Comment: A commenter stated that the preview report timeframe is too short and that hospices should receive preview data at least 1 year prior to its publication in order to analyze performance and implement quality improvement. We are finalizing our proposal to remove the seven HIS process measures from the HQRP as individual measures, and no longer applying them to the FY 2024 APU and thereafter. Any future revisions to the hospice labor shares will be proposed and subject to public comments in future rulemaking. 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. They complement each other and further support the need for each measure in the HQRP. Index Earned Point Criterion: Hospices earn a point towards the HCI if their individual hospice score for percentage of decedents receiving a visit by a skilled nurse or social worker in the last 3 days of life falls above the 10th percentile ranking among hospices nationally. We acknowledge that there may have been an increase in refusals during the COVID-19 PHE. However, in accordance with 418.54(b), the hospice IDG, in consultation with the individual's attending physician (if any), must complete the hospice comprehensive assessment no later than 5 calendar days after the election of hospice care. Register, and does not replace the official print version or the official 45. Section 4441(a) of the Balanced Budget Act of 1997 (BBA) (Pub. These updates apply to Publication (Pub) 100-04, Chapter 11, section 30.2. NQF 3235 does not require NQF's endorsements of the previous components to remain valid. 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. Public Health Emergency. Section 1814(i)(5) of the Act requires the Secretary to establish and maintain a quality reporting program for hospices. Commenters encouraged CMS to stratify quality measures by demographic data, social risk factors, and social determinants of health. This rule provided individuals and entities that provide services to Medicare beneficiaries needed flexibilities to respond effectively to the serious public health threats posed by the spread of COVID-19. Some commenters questioned whether services provided by LPNs would be accounted for in the HCI indicators and many commenters requested that CMS clarify whether code 055X would be further differentiated between RN visits versus LPN visits for the indicators. #2158 Payment-Standardized Medicare Spending Per Beneficiary (MSPB). Then, for each level of care separately, we proposed to further trim the sample of MCRs. These other settings utilize a clustering algorithm such that providers within a cluster are more alike than providers across clusters. We have reviewed this rule under these criteria of Executive Order 13132, and have determined that it will not impose substantial direct costs on state or local governments. Section 1814(a)(7)(D)(i) of the Act, as added by section 3132(b)(2) of the. If we were to delay our data extraction point to 12 months after the last date of the last discharge in the applicable period, we would not be able to deliver the calculations to hospices sooner than 18 to 24 months after the last discharge. States choosing to implement this cap must specify its use in the Medicaid state plan. There are several forthcoming HH QRP refreshes for which the original public reporting schedule included other quarters from the quality data submission exception. We view the HCI as an opportunity to add value to the HQRP, augmenting the current measure set with an index of indicators compiled from currently available claims data. If you do not agree to the terms and conditions, you may not access or use the software. HOPE items assessing Symptom Impact, and Patient Desired Tolerance Level for Symptoms or Patient Preferences for Symptom Management were used to calculate this measure. We proposed to use the CAR scenario for the last of the refreshes affecting OASIS-based measures, which will occur in January 2022. Hospice Rates for Providers that Have Submitted the Required Quality Data Federal Fiscal Year 2023 Effective Retroactive to October 1, 2022 County-level Hospice Rates for Providers that Have Submitted the Required Quality Data County Name County Number CBSA FFY 2022 Hospice Wage Index Continuous Home Care Inpatient Respite Care General Inpatient We received many comments on these proposals. As stated in the FY 2022 Hospice proposed rule (86 FR 19718 through 19719) and above, for purposes of calculating the IRC and GIP compensation cost weights, we excluded providers that reported costs greater than zero on Worksheet A-3, column 7, line 25 (Inpatient CareContracted) for IRC and Worksheet A-4, column 7, line 25 (Inpatient CareContracted) for GIP. This measure helps to ensure all hospice patients receive a holistic comprehensive assessment. Given the overall positive response to our proposal, we believe that the proposed approach balances fairness to providers with a commitment to transparency and information for consumers. 2013 99902 1.2687999999999999 230.42243199999996 182.11065600000001 68.888559999999998 1653.3930720000001 515.59043199999996 1196.9645600000001. We disagree with commenters that notices should be posted on Care Compare regarding the inclusion of data from the COVID-19 PHE as such notice would not help consumers distinguish between hospices in their region. Accessible via: https://oig.hhs.gov/oei/reports/oei-02-10-00491.asp. (1) The relevant Reporting Year, payment FY and the Reference Year. In order to finalize this proposal in time to release the required preview report related to the refresh, which we release 3 months prior to any given refresh (October 2021), we need the rule containing this proposal to finalize by October 2021. by the Education Department index of the city or county where the hospice facility is located. Hospice Deficiencies Pose Risks to Medicare Beneficiaries. CMS requires no additional resources to create and display CAHPS star ratings. Second, for each scenario, we conducted a split-half reliability analysis and estimated intra-class correlation (ICC) scores, where higher scores imply better internal reliability. 35. 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. Dellon, E.P., et al. Hospices' scores on the HCI can range from zero to ten. Section 4441(a) of the BBA (Pub. We are revising the provisions at 418.306(b)(2) to change the payment reduction for failing to meet hospice quality reporting requirements from 2 to 4 percentage points. This final rule makes changes to the hospice CoPs regarding hospice aide competency evaluation standards. Analysis for each year was based on the FY calendar. We received several comments regarding the updates to the Hospice Visits in the Last Days of Life (HVLDL) and Hospice Item Set V3.00. CY 2019 HH PPS final rule with comment period (. Nursing services require initial and ongoing assessment of patient family needs to ensure the successful preparation, implementation, and refinements for the plan of care. Testing results show that the CAR scenariospecifically using 3 quarters of data for the HIS Comprehensive Assessment Measuredemonstrates acceptable levels of reportability and reliability. However, we continue to believe that the OMB's geographic area delineations represent a useful proxy for differentiating between labor markets and that the geographic area delineations are appropriate for use in determining Medicare hospice payments. To accommodate the excepted HH QRP of 2020 Q1 and Q2, we resume public reporting using 3 out of 4 quarters of data for the January 2022 refresh. https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensions-quality-reporting-and-value-based-purchasing-programs.pdf. 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. Public Health Emergency. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. The following sections provide the results of our testing and explain how we used the results to develop a plan that we believe allows us to achieve these objectives as best as possible. Care Compare supports all Medicare settings and fulfills the Act's requirements for the HQRP. Our proposal for using the 90-day run-off strikes a balance between allowing time for hospices to make corrections to their claims, while also seeking to post more rather than less up-to-date information. Taking this public feedback into consideration, we designed the HCI and developed specifications based on simulated reporting periods. Our testing indicates that claims data from the COVID-19 PHE are generally stable. Rate File FFY2023 32. On July 29, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1754-F) that updates Medicare hospice payments and the aggregate cap amount for FY 2022 in accordance with existing statutory and regulatory requirements. %PDF-1.6 % We propose no changes to this exemption. This document displays the CCN, name, and address of every hospice that successfully met quality reporting program requirements for the fiscal year. Therefore, the Secretary has certified that this rule will not create a significant economic impact on a substantial number of small entities. At this time, the HCPCS code for spiritual care is not used on the hospice claim form (no revenue center exists to correspond to such code), and as such, cannot be applied to the HCI. de la Cruz, M., et al. (2) If the addendum is requested during the course of hospice care (that is, after the first 5 days of the hospice election date), the hospice must provide this information, in writing, within 3 days of the request to the requesting individual (or representative), non-hospice provider, or Medicare contractor. We discussed the analysis with a TEP convened by our measure development contractor in November 2019 and with the MAP, hosted by the NQF in December 2019[44] Comment: Several commenters stated concerns that the public might misinterpret the lack of star ratings for smaller hospices as being evidence of poor quality care. We propose that starting with the February 2022 refresh, CMS will display the most recent 8 quarters of CAHPS Hospice Survey data, excluding Q1 and Q2 2020. The Hospice Item Set V3.00 PRA Submission replaced the HVWDII measure with a more robust version: The claims-based measure HVLDL.

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