States choosing to implement this cap must specify its use in the Medicaid state plan. Only official editions of the For CHC, we proposed to then multiply this ratio by other patient care total costs for CHC (Worksheet A-1 column 7, lines 38 through 46). We note that simulated payments are based on utilization in FY 2020 as seen on Medicare hospice claims (accessed from the CCW in May 2021) and only include payments related to the level of care and do not include payments related to the service intensity add-on. We received a comment indicating some hospice agencies never hit the cap amount and recommend for CMS to utilize available claims and quality data to target hospices with questionable practices to avoid exceeding the cap amount. 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. Once we identified those hospice stays, we examined the timing of the provision of nursing visits within those stays. We will take the recommendation of a single star rating into consideration for the future. as patients and their family caregivers also place value on physical symptom management and spiritual/psychosocial care as important factors at the end-of-life. Final Decision: We are finalizing the clarifications and addendum regulation text changes at 418.24(c) as proposed, with the exception of requiring the reason that the addendum is not signed to be documented in the patient's medical record. As discussed in this section, the HVLDL and HCI claims-based measures support the Meaningful Measures initiative and address gaps in HQRP. 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. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. The final rule also finalizes a Home Health Quality Reporting Program (HH QRP) policy that becomes effective on October 1, The final rule (CMS-1754-F) can be downloaded from the, https://www.federalregister.gov/public-inspection, This rule also finalizes the addition of the Consumer Assessment of Healthcare Providers and Systems, The final rule ([CMS-1754-F)can be downloaded from the, https://www.federalregister.gov/public-inspection/current. While every effort has been made to ensure that In the FY 2021 Hospice Wage Index and Payment Rate Update final rule, we stated that most often we would expect the addendum would be in a hard copy format the beneficiary or representative can keep for his or her own records, similar to how hospices are required by the hospice CoPs at 418.52(a)(1) to provide the individual a copy of the notice of patient rights and responsibilities (85 FR 47091). This measure does not recognize visits during CHC and GIP because these higher levels of care inherently require skilled visits per the COPs in accordance with 418.110 and 418.302. We did not exclude providers based on the reporting of contracted inpatient days as reported on Worksheet S-1. 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. Consumers can now access the Hospice APU compliance file from Care Compare, enabling them to determine if a particular hospice is compliant with CMS' quality reporting requirements.Start Printed Page 42590. Response: As stated in the proposed rule, we will display CAHPS Hospice Survey star ratings no sooner than FY 2022. 48. From there, we identified all beneficiaries whose date of death is listed as occurring during the dates of the hospitalization. How do I know if I am in the right place? 25. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. This contract is currently held by the National Quality Forum (NQF). Before proceeding with the November 2020 refresh, we conducted testing to ensure that, even though we made an exception to reporting requirements for Q4 2019 in March 2020, public reporting would still allow us to publicly report data for a similar number of hospice providers, as compared to standard reporting. They also requested clarification on the logistics of the reporting processin particular, when specifications would be available. Indicator One: Continuous Home Care (CHC) or General Inpatient (GIP) Provided, (2). Hospice Rates for Providers that Have Submitted the Required Quality Data Federal Fiscal Year 2022 Effective Retroactive to October 1, 2021 . Accessible via: http://www.medpac.gov/docs/default-source/reports/mar20_medpac_ch12_sec.pdf?sfvrsn=0. 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. A third commenter stated that topic-specific evaluations will significantly reduce time and allow hospices to concentrate on the specific deficient skills with additional practice and training. Since launching Hospice Compare in 2017, HIS-measures have been reported using 4 quarters of data. 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). The other determinant of per-beneficiary spending is the level of care at which services are billed. One commenter stated concern that due to hospice MCRs not being audited, as well as some sections of the cost report offering multiple methods of reporting, there is a general lack of consistency in the way that the reports are completed by hospice providers that will necessarily distort the average labor figures. 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. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. At the same time, we want to report measures scores to the public for as many hospices as possible, including small hospices. Therefore, the Secretary has certified that this rule will not create a significant economic impact on a substantial number of small entities. Response: We will not pull claims data for calculating the measures from cost reports. Hospice providers must bill the correct rate for the appropriate period of routine home care days. Commenters noted that hospices were not included in the EHR Incentive Program, which provided grants to hospices to develop HIT systems. In the FY 2020 Hospice Wage Index final rule (84 FR 38484), we finalized the proposal to use the current FY's hospital wage index data to calculate the hospice wage index values. In that same final rule, we discussed that we will issue public notice, through rulemaking, of measures under consideration for removal, suspension, or replacement. First, it would reduce the proportion of hospices that would have CAHPS Hospice Survey data displayed on Care Compare. February 26, 2020. https://www.medscape.com/viewarticle/925769#vp_1. Many waivers and modifications were made effective as of March 1, 2020[4647] in accordance with the president's declaration. f. What could be the potential use of FHIR dQMs that could be adopted across all QRPs? For purposes of the RFA, we consider all hospices as small entities as that term is used in the RFA. We encourage those who have concerns about fraud, waste, or abuse to report these to CMS Center for Program Integrity. Finally, in the FY 2020 Hospice Wage Index and Rate Update final rule (84 FR 38505), we finalized modifications to the hospice election statement content requirements at 418.24(b) by requiring hospices, upon request, to furnish an election statement addendum effective beginning in FY 2021. Division CC, section 404 of the CAA 2021 has extended the accounting years impacted by the adjustment made to the hospice cap calculation until 2030. 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). We also appreciate the comments expressing concern about the impact these measures may have on small and/Start Printed Page 42566or rural hospices. Characteristics of hospice programs with problematic live discharges. A measure that is more strongly associated with desired patient outcomes for the particular topic is available; 7. This indicator identifies whether a hospice is above the 10th percentile in terms of the average number of skilled nursing minutes provided on RHC days during the reporting period examined. Section 3401(g) of the Affordable Care Act mandated that, starting with FY 2013 (and in subsequent FYs), the hospice payment update percentage would be annually reduced by changes in economy-wide productivity as specified in section 1886(b)(3)(B)(xi)(II) of the Act. However, while a hospice can choose to document the reason for an unsigned addendum in the medical record, as well as on the addendum, it is not required. All refreshes, during which we decided to hold these data constant, included more than 2 quarters of data that were affected by the CMS-issued COVID reporting exceptions; thus we did not have an adequate amount of data to reliably calculate and publicly display provider measures scores. In the proposed rule, the denominator description is discussed accurately, as the number of beneficiaries with at least one day of hospice during the last three days of life within a reporting period. In addition, the HCI and HOPE will complement each other, providing related but distinct information to providers and consumers to compare hospices. 38. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. The final FY 2022 hospice wage index will not include a cap on wage index decreases and would not take into account any geographic reclassification of hospitals, including those in accordance with section 1886(d)(8)(B) or 1886(d)(10) of the Act. The BNAF phase-out reduced the amount of the BNAF increase applied to the hospice wage index value, but was not a reduction in the hospice wage index value itself or in the hospice payment rates. Accessible via: http://www.medpac.gov/docs/default-source/reports/Mar09_Ch06.pdf?sfvrsn=0. Final Decision: We are implementing the updates to hospice payment rates as discussed in the proposed rule. If they did not experience the symptom, the instructions say to skip to another question. 5. to the Medicare Learning Network (MLN) Connects Newsletter and Other Program-Specific Listserv Recipients,[49] Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). National implementation of the CAHPS Hospice Survey commenced January 1, 2015, as stated in the FY 2015 Hospice Wage Index and Payment Rate Update final rule (79 FR 50452). One commenter suggested including a statement that data cover care provided during the COVID-19 PHE for eight quarters. (5) The availability of a measure that is more proximal in time to desired patient outcomes for the particular topic. 31. Similarly, we proposed to clarify at 418.24(d)(5) that in the event that a beneficiary requests the addendum and the hospice furnishes the addendum within 3 or 5 days (depending upon when the request for the addendum was made), but the beneficiary dies, revokes, or is discharged prior to signing the addendum, a signature from the individual (or representative) is no longer required. 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. Therefore, in general, using CAR scenario for the OASIS and claims-based measures would achieve acceptable reportability for the HH QRP measures. Public Display of Home Health Quality Data for the HH QRP, 3. National Quality Forum. We are also considering developing hybrid quality measures that would be calculated using claims, assessment (HOPE), or other data sources. All refreshes, during which we decided to hold this data constant, included more than 2 quarters of data that were affected by the CMS-issued COVID reporting exceptions, thus we did not have an adequate amount of data to reliably calculate and publicly display provider measures scores. Under these circumstances a not applicable is not needed. Section 1814(i)(5)(C) of the Act requires that each hospice submit data to the Secretary on quality measures specified by the Secretary. See Chapter 1000 and Appendix A for additional information. This indicator identifies whether a hospice is at or above the 10th percentile in terms of the percentage of skilled nursing minutes performed on weekends compared to all days during the reporting period examined. We noted this revised statutory requirement in our proposed rule (86 FR 19726) and are codifying the revision at 418.306(b)(2). 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. Future updates and engagement opportunities regarding HOPE can be found at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/HOPE.html. Moreover, a commenter recommended developing an exceptions process for when hospice providers are unable to provide an addendum because of `exceptional circumstances' that are beyond the control of the hospice. The TEP supported further exploration and development of these measures. to the courts under 44 U.S.C. Such data must be submitted in a form and manner, and at a time specified by the Secretary. The final rule also finalizes a Home Health Quality Reporting Program (HH QRP) policy that becomes effective on October 1, 2021, to prepare for public reporting beginning in January 2022. Specifically, for CHC, we proposed that total CHC costs (Worksheet B, column 18, line 50) and CHC compensation costs to be greater than zero. Contact Medicaid Care Management Organizations (CMOs), File a Complaint about a Licensed Facility, Facebook page for Georgia Department of Community Health, Twitter page for Georgia Department of Community Health, Linkedin page for Georgia Department of Community Health, YouTube page for Georgia Department of Community Health, https://dch.georgia.gov/providers/provider-types/nursing-home-providers, Ground Ambulance (Public/Private) Providers, Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC), Medicaid Sign-Up Portal (Georgia Gateway). The public reporting has been thoughtfully considered as discussed in this rule so that providers can access their data earlier and prepare for public reporting in FY 2022, no sooner than May 2022. CMS issued a final rule, CMS-1629-F, which created two routine home care daily payment rates. 23. Recommendations for quality measures, or measurement domains that address health equity, for use in the HQRP. One commenter requested delaying the effective date of the proposed Start Printed Page 42549clarification for the hospice election statement addendum to provide time for software updates in addition to reporting and system alerts. 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. Comment: A few commenters stated that providers should be protected against substantial payment reductions due to dramatic reductions in wage index values from one year to the next. The authority citation for part 418 continues to read as follows: Authority: Fast Healthcare Interoperability Resources (FHIR) in Support of the Hospice Quality Reporting Program RFI. Hospices are only considered compliant if they meet the standards for HIS and CAHPS reporting, as codified in 418.312. HOPE will enable CMS and hospices to understand the care needs of people through the dying process, supporting provider care planning and quality improvement efforts, and ensuring the safety and comfort of individuals enrolled in hospice nationwide. As such, the implementation of these clarifications on October 1, 2021 would not cause a burden for software updates. on Journal of Pain and Symptom Management, 50, 548-552. doi: 10.1016/j.jpainsymman.2015.05.001. be made routinely available on a 24-hour basis seven days a week. Section 418.24(c) sets forth the elements that must be included on the addendum: 1. Calculating and Publicly Reporting Claims-Based Measure as Part of the HQRP, (3). We believe these cost centers (Physician Administrative Services and Nursing Administration) are labor-intensive and vary with the local labor market and, thus, we believe contract labor costs for these services should be included in the labor shares for each level of care. This addressed five of the six COVID-19 PHE-affected quarters for HIS-based measures, and five of the 11 COVID-19 PHE-affected quarters of CAHPS-based measures. L. 116-136). Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for Fiscal Year (FY) 2023. Therefore, we stated that we expect that hospices already have processes and procedures in place to ensure that required signatures are obtained, either from the beneficiary, or from the representative in the event the beneficiary is unable to sign, and we anticipate that hospices would use the same procedures for obtaining signatures on the addendum. This indicator includes both RN and LPN visits to recognize the frequency of skilled nursing visits and to maintain consistency in HCI when using revenue center code 055X. https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensions-quality-reporting-and-value-based-purchasing-programs.pdf. a. Revising paragraphs (c) introductory text and (c)(9); c. Redesignating paragraphs (d) through (g) as paragraphs (e) through (h); and. We make that assumption instead of looking at the visits directly because Medicare does not require hospices to record all visits on the claim for the GIP level of care. 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. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Comment: Several commenters expressed concerns about the frequency of updating the labor shares in the future. These changes included a new condition for payment requiring a hospice, upon request, to provide the beneficiary (or representative) an election statement addendum (hereafter called the addendum) outlining the items, services, and drugs that the hospice has determined are unrelated to the terminal illness and related conditions. At the same time, reporting claims-based measures does require additional labor. We believe using updated labor shares based on 2018 data is a technical improvement over the current labor shares as they reflect recent cost data for freestanding hospice providers. However, several months lead-time is necessary after acquiring the data to conduct the claims-based calculations. 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. 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. As noted by the commenter, salaries and benefit costs for employed Medical Directors would be reported in Worksheet A, column 1, line 15 (salaries) and Worksheet B, column 3, line 15 (benefits), which are both included in our proposed methodology as these expenses are reported in overhead salaries and overhead benefits.
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