The FY 2022 payment rates for CHC, IRC, and GIP are shown in Table 3. Medicare regulations define palliative care as patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Many of these commenters requested that CMS wait a year (until 2023) to publicly report the measures, while also requesting to confidential reports with the claims-based measures as soon as possible. Journal of Pain & Symptom Management, 40(6): 829-837. doi: 10.1016/j.jpainsymman.2010.03.024. The commenter was concerned that costsand accordingly labor component costsare based on a small population with high risk of error. ;XQ"(dD+@4Gu1YiE V;;Aak. 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 second column shows the number of hospices in each of the categories in the first column. We encourage those who have concerns about fraud, waste, or abuse to report these to CMS Center for Program Integrity. CMS expects hospices to honor patient wishes on a case-by-case basis. (1) The relevant Reporting Year, payment FY and the Reference Year. In addition, MedPAC's Report to Congress: Medicare Payment Policy[9] 0Q8219eFC"3UX(&pU1X:r` Applying these Level I edits to the 2018 freestanding hospice MCRs resulted in 3,345 providers that passed the edits (four were excluded). Numerator: Total Medicare hospice payments received by a hospice within a reporting period. We identify the dates of RHC service by the corresponding revenue center date (which identifies the first day of RHC) and the revenue center units (which identifies the number of days of RHC (including the first day of RHC)). This rule updates the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2022 as required under section 1814(i) of the Social Security Act (the Act). Hospice Rates for Providers that Have Submitted the Required Quality Data Federal Fiscal Year 2021 Effective October 1, 2020 County Name County Number CBSA These results indicate that a hospice's HCI scores would not normally fluctuate a great deal from one year to the next, and that they will fluctuate even less from quarter to quarter. 22. Those changes and their respective histories and background information are discussed in the rule. Background: COVID-19 Public Health Emergency Temporary Exemption and Its Impact on the Public Reporting Schedule, (2). We obtained the Hospice-aggregate CAHPS Hospice Survey outcome data via: https://data.cms.gov/provider-data. These total costs would reflect medical supply and pharmacy costs when reported on Worksheet A line 10 and 14 or when reported on Worksheet A-1, A-2, A-3, and A-4. Section 1895(b)(3)(B)(v)(II) of the Act requires that for 2007 and subsequent years, each HHA submit to the Secretary in a form and manner, and at a time, specified by the Secretary, such data that the Secretary determines are appropriate for the measurement of health care quality. In the FY 2022 proposed rule (86 FR 19717 through 19719), we proposed to rebase and revise the labor shares for CHC, RHC, IRC and GIP using Medicare cost report (MCR) data for freestanding hospices (collected via CMS Form 1984-14, OMB NO. The FY 2015 Hospice Wage Index and Rate Update final rule (79 FR 50479) also finalized a requirement that the election form include the beneficiary's choice of attending physician and that the beneficiary provide the hospice with a signed document when he or she chooses to change attending physicians. It is not an official legal edition of the Federal better and aid in comparing the online edition to the print edition. We adopted 8 survey based measures for the CY 2018 data collection period and for subsequent years. Update to the Public Display of HH CAHPS Measures Due to the COVID-19 PHE Exception, A. To calculate the percentage, for each hospice we divided the number of live discharges that are followed by a hospitalization (within 2 days of hospice discharge) and then the patient dies in the hospital in a given FY by the number of live discharges in that same reporting period. Enhancements for mobile use will give practical benefits like accessing the tool using a smartphone that can initiate phone calls to providers simply by clicking on the provider's phone number. However, we do not agree with the commenter who suggested including a statement on Care Compare regarding the inclusion of data from the COVID-19 PHE because such an announcement will not help consumers distinguish between HHAs in their region. The seven HIS process measures are also available by visiting the data catalogue at https://data.cms.gov/provider-data/topics/hospice-care. Numerator: The total number of live discharges from the hospice followed by hospital admission within 2 days, then hospice readmission within 2 days of hospital discharge within a reporting period. (2020). The portfolio of quality measures in the HQRP will include outcome measures that reflect the results of care. We maintain transparency since Start Printed Page 42584stakeholders, who are interested in the seven HIS measures, will have access to the Provider Data Catalogue where they can find all HIS component measure scores. Response: We acknowledge and appreciate the commenters' concerns regarding labor costs and understand the challenges created by the PHE. As previously discussed, the adjusted pre-floor, pre-reclassified hospital wage index values below 0.8 will be further adjusted by a 15 percent increase subject to a maximum wage index value of 0.8. Furthermore, many of these clarifying regulations text changes have been previously addressed in sub-regulatory guidance. The hospice must note (on the addendum itself) the reason the addendum was not signed and the addendum would become part of the patient's medical record. Additionally, we acknowledged that hospices have noted that there is not a timeframe in regulations regarding the patient signature on the addendum. The Public Inspection page A hospice is awarded a point for meeting each criterion for each of the 10 indicators. [19] We received many comments on future quality measure development aspects. As discussed later in this section of the preamble, we will publicly report no earlier than May 2022. We also plan to continue to review the 2020 hospital-based hospice MCR data to see if the reporting of the detailed expense data by level of care has improved for possible incorporation into the labor share calculations. The commenter stated that they understand that this reporting is inaccurate; however, there is no existing Level 1 edit that would catch it. This is an illustrative example for hospices to modify and develop their own forms that meet the content requirements at 418.24. Medicare spending per beneficiary is then calculated by dividing the total payments by the total number of unique beneficiaries. Collection of Information Requirements, https://www.federalregister.gov/d/2021-16311, MODS: Government Publishing Office metadata, https://www.whitehouse.gov/wp-content/uploads/2020/03/Bulletin-20-01.pdf, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/Hospice-Wage-Index.html, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/Hospice-Wage-Index, https://www.cms.gov/About-CMS/Components/CPI, https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/MMF/General-info-Sub-Page.html, https://data.cms.gov/provider-data/topics/hospice-care, https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Provider-of-Services, http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=94893, https://www.cms.gov/regulations-and-guidancelegislationpaperworkreductionactof1995pra-listing/cms-10390, 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As stated in the Fiscal Year (FY) 1983 Hospice Wage Index and Rate Update proposed rule (48 FR 38149), the hospice must have an interdisciplinary group composed of paid hospice employees as well as hospice volunteers, and that the hospice benefit and the resulting Medicare reimbursement is not intended to diminish the voluntary spirit of hospices. This expectation supports the hospice philosophy of community based, holistic, comprehensive, and compassionate end of life care. Then, for each level of care separately, we further trimmed the sample of cost reports. We only consider the days within the period being examined. Comment: The majority of commenters supported the clarifications and proposed regulation text changes regarding the election statement addendum. For these reasons, we believe that no additional dry run period is warranted. As stated above, we believe that our current method for calculating the IRC and GIP compensation cost weights provides an accurate measure of the labor shares for these levels of care. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. The eight quarter approach does not result in a delay of when data become available (since the most recent quarters of data are included in the rolled-up score), but it does ensure more accurate measurement. The optional data submission for Q4 2019 results in publicly reporting of that data since the CAHPS Hospice Survey from that quarter were not impacted. A summary of these comment and our responses to those comments appear below: Comment: We received several comments objecting to the increase in the percentage penalty for failure to provide quality reporting data. 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 Division will reimburse the hospice provider an inpatient per diem rate for routine home care and continuous home care days of service that are furnished to a hospice resident living in a nursing facility. Response: The exclusion criteria used for HVWDII and now HVLDL criteria remain the same. Response: We are mindful of the burden related to our updates. Response: As mentioned previously, we plan to display stars no sooner than FY 2022. For example, see: Teno J.M., Bowman, J., Plotzke, M., Gozalo, P.L., Christian, T., Miller, S.C., Williams, C., & Mor, V. (2015). We also consider this work in coordination with planned future HOPE implementation and ensuring that the HQRP now covers the entire hospice stay with these 4 measures rather than just admission and discharge. 48. 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. 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. Exceptions and Extensions for Quality Reporting Requirements for Acute Care Hospitals, PPS-Exempt Cancer Hospitals, Inpatient Psychiatric Facilities, Skilled Nursing Facilities, Home Health Agencies, Hospices, Inpatient Rehabilitation Facilities, Long-Term Care Hospitals, Ambulatory Surgical Centers, Renal Dialysis Facilities, and MIPS Eligible Clinicians Affected by COVID-19. At 418.24(c)(10), we proposed that the hospice would include the date furnished in the patient's medical record and on the addendum itself. A measure that is more strongly associated with desired patient outcomes for the particular topic is available; 7. We note that based on comments received during the CMS-1984-14; OMB NO. This represents the effect of moving from the FY 2021 hospice wage index to the FY 2022 hospice wage index. Hospice web page. Under the final rule, the hospices would see a 2.0 percent increase ($480 million) in their payments for FY 2022 relative to FY 2021. MedPAC. Assuming an average reading speed of 250 words per minute, it would take approximately 2.4 hours for the staff to review half of it. Additionally, an individual can receive continuous home care (CHC) during a period of crisis in which an individual requires continuous care to achieve palliation or management of acute medical symptoms so that the individual can remain at home. We also appreciate the concern that we avoid duplicating measures in the development of new measures based on assessment data, claims, or other available data sources. We encourage commenters to provide us input and comments on these provisions in response to that rule. Toll Free Call Center: 1-877-696-6775. Fewer hospices, 2,328 (46.2 percent), would have had 30+ completes if 4 quarters of data were used to calculate scores and 1,970 (39.1 percent) would have 30+ completes if 3 quarters were used to calculate scores. We also excluded those providers whose IRC compensation costs were greater than total IRC costs. An official website of the United States government. Star ratings will continue to be calculated and released as we phase in the new survey version. FY 2022 Routine Annual Rate Setting Changes. Any potential health equity data collection or measure reporting within a CMS program that might result from public comments received in response to this solicitation would be addressed through a separate notice-and-comment rulemaking in the future. Response: We are currently conducting an experiment to test a shorter version of the CAHPS Hospice Survey. There exist some geographic areas where there were no hospitals, and thus, no hospital wage data on which to base the calculation of the hospice wage index. Stakeholders also suggested several valuable exploratory analyses, improvements for the indicators presented, and ideas for eventual public display for CMS to consider. PDF Medicare Program; FY 2023 Hospice Wage Index and Payment Rate - NHPCO Currently, only Medicare-certified hospices with more than 20 patient stays each year have quality measure results publicly available on Care Compare. It will assess patients in real-time, based on interactions with the patient. endstream endobj 600 0 obj <. After pooling data using FY 2018 to FY 2019, 326 additional hospices met the reportability threshold, or 33.8 percent of those previously missing. Chapter 12: Hospice Services. 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. This document displays the CCN, name, and address of every hospice that successfully met quality reporting program requirements for the fiscal year. This rule finalizes changes to the Hospice Quality Reporting Program (HQRP), summarizes the comments to the requests for information on advancing to digital quality measurement and the use of Fast Healthcare Interoperability Resources (FHIR) and the White House Executive Order related to health equity in the HQRP. Comment: While the majority of commenters supported the proposed changes; one commenter did not support the use of the pseudo-patient or targeted competency testing. We did not exclude providers based on the reporting of contracted inpatient days as reported on Worksheet S-1. Hospices can review and correct their HIS data before the Data Correction Deadline; for claims data, hospices will be able to ensure that the data are accurate through the end of the 90-day run-off period. Identification of the beneficiary's terminal illness and related conditions; 5. One commenter suggested including a statement that data cover care provided during the COVID-19 PHE for eight quarters. Specifically, we already post the annual Hospice APU Compliant List on the HQRP Requirements and Best Practices web page. A summary of the comments received regarding public reporting and our responses those comments appear below. We direct the public to review the PRA at https://www.cms.gov/regulations-and-guidancelegislationpaperworkreductionactof1995pra-listing/cms-10390 and HVWDII report at https://www.cms.gov/files/document/hqrphospice-visits-when-death-imminent-testing-re-specification-reportoctober-2020.pdf. We sought public comment on quality measure concepts and considerations for developing hybrid measures based on a combination of data sources. In fact, these findings were one of the primary reasons we have transitioned from Hospice Compare and the other individual compare sites to Care Compare. We plan continue to monitor hospice trends and vulnerabilities within the hospice benefit. Hospice Care A Physician's Guide Includes Medical Guidelines for Determining Prognosis 5123 W. St. Joseph Hwy., Ste 204 Lansing, Michigan 48917 For IRC, we proposed to multiply this ratio by total other patient care costs for IRC (Worksheet A-3, column 7, lines 38 through 46). 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. Table 13 displays the original schedule for public reporting prior to the COVID-19 PHE. Fast Healthcare Interoperability Resources (FHIR) in Support of the Hospice Quality Reporting Program RFI. The guidelines were developed by the National Consensus Project for Quality Palliative Care, comprising 16 national organizations with extensive expertise in and experience with palliative care and hospice, and were published by the National Coalition for Hospice and Palliative Care. These changes will be effective on October 1, 2021.Start Printed Page 42550. In addition to Physician Administrative Services (line 15), we identified one additional overhead cost center where contract labor costs for patient care are reported and not reflected in the labor shares for each level of care: Nursing Administration (line 9). %PDF-1.6 % COVID-19 Affected Reporting (CAR) Scenario: We calculated OASIS-based measures using 3 quarters of HH QRP CY 2019 data to simulate using only Q3 2020, Q4 2020, and Q1 2021 data for public reporting. Likewise, we solicited comments on what other factors may influence whether or how certain services are furnished to hospice beneficiaries. Addition of a Claims-Based Index Measure, the Hospice Care Index, b. After reviewing OMB Bulletin No. on 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. Azar, A. M. (2020 March 15). As discussed in the FY 2016 Hospice Wage Index and Rate Update final rule (80 FR 47172), we implemented two different RHC payment rates, one RHC rate for the first 60 days and a second RHC rate for days 61 and beyond. Live discharges occur when the patient discharge status code does not equal a value from the following list: 30, 40, 41, 42, 50, 51. Taking this public feedback into consideration, we designed the HCI and developed specifications based on simulated reporting periods. Section 4410(a) of the Balanced Budget Act of 1997 (Pub. The CAHPS Hospice Survey is a component of the CMS HQRP which is used to collect data on the experiences of hospice patients and the primary caregivers listed in their hospice records. We believe when a deficient area(s) in the aide's care is assessed by the RN, there may be additional related competencies that may also lead to additional deficient practice areas and thus would require that those skills be included in the targeted competency evaluation. However, for rural Puerto Rico, we would not apply this methodology due to the distinct economic circumstances that exist there (for example, due to the close proximity to one another of almost all of Puerto Rico's various urban and non-urban areas, this methodology would produce a wage index for rural Puerto Rico that is higher than that in half of its urban areas); instead, we would continue to use the most recent wage index previously available for that area. (2013). Response: We appreciate MedPAC raising this concern. This also entailed using 4 quarters of HH QRP data from CY 2019 for the all-cause hospitalization and emergency department use claims-based measures, 8 quarters of HH QRP data from CY2018 and CY2019 for Medicare spending per beneficiary (MSPB) and discharge to community (DTC) claims-based measures; and or 12 quarters from January 2017 to December 2019 for the potentially preventable readmission claims-based measure. establishing the XML-based Federal Register as an ACFR-sanctioned Several commenters encouraged CMS to use quality claims-based data and other data sources for hybrid measure, consider the implications of claims-based measures to measure quality, use of survey data if feasible, explore outcome measures related to pain and other symptom management, and explore goal achievement. This repetition of headings to form internal navigation links Moreover, because we proposed to change the timeframe requirements to correspond with the date furnished rather than the signature date, we disagree that this timeframe would be burdensome to beneficiaries. 1503 & 1507. At the same time, reporting claims-based measures does require additional labor. 27. We note that hospices should be able to receive timely reports and data directly from their survey vendors. To maintain budget neutrality, as required under section 1814(i)(6)(D)(ii) of the Act, the new RHC rates were adjusted by a service intensity add-on budget neutrality factor (SBNF). The commenters recommended that CMS look further into reporting all pharmacy and medical supply costs as direct patient care costs on future cost reports.