This means that we will no longer report HVWDII with patient stays and will start publicly reporting HVLDL no earlier than May 2022. The literature strongly supported the focus on RNs and medical social workers in the revised measure. Table 12. For CAHPS-based measures, we have reported CAHPS measures using eight rolling quarters of data on Hospice Compare since 2018. Comment: We received comments in support of the proposal to use two years of data for publicly reporting HVLDL and HCI. include documents scheduled for later issues, at the request We estimate that in FY 2022, hospices in urban areas will experience, on average, 2.0 percent increase in estimated payments compared to FY 2021. These eight measures are publicly reported on a designated CMS website, Care Compare, https://www.medicare.gov/care-compare/. Hospice Conditions of Participation (CoPs). Thus, if the components included in NQF 3235 do not individually maintain endorsement, the endorsement status of NQF 3235, as a single measure, will not change. Using percentile rankings derived from national performance, it is very unlikely for all hospices to receive the same score. Response: We appreciate the support from commenters as well as MedPAC's concerns. Additionally, we do not believe that we have the authority to apply the outmigration hospital adjustment to the hospice wage index because it is specific to the commuting patterns of hospital employees. For RHC, we proposed to multiply this ratio by total other patient care costs for RHC (Worksheet A-2, column 7, lines 38 through 46). We also conducted a stability analysis by comparing index scores calculated for the same hospice using claims from Federal FY 2017 and 2019. In addition, to help hospices understand the HCI and their hospice's performance, we will revise the confidential QM report to include claims-based measure scores, including agency and national rates through the Certification and Survey Provider Enhanced Reports (CASPER) or its replacement system. In the FY 2014 Hospice Wage Index and Payment Rate Update final rule (78 FR 48234) we stated that reportability of 71 percent through 90 percent is acceptable. In the FY 2014 Hospice Wage Index and Payment Rate Update final rule (78 FR 48234), and in compliance with section 1814(i)(5)(C) of the Act, we finalized the specific collection of data items that support the seven NQF-endorsed hospice measures described in Table 6. Recommendations to minimize the information collection burden on the affected public, including automated collection techniques. 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. Specifically these three days are indicated by the day of death, the day prior to death, and two days prior to death. The day of death is the same as the date provided in A0270, Discharge Date. The 2020-2021 MAP 2020 Final Recommendations can be found at: http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=94893. One commenter indicated that comprehensive competency testing can take up to a full 8-hour day and a targeted approach will save time related to this requirement. We proposed to define direct patient care salaries and contract labor costs to be equal to costs reported on Worksheet A-1 (for CHC) or Worksheet A-2 (for RHC) or Worksheet A-3 (for IRC) or Worksheet A-4 (for GIP), column 7, for lines 26 through 37. 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. While all patient visits are meaningful, only patients with visits on two different days during the last three days of life will count towards the numerator for this measure. Table 1: 2023 Medicaid Hospice Rates for Routine Home Care (including the service intensity . The candidate measure Reduction in Pain Severity reports the percentage of patients who had a reduction in reported pain severity. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. Others noted that the delay could allow time for additional analysis of the measure, and for more transparency about the rationale for it. We will include state average scores to further ensure any regional differences in the impact of the Start Printed Page 42582COVID-19 PHE on hospices are captured for consumers. Response: We are mindful of the burden related to our updates. 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. We proposed to continue to establish separate labor shares for CHC, RHC, IRC, and GIP and base them on the calculated compensation cost weights for each level of care from the 2018 MCR data. 14. For more details, see section (3). This revision is subject to the PRA; however, the information collection burden associated with the existing requirements at 418.76(c)(1) are accounted for under the information collection request currently approved OMB control number 0938-1067 (Expiration date: March 31, 2024). 22. Hospices are also subject to additional Federal civil rights laws, including the Age Discrimination Act, Section 1557 of the Affordable Care Act, and conscience and religious freedom laws. We received seven comments on the proposed FY 2022 hospice wage index from various stakeholders including hospices, and national industry associations. We note that any future revisions to the hospice labor shares will be proposed and subject to public comments in future rulemaking. 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. While we acknowledged in that rule the limitations with using claims data as a source for measure development, there are several advantages to using claims data as part of a robust HQRP as discussed previously in the FY 2020 rule. 2016 99902 This timeframe is based on the CY. Many commenters noted a 2019 Abt Associates and RAND Corporation study which excluded hospices from the standardized data elements for patient assessment denominator, citing that hospice patients have a different goal of care which does not align with standardized data elements for patient assessment. We observed that the quality data submission rate for Q4 2019 was in fact 0.4 percent higher than the previous calendar year (Q4 2018). Hospices were required to begin collecting quality data in October 2012, and submit that quality data in 2013. We are revising the provisions at 418.76(c)(1) that requires the hospice aide to be evaluated by observing an aide's performance of the task with a patient. We proposed and are finalizing these changes to remove the seven HIS process measures as individual measures from HQRP no earlier than May 2022. 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. The nature of the Medicare program is such that the changes may interact, and the complexity of the interaction of these changes could make it difficult to predict accurately the full scope of the impact upon hospices. These commenters believed that the existing process measures provide more valuable and transparent information about hospice performance than the HIS Comprehensive Assessment composite measure. 7. In addition, we will provide hospices with confidential reporting of their HVLDL and HCI measure scores in the Agency-Level QM report after this rule is finalizedafter August 2021. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. References to any relevant clinical practice, policy, or coverage guidelines; 9. Hospice Payment Rates Calculator FY 2023 (Oct 2022 - Sept 2023) Wage Index Hospice Rates FY 2022 (Oct 2021 - Sept 2022) 1302 and 1395hh. We encourage providers to report their cost report data accurately and timely. One commenter noted that the hospice cost report for freestanding providers is being proposed to be used for the first time to determine the labor component of the rates for each level of care. IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. 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. 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. This is particularly important during the COVID-19 PHE; (ii) With annual reporting of claims data, we can reasonably state that the COVID-19 PHE affected hospices nationally in a similar way. We will notify the public about any system migration updates using subregulatory mechanisms such as web page postings, listserv messaging, and webinars. In addition to the publicly-reported quality measure data, in 2019 we added to public reporting, information about the hospices' characteristics, taking raw data available from the Medicare Public Use File and other publicly-available government data sources and making them more consumer friendly and accessible for people seeking hospice care for themselves or family members, (83 FR 38649). 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. http://medpac.gov/docs/default-source/reports/mar20_medpac_ch12_sec.pdf. Response: We appreciate that providers will benefit from advanced notice regarding the transition of hospice to the iQIES systems. We solicited public comment on this proposal to use 3 quarters of HIS data for the February 2022 public reporting refresh. Under the Paperwork Reduction Act of 1995, we are required to provide 30-day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to OMB for review and approval. As of September 2020, HH QRP OASIS, claims-based, and HH CAHPS Survey measures are reported on the www.medicare.gov' s Care Compare website. We tabulate the resulting payments according to the classifications (for example, provider type, geographic region, facility size), and compare the difference between current and future payments to determine the overall impact. The commenter asked whether any consideration was made regarding this inconsistency or other common inconsistencies in the nature of the expenses. 6. along with the publication of the FY 2021 Hospice Wage Index and Payment Rate Update final rule (85 FR 47070). We performed analyses using Stata/MP Version 16.1. for CMS to publicly report, or a requirement included in the hospice CoPs. 04/28/2023, 858 Comment: Several commenters expressed concerns that the public will not interpret the star ratings correctly. FY 2022 Medicaid Hospice Rates Released. This approach parallels the one used by CMS for calculating star ratings for hospitals. The sixth column shows the effect of all the proposed changes on FY 2022 hospice payments. have brought to light the potential role hospices could play in medical aid in dying (MAID) where such practices have been legalized in certain states, we wish to remind hospices that The Assisted Suicide Funding Restriction Act of 1997 (Pub. Response: We appreciate the commenter's concern. One commenter requested clarification that the day of request is considered day zero. They stated that the PHE could considerably change the labor share in the next several years of cost report data, as the use of cost reports has a 2-year delay in data. As a claims-based measure, the HVLDL measure would not impose any new requirements for the collection of information. FY 2022 Hospice Payment Update Percentage, D. Clarifying Regulation Text Changes for the Hospice Election Statement Addendum, E. Hospice Waivers Made Permanent Conditions of Participation, 2. Therefore, we will continue our practice of using the most recent, complete hospice claims data available; that is, we used FY 2020 claims data for the FY 2022 payment rate updates. hereafter referred to as the March 27, 2020 CMS Guidance Memorandum. 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. How do you currently share information with other providers and are there specific industry best practices for integrating SDOH screening into EHR's? Comment: Some commenters raised questions about using 75 completed surveys as the threshold for public reporting of stars. While hospice is not included in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act of 2014) (Pub. We solicited public comment on these proposals related to the use of 2 years of data for claims-based measures and public reporting of claims measures in general and their application to HVLDL and HCI specifically. April 13, 2018. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R3P243.pdf. An official website of the United States government. As we showed with the HVLDL claims-based measure, RN services correlate well with CAHPS data and therefore are important services to reflect hospice quality of care. Specifically, we conducted a simulation using 2 years of data. This final rule consists of approximately 72,000 words. Unlike inpatient prospective payment system (IPPS) hospitals, inpatient rehabilitation facilities (IRFs), and skilled nursing facilities (SNFs), where each provider uses a single CBSA, hospice agencies may be reimbursed based on more than one wage index. If released in May 2022 using eight quarters of data, the HCI and HVLDL measure reporting period would begin with FY2021 (Q1, Q2, and Q3 2021 and Q4 2020). One commenter urged CMS to give special consideration to challenges faced by rural health care providers with specific attention given to the impact workforce shortages have in setting reimbursement rates related to the labor shares. Since FY 2014, hospices that fail to report quality data have their market basket percentage increase reduced by 2 percentage points. Table 7 indicates the number of hospice days, hospice claims, beneficiaries enrolled in hospices and hospices with at least one claim represented in each year of our analysis. The specifications for Indicator Two, Gaps in Skilled Nursing Visits, are as follows: Prior work has identified various concerning patterns of live discharge from hospice. The new website builds on the eMedicare initiative to deliver simple tools and information to current and future Medicare beneficiaries. Section 1861(dd)(1) of the Act establishes the services that are to be rendered by a Medicare-certified hospice program. Recommendations for quality measures, or measurement domains that address health equity, for use in the HQRP. Care Compare provides a single user-friendly interface that patients and family caregivers can use to make informed decisions about healthcare based on cost, quality of care, volume of services, and other data. Consequently, we determined to freeze the data displayed, that is, holding data constant after the October 2020 refresh without subsequently updating the data through October 2021. For FY 2022, two of the four measures we proposed to add were claims-based measures which do not increase burden to providers. In Table 15, we explore changes in hospices' relative rankings between the SPR and CAR scenarios. Background: COVID-19 Public Health Emergency Temporary Exemption and Its Impact on the Public Reporting Schedule, (2). documents in the last year, 19 Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). (iii) A measure does not align with current clinical guidelines or practice. However, providers with substantially higher percent of live discharge than their peers could signal a potential concern with quality of care or program integrity. Several commenters suggested that CMS adjust the thresholds for specific services, such as gaps in skilled nursing visits, and phase in the thresholds over time. This site displays a prototype of a Web 2.0 version of the daily In that memo, which applies to HIS and CAHPS Hospice Survey, CMS granted an exemption to the HQRP reporting requirements for Quarter 4 (Q4) 2019 (October 1, 2019 through December 31, 2019), Quarter 1 (Q1) 2020 (January 1, Start Printed Page 425782020 through March 30, 2020), and Quarter 2 (Q2) 2020 (April 1, 2020 through June 30, 2020). We noted this revised statutory requirement in our proposed rule (86 FR 19726) and are codifying the revision at 418.306(b)(2). These are the same quarters that would have been publicly displayed despite the COVID-19 PHE. In the proposed rule, we proposed to introduce Star Ratings for public reporting of CAHPS Hospice Survey results on the Care Compare or successor websites no sooner than FY 2022. We assume that days billed as GIP will include nursing visits. Index Earned Point Criterion: Hospices earn a point towards the HCI if their average Medicare spending per beneficiary falls below the 90th percentile ranking among hospices nationally. The finalized reasons for removing quality measures are: 1. [21] Use the PDF linked in the document sidebar for the official electronic format. In these situations, the regulations require the hospice to provide the addendum within 3 days, as the beneficiary requested the addendum during the course of care. This policy will apply beginning with FY 2024 annual payment update (APU). For example, see: Teno J.M., Bowman, J., Plotzke, M., Gozalo, P.L., Christian, T., Miller, S.C., Williams, C., & Mor, V. (2015). We are finalizing our proposal to remove the seven HIS process measures no earlier than May 2022 refresh from public reporting on Care Compare and from the Preview Reports but continue to have it publicly available in the data catalogue at https://data.cms.gov/provider-data/topics/hospice-care.

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