In the FY 2008 Hospice Wage Index final rule (72 FR 50217 through 50218), we implemented a methodology to update the hospice wage index for rural areas without hospital wage data. These commenters provided general and specific suggestions about how to display the HIS Comprehensive Measure on Care Compare if the seven HIS measures are removed. Hospices should update the addendum to include such conditions, items, services, and drugs they determine to be unrelated throughout the course of a hospice election. HOPE items assessing Symptom Impact, and Patient Desired Tolerance Level for Symptoms or Patient Preferences for Symptom Management were used to calculate this measure. The commenters recommended that CMS look further into reporting all pharmacy and medical supply costs as direct patient care costs on future cost reports. We will publicly report the HVLDL no earlier than May 2022. Hospital claims-based measures are also updated annually. Registered Nurses Did Not Always Visit Medicare Beneficiaries Homes at Least Once Every 14 Days to Assess the Quality of Care and Services Provided by Hospice Aides. are not part of the published document itself. Accessible via: https://oig.hhs.gov/oei/reports/oei-02-10-00490.asp. The provision of stratified measure results will allow hospices to understand how they are performing with respect to certain patient risk groups, to support these providers in their efforts to ensure equity for all of their patients, and to identify opportunities for improvements in health outcomes. The distributional effects of the final FY 2022 hospice wage index do not result in a greater than 5 percent of hospices experiencing decreases in payments of 3 percent or more of total revenue. This excluded two providers and had no impact on the compensation cost weights for both IRC and GIP when rounded to a tenth of a percentage point. The quality, utility, and clarity of the information to be collected. The difference between using FY 2019 and FY 2020 hospice claims data was minimal. The proposed labor shares are based on MCR data for freestanding hospice facilities. Response: While these comments are out of scope of the proposed rule, we appreciate and welcome all feedback related to the late penalty; ABN and expansion of the addendum; signatures; exceptional circumstances; and educating hospice providers. One commenter who opposed the proposal to remove the seven HIS measures expressed concern that such a removal runs counter to the objectives of Care Compare to provide a personalized experience. See Condition of participation: Interdisciplinary group, care planning, and coordination of services, Title 42, Chapter IV, Subchapter B, Part 418, 418.56 (https://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=42%3A3.0.1.1.5#se42.3.418_156) and Condition of participation: Hospice aide and homemaker services, Title 42, Chapter IV, Subchapter B, Part 418, 418.76 (https://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=42%3A3.0.1.1.5#se42.3.418_176). Other commenters recommended that CMS change the requirement from 3 calendar days to 3 business days. To comply with CMS' quality reporting requirements for CAHPS, hospices are required to collect data monthly using the CAHPS Hospice Survey. Public Display of Home Health Quality Data for the HH QRP, 3. National Quality Forum. Furthermore, we expect that hospices will have processes in place when they are obtaining a signed addendum from a beneficiary or representative. Comment: One commenter stated that many of the hospice cost reports filed in 2018 failed to report contracted GIP days and contracted IRC care days on Worksheet S-1. Medicare fee-for-service (FFS) hospice claims with through dates on and between October 1, 2016 and September 30, 2019 to determine information such as hospice days by level of care, provision of visits, live discharges, hospice payments, and dates of hospice election. State/County MEDICAID Rate Charts: NHPCO has prepared the . There are four payment categories that are distinguished by the location and intensity of the hospice services provided. We stated that hospices can develop processes (including how to document such requests from non-hospice providers and Medicare contractors) to address circumstances in which the non-hospice provider or Medicare contractor requests the addendum, and the beneficiary or representative does not (86 FR 19725). CY 2021 data submissions compliance impacts the FY 2023 APU. In fact, on weekends, patients' caregivers are more likely to be around and could prefer privacy from hospice staff. In the FY 2021 Hospice Wage Index and Payment Rate Update final rule (85 FR 47079), we finalized a 1-year transition for fiscal year (FY) 2021 only, to mitigate the resulting short-term instability and negative impacts on certain providers and to provide time for providers to adjust to their new labor market delineations. Others noted that the delay could allow time for additional analysis of the measure, and for more transparency about the rationale for it. We anticipate that HOPE will replace the HIS. There is one rate for the first 60 days of care and another rate for care beyond 60 days. Finally, some commenters recommended both removing the seven individual HIS process measures and retiring the HIS Comprehensive Assessment measure. Another commenter stated that completing a full competency test takes the focus away from the identified deficiency and is not effective. Print | We considered several factors to determine the number of years to include in measure calculations. This per diem payment is meant to cover all of the hospice services and items needed to manage the beneficiary's care, as required by section 1861(dd)(1) of the Act. We received many comments expressing the need for HCPCS codes for all hospice disciplines, including spiritual care professionals. 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. We used 3 quarters of HH QRP data from CY 2019 for the all-cause hospitalization and emergency department use claims-based measures and 6 quarters of data from HH QRP CY 2018 and CY 2019 were used for both the Medicare spending per beneficiary and discharge to community claims-based measures. The data source for this HCI measure will be Medicare claims data that are already collected and submitted to CMS. Therefore, the HCI composite yields a more reliable provider ranking. To calculate the compensation costs for each provider, we proposed to then sum each of the costs estimated in steps (1) through (5) to derive total compensation costs for CHC, RHC, IRC, and GIP. Update on Use of Q4 2019 Data and Data Freeze for Refreshes in 2021, (3). We reiterated that the signature on the addendum is only acknowledgement of receipt and not a tacit indication of agreement with its contents, and that we expect the hospice to inform the beneficiary of the purpose of the addendum and rationale for the signature. The sixth column shows the effect of all the proposed changes on FY 2022 hospice payments. Therefore, in the FY 2022 proposed rule (86 FR 19724) we provided clarification on, and proposed modifications to, certain signature and timing requirements and proposed corresponding clarifying regulations text changes. The 7 HIS measures credited hospices when any of these measures were performed regardless of the individual patient. This indicates that scores estimated using 3 quarters of data continue to capture provider-level differences and that admission-level scores remain consistent within hospices. We also discussed developing the Hospice Outcomes & Patient Evaluation (HOPE), a new patient assessment instrument that is planned to replace the HIS. Palliative care is at the core of hospice philosophy and care practices, and is a critical component of the Medicare hospice benefit. Further information about these requirements may be found at: http://www.hhs.gov/ocr/civilrights. We acknowledge that there may have been an increase in refusals during the COVID-19 PHE. Section 418.312 is amended by revising paragraph (b) to read as follows: (b) Submission of Hospice Quality Reporting Program data. The CAHPS Hospice Survey measures received NQF endorsement on October 26, 2016 and was re-endorsed November 20, 2020 (NQF #2651). The publicly-reported version of HCI on Care Compare will only include the final HCI score, and not the component indicators. Comment: One commenter strongly suggested that there should be a not applicable response option available for each question in the questionnaire. Both the use of the pseudo-patient and targeted aide training align requirements between these two providers, home health and hospice, affording the opportunity for efficiency in implementation for many agencies that are Medicare certified to provide both services. Based on the caregivers' feedback, we proposed reporting the HCI as a single score to report on Care Compare, while providing the indicator scores in the Provider Data Catalog (PDC). We believe that using the most current OMB delineations provides a more accurate representation of geographic variation in wage levels and do not believe it would be appropriate to allow hospices to be assigned a higher CBSA designation or to allow 1-year limited increase in hospice wage index payments for hospices only in the Montgomery County Metropolitan Divisions. We proposed and are finalizing these changes to remove the seven HIS process measures as individual measures from HQRP no earlier than May 2022. Comment: One commenter stated that the proposed methodology for calculating compensation costs omits two of the required disciplines in a hospice patient's interdisciplinary team. The interdisciplinary, holistic scope of the HIS Comprehensive Assessment Measure aligns with the public's expectations for hospice care. They encouraged HHS to continue pursuing adoption of FHIR APIs for health IT vendors. One commenter requested that CMS work with stakeholders and the hospice community to identify the best approaches, and separate worksheets, for GIP and inpatient respite costs, including both hospices that operate a freestanding facility and hospices that have contracted beds. Prior to the COVID-19 PHE, we reported the most recent 8 quarters of data on the basis of a rolling average, with the most recent quarter of data being added and the oldest quarter of data removed from the averages for each data refresh. Medicare claims are administrative records of health care services provided and payments which Medicare (and beneficiaries as applicable) made for those services. Along with nine HIS-based quality measures, the CAHPS Hospice Survey measures are publicly reported on a designated CMS website that is currently Care Compare. Claims data are the best available data source for measuring care during the hospice stay and present an opportunity to bridge the quality measurement gap that currently exists between the HIS and CAHPS Hospice Survey. 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. In the FY 2022 IPPS proposed rule[5] https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/IPPS-Regulations-and-Notices. Name and signature of the Medicare hospice beneficiary (or representative) and date signed, along with a statement that signing this addendum (or its updates) is only acknowledgement of receipt of the addendum (or its updates) and not necessarily the beneficiary's agreement with the hospice's determinations. 634 0 obj <>/Filter/FlateDecode/ID[<8D0FEFA0854FFD48BF49C8390CF2465C><39D71D2E00E4F448BD5CFDC7422C44B0>]/Index[599 63]/Info 598 0 R/Length 148/Prev 456283/Root 600 0 R/Size 662/Type/XRef/W[1 3 1]>>stream Therefore using 3 quarters of data for the HIS Comprehensive Assessment Measure would achieve acceptable reportability shown in Table 14. We noted in the FY 2021 Hospice Wage Index & Payment Rate Update final rule that because the beneficiary signature is an acknowledgement of receipt of the addendum, this means the beneficiary would sign the addendum when the hospice provides it, in writing, to the beneficiary or representative (85 FR 47092). Under section 1135 of the Act, the Secretary may temporarily waive or modify certain Medicare, Medicaid, and Children's Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the programs in the emergency area and time periods, and that providers who furnish such services in good faith, but who are unable to comply with one or more requirements as described under section 1135(b) of the Act, can be reimbursed and exempted from sanctions for violations of waived provisions (absent any determination of fraud or abuse). 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. Hospice Care We also support hospices providing necessary visits in the last days of life such that two visits occurring on the same day may be necessary. Comment: Another specific concern stated by the commenters was that the determination of the labor share for GIP and IRC is based on Worksheet A-3 and A-4; however, any hospices reporting costs on line 25 (contracted services) were not included in the sample used for setting the labor share. . This indicator helps the HCI to capture patients' receipt of skilled nursing visits and direct patient care, which is an important aspect of hospice care. These can be useful We began public reporting of the results of the CAHPS Hospice Survey on Hospice Compare as of February 2018. Closing the Health Equity Gap in the Hospice Quality Reporting Program Request for Information (RFI). For questions regarding the CAHPS Hospice Survey, contact Lori Teichman at (410) 786-6684, Lauren Fuentes at (410) 786-2290, and Debra Dean-Whittaker at (410)786-9848. Comment: Several commenters requested that CMS issue confidential reports with hospices' claims-based measure scores in CASPER to help hospices understand and validate their scores before they are publicly reported. Several existing measures, such as the HIS-based HVWDII measure and its replacement HVLDL, also do not differentiate refused visits. Further, section 1814(i)(6) of the Act, as added by section 3132(a)(1)(B) of the PPACA, authorized the Secretary to collect additional data and information determined appropriate to revise payments for hospice care and other purposes. Under these circumstances a not applicable is not needed. FY 2022 Routine Annual Rate Setting Changes. (b) 40660 The SIA Claim may cover up to the last seven days of life and include the date of death. Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for Fiscal Year (FY) 2023. We also do not believe it would be appropriate to allow hospices to opt for or be assigned a higher CBSA designation based on subdivided metropolitan divisions. Federal Register. We plan to consider multiple years of data, like the 2 years of data, for other claims-based measures proposed in subsequent years. A list of the beneficiary's current diagnoses/conditions present on Start Printed Page 42546hospice admission (or upon plan of care update, as applicable) and the associated items, services, and drugs, not covered by the hospice because they have been determined by the hospice to be unrelated to the terminal illness and related conditions; 6. For more information about Care Compare, please see the Update on the Hospice Quality Reporting Requirements for FY 2022 in section D. Since 2017, we have increased and improved available information about the care hospices provide for consumers. Regarding the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey, CMS finalized a policy that hospices that receive their CMS Certification Number (CCN) after January 1, 2017 for the FY 2019 Annual Payment Update (APU) and January 1, 2018 for the FY 2020 APU will be exempted from the Hospice CAHPS requirements due to newness (81 FR 52182). Comment: Many commenters requested clarification related to the use of technology under the Medicare hospice benefit during the PHE. However, if additional Medicare hospice claims data points become available, we may consider modifying the measure in light of the new data. A hospice-level score for a given survey item would then be calculated as the average of the individual-level responses, with adjustment for differences in case mix and mode of survey administration. Section 1861(dd)(1) of the Act establishes the services that are to be rendered by a Medicare-certified hospice program. As discussed later in this section of the preamble, hospices will have access to preview reports in advance of publicly reporting HCI. The HCI uses information from all ten indicators to collectively represent a hospice's ability to address patients' needs, best practices hospices should observe, and/or care outcomes that matter to consumers. Another commenter indicated that the use of pseudo-patients and simulation will support patient privacy. The commenter stated that it is unclear in the proposed rule whether they are Start Printed Page 42536included in Other Patient Care Salaries since only mentioned are patient transportation, labs and imaging services. We identify the dates of those visits by the revenue center date for those revenue codes. We also considered using three years of data for HVLDL and HCI, and determined that three years did not yield the same benefit (that is, inclusion of hospices) relative to cost (that is, lag in reporting), and thus proposed using two years of data. See Special coverage requirements, Title 42, Chapter IV, Subchapter B, Part 418, 418.204. https://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=42%3A3.0.1.1.5#se42.3.418_1204. The Act requires that, beginning with FY 2014 through FY 2023, the Secretary shall reduce the market basket update by 2 percentage points and then beginning in FY 2024 and for each subsequent year, the Secretary shall reduce the market basket update by 4 percentage points for any hospice that does not comply with the quality data submission requirements for that FY. In the FY 2019 Hospice Wage Index and Payment Rate Update final rule (83 FR 38642), we continued the newness exemption for FY 2023, and all subsequent years. They also called for more explanatory information on the Care Compare website. Obtaining the required signatures on the election statement has been a longstanding regulatory requirement (84 FR 38484); however, we did acknowledge in the proposed rule that there may be time constraints and/or circumstances that would prevent a beneficiary from signing and returning the addendum to the hospice by a specified deadline. Hospice Aide Training and EvaluationUsing Pseudo-Patients, 3. 6. As we proposed, the labor shares are rounded to three decimal places consistent with the labor shares used in other Prospective Payment Systems (PPS) (such as the inpatient prospective payment system (IPPS) and the Home Health Agency PPS). 12. In the FY 2020 Hospice Wage Index and Payment Rate Update final rule (84 FR 38484), we discussed our interest in developing quality measures using claims data, to expand data sources for quality measure development. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. To: NHPCO Provider and State Members From: NHPCO Regulatory Team Date: September 29, 2021 . The data for these additional characteristics are pulled directly from the PAC PUF file and provide potential hospice service patients and family caregivers with more detail prior to selecting a hospice. Final Decision: We are finalizing the hospice payment update percentage of 2.0 percent for FY 2022. legal research should verify their results against an official edition of The non-labor portion is equal to 100 percent minus the labor portion for each level of care. The new website builds on the eMedicare initiative to deliver simple tools and information to current and future Medicare beneficiaries. CMS will monitor data availability as well as measure performance, and may re-specify the measure if needed. The 'Wage Index' links contain the listing of Core Based Statistical Area (CBSA) codes and the corresponding wage index. For HVLDL, one commenter suggested that CMS notify consumers that the measure does not capture visits from chaplains, volunteers, hospice aides, and complementary therapies, among others. Then, for each level of care separately, we proposed to further trim the sample of MCRs. Both the Hospice and PAC PUFs provide information on services provided to Medicare beneficiaries by hospice providers. We note that any future revisions to the hospice labor shares will be proposed and subject to public comments in future rulemaking. 38. The sum of the points earned from meeting the criterion of each indictor results in the hospice's HCI score, with 10 as the highest possible score. http://medpac.gov/docs/default-source/reports/mar20_medpac_ch12_sec.pdf. In Paperwork Reduction Act package (PRA), CMS-10390 (OMB control number: 0938-1153), we provided the HVLDL specifications and also proposed to replace the HVWDII measure pair with the HVLDL. This CY data submission impacting FY APU pattern follows for subsequent years. As discussed in the final rule, CMS hopes to provide additional stratified information related to race and ethnicity if feasible. We appreciate and understand the importance of provider input and involvement in ensuring that this document is effective in increasing coverage transparency for beneficiaries. For example, if the hospice discharge occurred on a Sunday, the hospitalization had to occur on Sunday, Monday, or Tuesday to be counted. This explanation must be clearly noted on the addendum itself, but is not required to be documented in both places. 0938-0758 clearance process, the implementation of the MCR form was delayed to October 1, 2014. Despite the COVID-19 PHE, we would expect that hospices would still provide comprehensive care to hospice patients during the pandemic, and believe that telehealth visits are not full substitutes for care provided in person, particularly in the case of the visits measured in the HVLDL and HCI measures.
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