our policy for measure retention and removal, finalized in the FY 2016 Hospice Wage Index and Rate Update final rule (80 FR 47142), we reviewed these measures against the factors for removal. [19] Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. Any measures selected by the Secretary must have been endorsed by the consensus-based entity which holds a performance measurement contract with the Secretary under section 1890(a) of the Act. The following sections provide the results of our testing for OASIS and claims and explain how we used the results to inform a proposal for accommodating excepted data in public reporting. Final Decision: We are finalizing our proposal to use the CAR scenario for refreshes for January 2022 for OASIS-based measures and for refreshes from Start Printed Page 42598January 2022 through July 2024 for some claims-based measures. Submission requirements are codified in 418.312. endstream endobj 600 0 obj <. CBSA Code CBSA Name CBSA Type; 10100: Aberdeen, SD: Micropolitan: 10140: Aberdeen, WA: Micropolitan: 10180: Abilene, TX: Metropolitan: 10220: Ada, OK: Micropolitan: 10260 The analysis found that 83% of hospices had HCI scores that were 0-1 percentage points different in FY2019 relative to their FY2017 scores. We invited public comment on the following: While we stated that we would not be responding to specific comments submitted in response to this RFI in the FY 2022 Hospice Wage Index final rule, we appreciate all of the comments and interest in this topic. We are finalizing our proposal to remove the seven individual HIS process measures from the HQRP, no longer publicly reporting them as individual measures on Care Compare beginning with FY 2022. Our proposed methodology utilizes freestanding hospice cost report data reflecting the skilled hospice care provided in 2018 and the associated direct and indirect costs required to provide these services in 2018. This report is intended to support quality improvement for hospices. They believe that this is too long and that it makes it difficult for hospices to use publicly-reported data for quality improvement. They stated that in many healthcare systems someone from the accounting department completed the cost report form with very little input from the hospice program. (2020). Second, for each scenario, we conducted a split-half reliability analysis and estimated intra-class correlation (ICC) scores, where higher scores imply better internal reliability. For these reasons, we determined the best course of action would be to continue to publicly report the most recent 8 quarters of data, but exempting Q1 and Q2 2020. Response: We appreciate commenters' interest in having the HCI reflect how prepared hospices are to provide key services to patients. Other commenters stated that denying the whole hospice claim when the addendum is furnished late is excessive. The candidate measure Timely Reduction of Pain Impact reports the percentage of patients who experienced a reduction in the impact of moderate or severe pain. Therefore, we estimate that the total cost of reviewing this regulation is $14,531.54 ($274.18 53 reviewers). 20-01 provided detailed information on the update to statistical areas since September 14, 2018, and were based on the application of the 2010 Standards for Delineating Metropolitan and Micropolitan Statistical Areas to Census Bureau population estimates for July 1, 2017 and July 1, 2018. Response: As stated in the proposed rule, we will display CAHPS Hospice Survey star ratings no sooner than FY 2022. One commenter stated that it is important that CMS address this frequency so that hospices and cost report preparers can ensure that the data submitted on the cost report can be used for the labor share calculations. Based on IHS Global, Inc.'s more recent forecast of the inpatient hospital market basket update and the productivity adjustment, the hospice payment update percentage for FY 2022 will be 2.0 percent for hospices that submit the required quality data and 0.0 percent (FY 2022 hospice payment update of 2.0 percent minus 2.0 percentage points) for hospices that do not submit the required data. We finalized the FY 2020 proposal to reduce the RHC payment rates by 2.72 percent to offset the increases to CHC, IRC, and GIP payment rates to implement this policy in a budget-neutral manner in accordance with section 1814(i)(6) of the Act (84 FR 38496). Any reduction based on failure to comply with the reporting requirements, as required by section 1814(i)(5)(B) of the Act, would apply only for the specified year. 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. We will continue development of HOPE in accordance with the Blueprint for the CMS Measures Management System. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. We sought public comment on quality measure concepts and considerations for developing hybrid measures based on a combination of data sources. and services, go to For each hospice, we divide the number of beneficiaries with skilled nursing or medical social service visits on a hospice claim during the last 3 days of life by the number of beneficiaries with at least 1 day of hospice during the last 3 days of life. Using more years of data allows more of these hospices to meet this threshold. L. 113-185) became law on October 6, 2014. Table 14 indicates that the reliability of the HIS Comprehensive Assessment Measure scores is similar for the CAR and SPR scenarios. Response: We agree that there are benefits to reporting just one year of data. Commenters encouraged CMS to only utilize certain aspects of standardized data elements for patient assessment (specifically, Z-codes 55-65) in collecting health equity data. Use the PDF linked in the document sidebar for the official electronic format. Response: We did not propose to change the timeline for furnishing the addendum when a beneficiary requests the addendum during the course of a hospice election (that is, after the first five days of a hospice election date), and we continue to believe that 3 days is an adequate amount of time for the hospice to furnish the addendum. 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. Response: We agree that there is a lag time between the delivery of care and the calculation and reporting of the claims-based quality measures, including HCI. Therefore, the Secretary has certified that this rule will not create a significant economic impact on a substantial number of small entities. (vi) The availability of a measure that is more strongly associated with desired patient outcomes for the particular topic. 43. We performed analyses using Stata/MP Version 16.1. Refinements to repricing: For CY 2022, CMS will reprice the CY 2017-2019 historical hospice . To test the reliability of restricting the providers included in the Standard Public Reporting (SPR) Scenario to those included in the CAR Scenario, we performed three tests. To support new measure development, our contractor convened TEP meetings in 2020 to provide feedback on several measure concepts. These waivers promoted greater flexibility and reduced burden, allowing hospices to focus on delivering improved patient care during the COVID-19 PHE. The SIA payment is equal to the CHC hourly rate multiplied by the hours of nursing or social work provided (up to 4 hours total) that occurred on the day of service, if certain criteria are met. These will be effective no earlier than May 2022. We are also finalizing our proposal to publicly report the HCI, another claims-based measure no earlier than May 2022. Hospices comply by utilizing a CMS-approved third-party vendor. [31] The literature strongly supported the focus on RNs and medical social workers in the revised measure. 04/28/2023, 858 The provision of care would proportionately escalate to meet the increased clinical, emotional, and other needs of the patient and family. Instead, progress on HCI will occur over longer time frames, and annual updates are sufficient to support hospices' efforts to improve.