Fewer observed hospice Start Printed Page 42562services on weekends (relative to that provided on weekdays) is not itself an indication of a lack of access. Response: We recognize commenters' concern that HQRP measures reflect quality of care rather than program integrity issues. Final Decision: We are finalizing the proposal to add composite HCI measures to the HQRP as of FY 2022 and will monitor the measure. Hospice Reimbursement | Georgia Department of Community Health Now that we reached that milestone, we need to recognize that there is a need to focus on assessing the 7 HIS measures to each patient at admission, which is what the HIS Comprehensive Assessment Measure addresses. The addendum must list those items, services, and drugs the hospice has determined to be unrelated to the terminal illness and related conditions, increasing coverage transparency for beneficiaries under a hospice election. Therefore, the hospice payment update percentage for FY 2022, based on more recent data, is 2.0 percent. DISCLAIMER: The contents of this database lack the force and effect of law, except as In addition, this rule finalizes changes to the Hospice Conditions of Participation (CoPs) and Hospice Quality Reporting Program (HQRP). We also solicited comments regarding skilled visits in the last week of life, particularly, what factors determine how and when visits are made as an individual approaches the end of life and how hospices make determinations as to what items, services and drugs are related versus unrelated to the terminal illness and related conditions. Given the importance of structured data and health IT standards for the capture, use, and exchange of relevant health data for improving health equity, the existing challenges providers' encounter for effective capture, use, and exchange of health information, such as data on race, ethnicity, and other social determinants of health, to support care delivery and decision making. (3) CMS may remove a quality measure from the Hospice QRP based on one or more of the following factors: (i) Measure performance among hospices is so high and unvarying that meaningful distinctions in improvements in performance can no longer be made. Background and Description of the CAHPS Hospice Survey, b. Overview of the CAHPS Hospice Survey Measures, d. Public Reporting of CAHPS Hospice Survey Results, e. Volume-Based Exemption for CAHPS Hospice Survey Data Collection and Reporting Requirements, f. Newness Exemption for CAHPS Hospice Survey Data Collection and Public Reporting Requirements, h. Proposal to Add CAHPS Hospice Survey Star Ratings to Public Reporting, 9. Finally, the FY 2015 Hospice Wage Index and Rate Update final rule required providers to complete their aggregate cap determination not sooner than 3 months after the end of the cap year, and not later than 5 months after, and remit any overpayments. This final rule updates the hospice wage index, payment rates, and aggregate cap amount for Fiscal Year 2022. As such, they are a valuable source of information that can be used to measure the quality of care provided to beneficiaries for several reasons: CMS already publicly reports several pieces of information derived from hospice claims data in the HQRP on Care Compare, including (i) the levels of care provided by the hospice, (ii) the primary diagnoses of patients served by the hospice, (iii) the location of hospice service provided, and (iv) the hospice's average daily census. . For HVLDL, where higher scores indicate better quality of care, the national average score was 65.5 percent in FY 2019, where 965 hospices did not meet the reportability threshold. Provider of Services (POS) File to examine trends in the scores of the HCI and its indicators, including by decade by which the hospice was certified for Medicare, ownership status, facility type, census regions, and urban/rural status. We received many comments expressing the need for HCPCS codes for all hospice disciplines, including spiritual care professionals. 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). Similar to other CAHPS programs, we proposed that the cut-points used to determine the stars be constructed using statistical clustering procedures that minimize the score differences within a star category and maximize the differences across star categories. The letter can be used to show when you received your number. Hospice providers, must report HIS data used for the HIS Comprehensive Assessment Measure, in order to meet the requirements for compliance with the HQRP. Additionally, other provider types, such as IPPS hospitals, home health agencies (HHAs), SNFs, IRFs, and the dialysis facilities all use CBSAs to define their labor market areas. Therefore, the Secretary has certified that this rule will not have a significant impact on the operations of a substantial number of small rural hospitals (see Table 25). (2019). Response: We appreciate commenters' concerns that hospice providers continue to recognize and address the unique circumstances of hospice patients. We also continued those requirements in all subsequent years (84 FR 38526). 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. 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. Section 6005(a) of the Omnibus Budget Reconciliation Act of 1989 (Pub. Many commenters also noted the special focused program that requires each state and local survey agency, and each national accreditation body with an approved hospice accreditation program, to submit information respecting any survey or certification made with respect to a hospice program. In other words, these OMB updates would not affect any geographic areas for purposes of the wage index calculation for FY 2022. For more information, please visit the PAC PUF web page at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/PAC2017. CMS also finalized a service intensity add-on (SIA) payment payable for certain services during the last 7 days of the beneficiary's life. Further, HCI like the other HQRP quality measures validates well with the CAHPS Hospice Survey willingness to recommend, which signifies a quality measure useful for public reporting. The HIS Comprehensive Assessment Measure captures whether multiple key care processes were delivered upon patients' admissions to hospice in one measure as described in the Table 6. They suggested using multiple avenues of communication including the HQRP website and MLN Connects. These refreshes for claims-based measures, OASIS-based measures, and for HH CAHPS Survey measures are outlined in Table 20. Response: We appreciate commenters' interest in having the HCI reflect how prepared hospices are to provide key services to patients. If you do not agree to the terms and conditions, you may not access or use the software. edition of the Federal Register. Therefore, we proposed to clarify in regulation that the date furnished must be within the required timeframe (that is, 3 or 5 days of the beneficiary or representative request, depending on when such request was made), rather than the signature date. To calculate the compensation costs for each provider, we proposed to then sum each of the costs estimated in steps (1) through (5) to derive total compensation costs for CHC, RHC, IRC, and GIP. We also appreciate the comments expressing concern about the impact these measures may have on small and/Start Printed Page 42566or rural hospices. They noted the implementation of a new assessment instrument would be burdensome on both providers and EMR vendors. Federal Register. Many commenters noted that there is a great deal of variation among FHIR systems, which could impede the adoption of a standard system across hospices. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Additionally, the rule finalizes the addition of the claims-based Hospice Visits in the Last Days of Life (HVLDL) measure for public reporting, which supports patient empowerment and transparency of hospice performance. Section 418.76 is amended by revising paragraphs (c)(1) and (h)(1)(iii) to read as follows: (1) The competency evaluation must address each of the subjects listed in paragraph (b)(3) of this section. We identify the dates of those visits by the revenue center date for those revenue codes. As stated above, in order to calculate the labor share standardization factor, we simulate total payments using FY 2020 hospice utilization claims data with the FY 2022 hospice wage index and the current labor shares and compare it to our simulation of total payments using the FY 2022 hospice wage index with the final revised labor shares. 553 requires the agency to publish a notice of the proposed rule in the Federal Register that includes a reference to the legal authority under which the rule is proposed, and the terms and substance of the proposed rule or a description of the subjects and issues involved. 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). Live discharges are assigned to a particular reporting period based on the date of the live discharge (which corresponds to the through date on the claim). Response: On the questionnaire, the respondent is asked if their family member experienced the symptom. We believe additional delays in public reporting of data is not in the interest of the public using Care Compare. 3. Through the proposed rule, we sought input on the following steps that would enable transformation of CMS' quality measurement enterprise to be fully digital (86 FR 19765): b. We disagree with commenters that the hospice MCR data does not provide adequate or appropriate measure of labor expenses. Table 13 displays the original schedule for public reporting prior to the COVID-19 PHE. The beneficiary's care plan will shift over time to meet the changing needs of the individual, family, and caregiver(s) as the individual approaches the end of life. The MAP conditionally supported the HCI for rulemaking contingent on NQF endorsement. the material on FederalRegister.gov is accurately displayed, consistent with For example, the higher labor share for CHC compared to RHC reflects the higher number of visits per day provided with CHC relative to RHC. We expect that approximately 70 percent of hospices with publicly reported CAHPS Hospice Survey measure scores meet the threshold of 75 completed surveys. Previously, local wage index values were applied based on the geographic location of the hospice provider, regardless of where the hospice care was furnished. One commenter recommended that CMS maintain the 5 percent cap that was put in place for FY 2021 or lower the cap to 3 percent to protect hospice providers who are already operating with negative or razor thin operating margins. Results of this experiment will Start Printed Page 42575help to inform changes to the survey in the future. This option maintains requirements in the FY 2017 Hospice Wage Index and Payment Update final rule for publicly reporting 4 quarters of data, but it requires using some data that are more than 2 years old. While comments were overwhelmingly supportive, we did not receive any comments that would support burden changes. Hospice Start Printed Page 42547providers are only able to discern what items, services, and drugs they will not cover once they have a beneficiary's comprehensive assessment. We also received several comments responding to how CMS should incentivize the use of HIT. %PDF-1.6 % To: NHPCO Provider and State Members From: NHPCO Regulatory Team Date: September 29, 2021 . Data submission requirements under the hospice quality reporting program. CAHPS Hospice Survey to examine alignment between the survey outcomes and the HCI. 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. offers a preview of documents scheduled to appear in the next day's Comment: We received comments in support of the proposal to use two years of data for publicly reporting HVLDL and HCI. The wage index and labor share standardization factors for each level of care are shown in the Tables 2 and 3. Specifically, we will refresh claims-based measure scores on Care Compare, in preview reports, and in the confidential CASPER QM preview reports annually. We previously finalized a volume-based exemption for CAHPS Hospice Survey Data Collection and Reporting requirements for FY 2021 and every year thereafter (84 FR 38526). Hospice is compassionate beneficiary and family/caregiver-centered care for those who are terminally ill. As referenced in our regulations at 418.22(b)(1), to be eligible for Medicare hospice services, the patient's attending physician (if any) and the hospice medical director must certify that the individual is terminally ill, as defined in section 1861(dd)(3)(A) of the Social Security Act (the Act) and our regulations at 418.3; that is, the individual has a medical prognosis that his or her life expectancy is 6 months or less if the illness runs its normal course. Washington, D.C. 20201 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. This process will be necessary for each IP address you wish to access the site from, requests are valid for approximately one quarter (three months) after which the process may need to be repeated. Star ratings benefit the public in that they can be easier for some to understand than absolute measure scores, and they make comparisons between hospices more straightforward. Starting with FY 2013 (and in subsequent FYs), the market basket percentage update under the hospice payment system referenced in sections 1814(i)(1)(C)(ii)(VII) and 1814(i)(1)(C)(iii) of the Act are subject to annual reductions related to changes in economy-wide productivity, as specified in section 1814(i)(1)(C)(iv) of the Act. Additionally, we acknowledged that hospices have noted that there is not a timeframe in regulations regarding the patient signature on the addendum. 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. NQF #1617 Patients Treated with an Opioid who are Given a Bowel Regimen, NQF #1647 Beliefs/Values Addressed (if desired by the patient). By offering an accessible and user-friendly interface and a simple design that is optimized for mobile and tablet use, it is easier than ever to find information that is important to patients when shopping for healthcare. See Chapter 1000 and Appendix A for additional information. Hospice Payment Rates Calculator FY 2023 (Oct 2022 - Sept 2023) Wage Index Hospice Rates FY 2022 (Oct 2021 - Sept 2022) (2015). 36. We are also revising the hospice aide supervision requirements to address situations when deficient practice is noted and remediation is needed related to both deficient and related skills, in accordance with 418.76(c). The comprehensive assessment includes all areas of hospice care related to the palliation and management of a beneficiary's terminal illness. In addition, Table 18 shows the proposed CAHPS public reporting schedule during and after the data freeze. 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. In October 2020, our contractor convened a workgroup of family caregivers whose family members have received hospice care to provide input on this measure concept from the family and caregiver perspective.

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