Therefore, we would consider the hospice claims data to be complete for purposes of calculating the claims-based measures at this point. Final Decision: We are finalizing the hospice payment update percentage of 2.0 percent for FY 2022. include documents scheduled for later issues, at the request 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. Update on Quality Measure Development for Future Years, 8. documents in the last year, 125 IPPS Regulations and Notices. OMB approved the proposal to replace the HVWDII measure with the HVLDL measure and remove Section O from the discharge assessment on February 16, 2021. Response: The proposed hospice labor shares for the IRC level of care and GIC level of care (after trimming for outliers) is based on costs for 416 and 295 providers, respectively. Any such reduction would not be cumulative nor be taken into account in computing the payment amount for subsequent FYs. electronic version on GPOs govinfo.gov. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. (2020). Currently, only Medicare-certified hospices with more than 20 patient stays each year have quality measure results publicly available on Care Compare. Comments specific to HCI noted that abnormalities due to the COVID-19 PHE would affect all of the indicators, while those for HVLDL indicated that the number of in-person visits likely fell during the COVID-19 PHE due to patient and caregiver preferences, with implications for quality measurement. along with the publication of the FY 2021 Hospice Wage Index and Payment Rate Update final rule (85 FR 47070). The Future of Hospice and Medicare Advantage Organizations Hospice providers will be increasingly impacted by the growth of Medicare Advantage Organizations and their evolving ability to offer hospice benefits to patients. However, OMB occasionally issues minor updates and revisions to statistical areas in the years between the decennial censuses. 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). However, in light of the COVID-19 PHE, we plan to monitor the upcoming MCR Start Printed Page 42534data to see if a more frequent revision to the hospice labor shares is necessary in order to reflect the most recent cost structures of hospice providers. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. In addition, the FY 2015 Hospice Wage Index and Rate Update final rule (79 FR 50496) provided background, described eligibility criteria, identified survey respondents, and otherwise implemented the Hospice Experience of Care Survey for informal caregivers. https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensions-quality-reporting-and-value-based-purchasing-programs.pdf. PDF Hospice Rates for Providers that Have Submitted the Required - Texas The hospice interdisciplinary group works with the beneficiary, family, and caregivers to develop a coordinated, comprehensive care plan; reduce unnecessary diagnostics or ineffective therapies; and maintain ongoing communication with individuals and their families about changes in their condition. Consultant specialty services, when necessary for the palliative care and management of the terminal illness (e.g., radiation for pain relief), are covered separately and are reimbursed only to the elected hospice. Another commenter recommended that CMS develop and implement a wage index model that is consistent across all provider types so that all types of providers have a level playing field from which to compete for personnel. Section 3(a) of the IMPACT Act mandated that all Medicare certified hospices be surveyed every 3 years beginning April 6, 2015 and ending September 30, 2025. Hospice providers suggested that claims may lack sufficient information to adequately reflect individual patient Start Printed Page 42565needs or the full array of hospice practices. Response: We agree that hospice care is interdisciplinary care delivered by clinical and non-clinical staff supporting the patient's plan of care. We measure whether a live discharge occurs on or after the 180th day of hospice by looking at a patient's lifetime length of stay in hospice. Update on Publicly Reporting for the Hospice Visits When Death is Imminent (HVWDII) Measure 1 and the Hospice Visits in the Last Days of Life (HVLDL) Measure, D. Update on Transition From Hospice Compare to Care Compare and Provider Data Catalog, e. Update on Additional Information on Hospices for Public Reporting, G. January 2022 HH QRP Public Reporting Display Schedule with Fewer than Standard Number of Quarters Due to COVID-19 Public Health Emergency Exemptions, 2. The FY 2022 rates for hospices that do not submit the required quality data would be updated by the FY 2022 hospice payment update percentage of 2.0 percent minus 2 percentage points. Many waivers and modifications were made effective as of March 1, 2020 in accordance with the President's declaration.[51]. The letter can be used to show when you received your number. 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 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. You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. The final hospice rate increase for FY 2022 is 2.0%. In the FY 2020 Hospice Wage Index and Payment Rate Update final rule (84 FR 38484), we finalized modifications to the hospice election statement content requirements at 418.24(b) to increase coverage transparency for patients under a hospice election. by the Education Department The types of data and information suggested in the PPACA could capture accurate resource utilization, which could be collected on claims, cost reports, and possibly other mechanisms, as the Secretary determined to be appropriate. Response: We appreciate the commenters' concerns on the accuracy of the IRC and GIP cost data on the MCR. Live discharges occur when the patient discharge status code does not equal a value from the following list: 30, 40, 41, 42, 50, 51. (2020, March 27). As for the request to notify consumers that the measure is based on admission alone, we do not believe this would help consumers use the measure to compare and select hospices, as intended. For both claims and OASIS-based measures, the quarters used in our analysis were the most recently available data that exclude the same quarters (Q1 and Q2) as that are relevant from the COVID-19 PHE exception, and thus take seasonality into consideration. In addition, Table 18 shows the proposed CAHPS public reporting schedule during and after the data freeze. 47. Comment: MedPAC recommended that CMS consider removing the HIS Comprehensive Assessment Measure because the scores suggest the composite measure is limited in distinguishing provider quality. One way to approach this would be to use state survey data to identify hospices that are deficient and do not have contracts to provide GIP. They stated that more nurses are retiring, competition for available nurses is fierce, and many hospices are paying premium salaries and bonuses to recruit and retain qualified nursing staff. G-codes are used to identify the SW and RN versus LPN visits. The presence of revenue center code 055x (Skilled Nursing) on the hospice claim. Comment: Some commenters expressed concern that the request from a non-hospice provider for the election statement addendum does not require a signature. Notice and comment are unnecessary because we are conforming the regulation to statute and there is no discretion on the part of the Secretary. 20-01, we have determined that the changes in Bulletin 20-01 encompassed delineation changes that would not affect the Medicare wage index for FY 2022. Table 20 displays the original schedule for public reporting of OASIS and HH CAHPS Survey measures prior to the Q1 and Q2 2020 data impacted by the COVID-19 PHE. Any updates to specific program requirements related to quality measurement and reporting provisions would be addressed through separate and future notice- and-comment rulemaking, as necessary. 804(2). As stated earlier, we pre-emptively issued the March 27, 2020 CMS Guidance Memorandum making 2019 Q4 and Q1 and Q2 2020 exempt from reporting requirements. The Department of Health and Human Services practice in interpreting the RFA is to consider effects economically significant only if greater than 5 percent of providers reach a threshold of 3 to 5 percent or more of total revenue or total costs. (2019). This public reporting threshold protects the privacy Start Printed Page 42585of patients who seek care at smaller hospices. As discussed in the FY 2016 Hospice Wage Index and Rate Update final rule (80 FR 47183), we implemented changes mandated by the IMPACT Act of 2014 (Pub. For the CAHPS Hospice Survey, 2.1 percent more hospices submitted data in Q4 2019 than in the same quarter a year earlier. Comment: Several commenters expressed concerns about the frequency of updating the labor shares in the future. The final definitions are as follows: These changes will allow hospices to utilize pseudo-patients, such as a person trained to participate in a role-play situation or a computer-based mannequin device, instead of actual patients, in the competency testing of hospice aides for those tasks that must be observed being performed on a patient. Such comparative star ratings, as proposed by CMS, help consumers identify high and low performing hospices. 553 authorize the agency to waive these procedures, however, if the agency for good cause finds that notice and comment procedures are impracticable, unnecessary, or contrary to the public interest and incorporates a statement of the finding and its reasons in the rule issued. FY 2022 Medicaid Hospice Rates Released. Hospices are able to create their own process when it comes to updating and providing the requested addendum to the beneficiary (or representative). documents in the last year, 1471 During these meetings, the discussions reflecting on the analysis generally supported the replacement of HVWDII with a claims-based HVLDL measure. We solicit comments on current HOPE-based quality measure development and recommendations for future process and outcome measure constructs. A gap of at least 1 day without hospice ends the sequence. A summary of the comments we received and our responses those comments are below: Comment: Several comments support the re-specified HVLDL claims-based measure and the resulting reduction of burden, but expressed concern that the measure is limited to RN and medical social worker. While changing the data included in claims is outside the scope of this proposed measure, we believe that using the claims data that currently exists still provides new and useful information not currently available to patients, families, and caregivers with the existing HQRP measures. Claims data are collected based on the actual care delivered, providing a more direct reflection of care delivery decisions and actions than patient assessments or surveys. We will work with colleagues to provide information on Care Compare that alerts users the composition of the data. Live discharges are assigned to a particular reporting period based on the date of the live discharge (which corresponds to the through date on the claim). 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). We will explore alternatives for presenting additional information about star ratings on the Care Compare website so that consumers may be informed about why smaller hospices may not have stars. Using the same FY 2020 data, we apply the FY 2022 wage index and the current labor share values to simulate FY 2022 payments. The final payment rates for FFY 2022 are as follows: Code FY 2021 Payment Rates Final FY 2022 Payment Rates 651: RHC (days 1-60) $199.25 $203.40 651: RHC (days 61+) $157.49 $160.74 655: IRC $461.09 $473.75 Hospice providers that do not submit the required quality data will experience a 2 percentage point reduction to their market basket. This policy will apply beginning with FY 2024 annual payment update (APU). Additionally, the rule finalizes the addition of the claims-based Hospice Visits in the Last Days of Life (HVLDL) measure for public reporting, which supports patient empowerment and transparency of hospice performance. Under our proposal, the HQRP will go from 10 measures down to 4 measures with two of these measures being claims-based measures, and the two already publicly reported measures of the CAHPS Hospice Survey and NQF #3235, the HIS-Comprehensive Assessment Measure. 42 U.S.C. Response: We appreciate MedPAC's comments; however, we are required by law to update the hospice cap amount from the preceding year by the hospice payment update percentage, in accordance with section 1814(i)(2)(B)(ii) of the Act. We received many comments emphasizing that financial incentives would encourage providers to adopt new HIT systems and work to reduce burden using FHIR and EHR. Comment: Many commenters requested clarification related to the use of technology under the Medicare hospice benefit during the PHE. States choosing to implement this cap must specify its use in the Medicaid state plan. Journal of Pain and Symptom Management, 50, 548-552. doi: 10.1016/j.jpainsymman.2015.05.001. (2013). They complement each other and further support the need for each measure in the HQRP. We performed analyses using Stata/MP Version 16.1. Should a hospice believe they have found an error with an HIS or claims-based measure calculation as displayed in their preview reports, they can request a review, and we will suppress if the review finds the calculation problematic. provide legal notice to the public or judicial notice to the courts. With just one click, patients can find information that is easy to understand about doctors, hospitals, nursing homes, and other health care services instead of searching through multiple tools. Other commenters recommended that CMS change the requirement from 3 calendar days to 3 business days. A few commenters requested additional clarification on certain topics and offered recommendations for the election statement addendum. 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. Addition of a Claims-Based Index Measure, the Hospice Care Index, b. This means that hospice providers must furnish the addendum to the beneficiary or representative on or before the third day after the date of the request. Hospice Conditions of Participation (CoPs). Currently the regulations at 418.24(c) require that if a beneficiary or his or her representative requests the addendum at the time of the initial hospice election (that is, at the time of admission to hospice), the hospice must provide this information, in writing, to the individual (or representative) within 5 days from the date of the election. We also required that IRC direct patient care salaries and contract labor costs per day would be greater than 1. This means that we will no longer report HVWDII with patient stays and will start publicly reporting HVLDL no earlier than May 2022. Table 14 indicates that the reliability of the HIS Comprehensive Assessment Measure scores is similar for the CAR and SPR scenarios. One commenter stated that with only those cost reports from providers that have a hospice inpatient unit being used to determine the GIP and inpatient respite labor costs, they are concerned because one of their two affiliated hospices does have an inpatient unit, and yet they sometimes refer patients to contracted facilities for these levels of care as well. Using fewer quarters of more recent data, the first option, would require that (1) a sufficient percentage of providers would still likely have enough assessment data to report quality measures (reportability); and (2) fewer quarters would likely produce similar measure scores for hospices, and thus not unfairly represent the quality of care hospices provide during the period reported in a given refresh (reliability). They also questioned whether CMS expected that use of a revised questionnaire would increase the number of hospices that achieve 75 completed questionnaires and would, therefore, be included in star ratings. The commenter claimed that the proposed methodology only captures salaries and benefits of physicians, nurse practitioners, RNs and hospice aides. $=.Ydb{f DrE3n"c#f220m :? 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. However, section 1814(i)(5)(D)(ii) of the Act provides that in the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical measure has not been endorsed by the consensus-based entity, the Secretary may specify measures that are not endorsed, as long as due consideration is given to measures that have been endorsed or adopted by a consensus-based organization identified by the Secretary. Section 1814(i)(5)(D)(iii) of the Act requires that the Secretary publish selected measures applicable with respect to FY 2014 no later than October 1, 2012. Final Decision: We are finalizing as proposed to publicly report the HCI and HVLDL beginning no earlier than May 2022, and to include it in the Preview Reports no sooner than the May 2022 refresh. 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. The effect of the FY 2022 hospice payment update percentage results in an overall increase in estimated hospice payments of 2.0 percent, or $480 million. Response: We are currently conducting an experiment to test a new version of the survey, including the web mode of administration which may have an impact on response rates and the number of survey completes. See Payment procedures for hospice care, Title 42, Chapter IV, Subchapter B, Part 418, 418.302. https://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=42%3A3.0.1.1.5#se42.3.418_1302.