Response: We appreciate the concerns sent in by the commenters regarding the impact of wages index changes from year to year as well as the concerns from providers who have been impacted by the implementation of the New Brunswick-Lakewood, NJ CBSA designation. For FY 2022, the final hospice wage index will be based on the FY 2022 hospital pre-floor, pre-reclassified wage index for hospital cost reporting periods beginning on or after October 1, 2017 and before October 1, 2018 (FY 2018 cost report data). The specifications for Indicator Six, Burdensome Transitions Type 2, are as follows: Estimates of per-beneficiary spending are endorsed by NQF (#2158)[29] 8. Performance or improvement on a measure does not result in better patient outcomes; 3. Each indicator equally affects the single HCI score, reflecting the equal importance of each aspect of care delivered from admission to discharge. Any future changes to the cost report or labor shares would be subject to public comments. The use of telehealth for conducting the required hospice face-to-face (F2F) encounter is statutorily limited to the PHE for COVID-19 in accordance with section 1814(a)(1)(7)(D)(i) of the Act, as amended by section 3706 of the Coronavirus Aid, Relief, and Economic Security Act (Pub. In the FY 2019 Hospice Wage Index and Payment Rate Update final rule (83 FR 38642), we continued the newness exemption for FY 2023, and all subsequent years. 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. Changes in a hospices' quintile from the SPR to CAR scenario would indicate a re-ranking of hospices when using 3 quarters compared to 4 quarters. The HCI will complement the existing HIS Comprehensive Measure and does not replace any existing reported measures. Therefore, we would consider the hospice claims data to be complete for purposes of calculating the claims-based measures at this point. regulatory information on FederalRegister.gov with the objective of During fall 2020, the TEP reviewed measure concepts focusing on pain and symptom outcomes that could be calculated from HOPE items. Medicare beneficiary summary file to determine dates of death. In addition, MedPAC's Report to Congress: Medicare Payment Policy[9] We did not receive comments on this proposal. Social workers and counselors serve both the patient and their family. 0938-0758 clearance process, the implementation of the MCR form was delayed to October 1, 2014. 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. Section 1861(dd)(1) of the Act establishes the services that are to be rendered by a Medicare-certified hospice program. While the impact of some waiver and flexibilities may be more apparent at this time, such as the waivers related to hospice aide supervision, flexibilities associated with other aspects of care are more complex requiring additional time for a complete understanding of their impact. Any reduction based on failure to comply with the reporting requirements, as required by section 1814(i)(5)(B) of the Act, would apply only for the specified year. They suggested that the display of star ratings be delayed because CMS needs to provide additional opportunities for providers to learn about and comment on the details of the methodology. 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. As a result of the changes mandated by Division CC, section 404 of the Consolidated Appropriations Act, 2021 (CAA 2021), this rule finalizes conforming regulation text changes at 418.309 to reflect the new language added to section 1814(i)(2)(B) of the Act, which extends the years that the cap amount is updated by the hospice payment update percentage rather than the consumer price index. 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. Counts are subject to sampling, reprocessing and revision (up or down) throughout the day. Fast Healthcare Interoperability Resources (FHIR) in Support of the Hospice Quality Reporting Program RFI. L. 116 260), the reduction changes to 4 percentage points beginning in FY 2024. However, we will consider this comment when requesting any future revisions to the Level 1 edits applied to the hospice cost report. 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. A federal government website managed by the In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. Section III.E makes permanent selected regulatory blanket waivers that were issued to Medicare-participating hospice agencies during the COVID-19 PHE. Response: We will post an updated model election statement addendum on the Hospice web page,[7] You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. This single measure differentiates hospices and holds them accountable for completing all seven process measures to ensure core services of the hospice comprehensive assessment are completed for all hospice patients. Therefore for the COVID-19 Affected Reporting (CAR) Scenario, we excluded data for patient stays with admission dates in Q1 2019. Many waivers and modifications were made effective as of March 1, 2020 in accordance with the President's declaration.[51]. We discuss the impact to the OASIS and claims here, and discuss to the HH CAHPS further in section III.G. This information would provide additional context to the claims data of whether a hospice provided CHC or GIP. (3) For the CAHPS Hospice Survey, the Reference Year is the CY prior to the Data Collection Year. Response: Star ratings are based on CAHPS Hospice Survey measure scores, which are adjusted for case mix and mode of survey administration. 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. 2. Response: CMS seeks to balance the goal of reporting star ratings for as many hospices as possible with the need to ensure that the star ratings can be stably estimated and distinguish between hospices' performance. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice (42 CFR 418.3). We believe this information provides the detail needed, as with prior versions of the Quality Measure Users' Manual, to model and analyze HCI and its indicators. We appreciate the industry's and national associations' engagement in providing input through information sharing activities, including listening sessions, expert interviews, key stakeholder interviews, and focus groups to support HOPE development. 42 U.S.C. 553), the agency is not required to conduct notice and comment rulemaking for a change that is statutory. The data submitted for Q4 2019 referred to deaths that occurred prior to COIVD-19. documents in the last year, 931 This repetition of headings to form internal navigation links 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. L. 113-185), we sought comment on the possibility of revising measure development, and the collection of other data that address gaps in health equity in HQRP (86 FR 19766). 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. Section III.A of this final rule includes a summary of comments from the public, including hospice providers as well as patients and advocates, regarding the presented analysis in the FY 2022 hospice proposed rule on hospice utilization, spending patterns and non-hospice spending during a hospice election. 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). For this reason, we proposed to calculate CAHPS Hospice star ratings using top-box scores. The CoPs are not relevant to payment questions regarding the use of technology, such as telehealth, in the provision of hospice services. In 2021, that threshold is approximately $158 million. Section 1814(i)(5) of the Act requires the Secretary to establish and maintain a quality reporting program for hospices. The final hospice rate increase for FY 2023 is 3.8%. There are four payment categories that are distinguished by the location and intensity of the hospice services provided. The current hospice aide competency standard regulations at 418.76(c)(1) requires the aide to be evaluated by observing an aide's performance of the task with a patient. Federal government websites often end in .gov or .mil. We will also continue to monitor the hospice labor shares as more recent data become available. Response: We acknowledge the commenters' concern that the proposed rule did not explicitly state when we plan to propose any revisions to the hospice labor shares beyond FY 2022. Accessible via: http://www.medpac.gov/docs/default-source/reports/Mar09_Ch06.pdf?sfvrsn=0. Accessible via: http://www.medpac.gov/docs/default-source/reports/Mar11_Ch11.pdf?sfvrsn=0. Response: While this comment is outside the scope of this rule as we did not make any proposals relating to our CHC policy, we thank the commenter for their recommendations and will take them under consideration for future rulemaking. Update Regarding the Hospice Outcomes & Patient Evaluation (HOPE) Development, 7. Response: The proposed regulatory policies to implement the hospice survey and enforcement provisions in section 407 of CAA, 2021 were included in CY 2022 Home Health Prospective Payment System proposed rule with the comment period found here: https://www.govinfo.gov/content/pkg/FR-2021-07-07/pdf/2021-13763.pdf. We appreciate and understand the importance of provider input and involvement in ensuring that this document is effective in increasing coverage transparency for beneficiaries. 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. Response: Star Ratings are easy for consumers to understand and interpret and are used in a variety of settings. The commenter stated that they are forced to outsource many nursing functions at high cost, along with paying retention bonuses to current staff. We will monitor the cost report data to determine whether the proposed updated labor shares are still appropriate. As we prepare to update Care Compare for the removal of the seven measures, we will consider ways to make consumers of Care Compare aware of this additional data, if they are interested in viewing them. We plan to communicate with the provider community via sub-regulatory means about the upcoming transition as the timing becomes clear, and will provide sufficient time and appropriate information for a smooth transition. About the Federal Register In the FY 2017 Hospice Wage Index and Rate Update final rule (81 FR 52160), CMS finalized several new policies and requirements related to the Hospice Quality Reporting Program (HQRP). Specifically, the IMPACT Act requires that, for accounting years that end after September 30, 2016 and before October 1, 2025, the hospice cap be updated by the hospice payment update percentage rather than using the CPI-U. Waiver or Modification of Requirements Under Section 1135 of the Social Security Act. The indicators required to calculate the single composite are discussed in the Specifications for the HCI Indicators Selected section. Response: CMS analyzed existing data to inform the development of star ratings in the hospice setting. In this final rule, we are not making any revisions to the HIS Comprehensive Assessment Measure because the single measure continues to show sufficient variability and therefore provides value to patients, their families, and providers. documents in the last year, 825 Therefore, we are finalizing the non-labor portion of the payment rates to be as follows: For CHC, 24.8 percent; RHC, 34 percent; for GIP, 36.5 percent; and For IRC, 39.0 percent. However, as discussed in the CMS-10390 Supporting Statement published October 23, 2020 and HIS V3.00 approved by OMB on February 16, 2021, our analysis comparing HVWDII and HVLDL with CAHPS would recommend scores demonstrates that HVLDL results in higher validity and variability testing results compared to HVWDII. 100-04 Medicare Claims Processing Transmittal 10929, Change Request 12354 dated August 4, 2021. These tools are designed to help you understand the official document This would allow sufficient time to complete the activities related, which is what we normally aim to give providers to understand and prepare for public reporting of a new measure, if we publicly report in May 2022. Medicare Payment Advisory Commission. The labor share for CHC and RHC of 68.71 percent was established with the FY 1984 Hospice benefit implementation based on the wage/nonwage proportions specified in Medicare's limit on home health agency costs (48 FR 38155 through 38156). Identification of the beneficiary's terminal illness and related conditions; 5. Specifically, we compared submission rates in Q4 2019 to average rates in other quarters to assess the extent to which HHAs had taken advantage of the exception, and thus the extent to which data and measure scores might be affected. Although the number of visits in did visibly decline in 2020, we remain committed to re-initiating publicly reporting of claims data beginning in Q3 2020 for the following reasons: (i) We believe that we have an important commitment to consumers of hospice care to empower them to make informed decisions. Patients electing to receive hospice services should expect quality care and a comprehensive assessment of their needs at admission, which the HIS Comprehensive Assessment Measure reflects. PUF data, along with clear text explaining the purpose and uses of this information and suggesting consumers discuss this information with their healthcare provider, first displayed in a consumer-friendly format on Hospice Compare in May 2019. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. We received a few comments on this policy. Simulation means a training and assessment technique that mimics the reality of the homecare environment, including environmental distractions and constraints that evoke or replicate substantial aspects of the real world in a fully interactive fashion, in order to teach and assess proficiency in performing skills, and to promote decision making and critical thinking. An official website of the United States government. 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. In that Memorandum, we stated that we would not include any post acute care (PAC) quality data that are greatly impacted by the exemption in the quality reporting programs. Comment: Some commenters recommended that the timeframe to furnish the addendum to the beneficiary (or representative) when requested after the first 5 days of a hospice election be changed from 3 days to 5 days. 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). A summary of these comments and our responses to those comments appear below: Comment: One commenter expressed concern that hospices in Montgomery County, Maryland are at a long-term competitive disadvantage due to what they refer to as a Medicare hospice Federal payment inequity involving CBSAs specifically when Metropolitan Divisions are present. Office of Analytics and Program Improvement, Medicaid Promoting Interoperability Program. Characteristics of hospice programs with problematic live discharges. MedPAC reported that nearly half of Medicare hospice expenditures are for patients that have had at least 180 or more days on hospice, and expressed a concern that some programs do not appropriately discharge patients whose medical condition makes them no longer eligible for hospice services, or, that hospices selectively enroll patients with non-cancer diagnoses and longer predicted lengths of stay in hospice. This methodology does not force a set number of hospices into each star category. In the FY 2012 Hospice Wage Index and Rate Update final rule (76 FR 47320 through 47324), we implemented a HQRP as required by those sections. We are finalizing in this rule the regulation at 418.312(b) to add paragraphs (b)(1) through (3) to include administrative data as part of the HQRP, and correct technical errors identified in the FY 2016 and 2019 Hospice Wage Index and Payment Rate Update final rules. Aides are usually trained by an employer, such as a hospice, HHA or nursing home and may already be certified as an aide prior to being hired. Services furnished voluntarily by physicians are not reimbursable. Therefore, we proposed to exclude 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. To be counted, the from date of the hospitalization had to occur no more than 2 days after the date of hospice live discharge. If a hospice does not have enough survey completes to reliably measure performance, the star ratings would be picking up more noise than true performance. Further information about these requirements may be found at: http://www.hhs.gov/ocr/civilrights. In addition, this rule finalizes changes to the Hospice Conditions of Participation (CoPs) and Hospice Quality Reporting Program (HQRP). Both the use of the pseudo-patient and targeted aide training align requirements between these two providers, home health and hospice, affording the opportunity for efficiency in implementation for many agencies that are Medicare certified to provide both services.
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