This indicator identifies whether a hospice is below the 90th percentile in terms of the percentage of live discharges that occur on or after the 180th day of hospice. The commenters recognize that the inclusion of any costs on line 25 would distort the labor component for these inpatient services; however, the commenters' experience indicates that most hospices with inpatient units also contract for some inpatient days with outside providers for a variety of reasons. We would note that the freestanding hospice providers account for about 85 percent of hospice providers and therefore, we believe our proposal to use only the freestanding hospice MCR data to revise the labor shares is reasonable and a technical improvement over the current labor shares. At the beginning of every fiscal year, SIA utilization is compared to the prior year in order calculate a budget neutrality adjustment. No single quality measure within the portfolio is expected, or necessarily intended, to provide that view on its own. The revised MCR enabled CMS to collect more detailed data regarding labor costs by level of care. This means that hospice providers must furnish the addendum to the beneficiary or representative on or before the third day after the date of the request. Denominator: The total number of RHC days provided by a hospice within a reporting period. Similarly, using fewer than standard numbers of quarters for claims-based measures that typically use eight or twelve months of data for reporting between January 2022 and July 2024 will allow us to begin providing more relevant data sooner. Numerator: The total number of live discharges from the hospice followed by hospital admission within 2 days, then hospice readmission within 2 days of hospital discharge within a reporting period. Hospices can develop processes (including how to document such requests from non-hospice providers and Medicare contractors) to address circumstances in which the non-hospice provider or Medicare contractor requests the addendum, and the beneficiary or representative does not, as a means of demonstrating that the addendum was furnished to a non-hospice provider and/or Medicare contractor upon request. 0938-0758). 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. For example, if the hospice discharge occurred on a Sunday, the hospitalization had to occur on Sunday, Monday, or Tuesday to be counted. Additionally, several commenters noted that the proposed rule does not state how many hospices will meet the 75 completes threshold. Response: As stated in section III F(3)(e). NQF 3235 does not require NQF's endorsements of the previous components to remain valid. The testing helped us develop a plan for displaying HH QRP data that are as up-to-date as possible and that also meet scientifically-acceptable standards for publicly displaying those data. They note that other star ratings use a 0-100 linear-scaled score. We then trim the data for each level of care separately to remove outliers. With respect to making calculations available before they are publicly reported, we do plan to provide star ratings calculations in preview reports prior to their display. 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. For example, see: Teno J.M., Bowman, J., Plotzke, M., Gozalo, P.L., Christian, T., Miller, S.C., Williams, C., & Mor, V. (2015). Hospices which do not report HIS data used for the HIS Comprehensive Assessment Measure will not meet the requirements for compliance with the HQRP. We also rebased IRC per diem rates equal to the estimated FY Start Printed Page 425322019 average costs per day, with a reduction of 5 percent to the FY 2019 average cost per day to account for coinsurance. Such comparative star ratings, as proposed by CMS, help consumers identify high and low performing hospices. Hospices were required to begin collecting quality data in October 2012, and submit that quality data in 2013. The seven individual components address care processes around hospice admission that are clinically recommended or required in the hospice CoPs. [10] Response: CMS seeks to balance the goal of publicly reporting measure scores for as many hospices as possible with the need to ensure that measure scores can be stably estimated and distinguish between hospices' performance. 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. The signed addendum is only acknowledgement of the beneficiary's (or representative's) receipt of the addendum (or its updates) and the payment requirement is considered met if there is a signed addendum (and any signed updates) in the requesting beneficiary's medical record with the hospice. It is projected that aggregate payments would increase by 2.0 percent; assuming hospices do not change their billing practices. In the March 27, 2020 CMS Guidance Memo, we granted an exception to the HH QRP reporting requirements under the HH QRP exceptions and extension requirements for Quarter 4 (Q4) 2019 (October 1, 2019 through December 31, 2019), Q1 2020 (January 1, 2020 through March 30, 2020), and Q2 2020 (April 1, 2020 through June 30, 2020). Our testing results indicate we can achieve these positive impacts while maintaining high standards for reportability and reliability. In addition, we will remove the 7 measures that make up the HIS Comprehensive Assessment Measure section of Care Compare, which displays the seven HIS measures. The regulations at 418.22(b)(2) require that clinical information and other documentation that support the medical prognosis accompany the certification and be filed in the medical record with it and those at 418.22(b)(3) require that the certification and recertification forms include a brief narrative explanation of the clinical findings that support a life expectancy of 6 months or less. Commenters also encouraged CMS to provide early testing and education for providers on HIT and to provide a structured FHIR transition framework for key stakeholders. http://medpac.gov/docs/default-source/reports/mar20_medpac_ch12_sec.pdf. We believe the information provided in the proposed and final rule allows for commenters to replicate, with their own claims data, the indicators, thresholds, and points earned. As described in the proposed rule (86 FR 19718) and above, we include a proportion overhead salaries and overhead benefits in the compensation cost weights for each level of care. (b) 40660 The SIA Claim may cover up to the last seven days of life and include the date of death. As a few commenters noted, Each hospice is afforded the opportunity to achieve excellent ratings on the CAHPS Hospice Survey. Table 13 displays the original schedule for public reporting prior to the COVID-19 PHE. In the FY 2022 Hospice Wage Index and Payment Rate Update proposed rule (86 FR 19720), we proposed the market basket percentage increase of 2.5 percent for FY 2022 using the most current estimate of the inpatient hospital market basket (based on IHS Global Inc.'s fourth-quarter 2020 forecast with historical data through the third quarter 2020). Public Health Emergency. In order to be counted, the from date of the hospitalization had to occur no more than 2 days after the date of hospice live discharge. The commenters asked CMS whether any consideration was given to this inconsistent, but acceptable, reporting for mileage allowances. In the FY 2020 Hospice Wage Index and Payment Rate Update final rule (84 FR 38484), we finalized the proposal to migrate our systems for submitting and processing assessment data. Aide competency evaluations should be conducted in a way that identifies and meets training needs of the aide as well as the patient's needs. One commenter suggested that we should identify the key 1 or 2 questions in each survey domain and use them instead. MedPAC. To learn more about the background of the HCI, please watch this video: https://youtu.be/by68E9E2cZc. We established our HH QRP Public Display Policy in the CY 2016 HH PPS final rule (80 FR 68709 through 68710). AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. This approach parallels the one used by CMS for calculating star ratings for hospitals. 04/28/2023, 204 In the FY 2020 Hospice Wage Index and Rate Update final rule (84 FR 38484), we finalized rebased payment rates for CHC and GIP and set those rates equal to their average estimated FY 2019 costs per day. This website allows consumers, providers, and other stakeholders to search for all Medicare-certified hospice providers and view their information and quality measure scores. 5. Additionally, we are finalizing definitions for both pseudo-patient and simulation at 418.3. edition of the Federal Register. Paragraph (b)(3) is a technical correction to address errors identified in the FY 2016 and FY 2019 Hospice Wage Index and Payment Rate Update final rules, (80 FR 47186 and 83 FR 38636). 50. We are including in total facility overhead benefits those costs reported in Worksheet A, column 2, lines 9 and 15. [4] The exemption is determined by CMS and is for 1 year only. Detailed information regarding adjustment of measure scores is available at https://hospicecahpssurvey.org/en/scoring-and-analysis/. Commenters encouraged CMS to stratify quality measures by demographic data, social risk factors, and social determinants of health. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). An unusually high rate of live discharges could indicate that a hospice provider is not meeting the needs of patients and families or is admitting patients who do not meet the eligibility criteria., Our live discharge indicators included in the HCI, like MedPAC's, comprise discharges for all reasons. Update on Use of Q4 2019 HH QRP Data and Data Freeze for Refreshes in 2021, 5. The points are earned without weighting to recognize the tradeoffs for each indicator's specifications. We appreciate and understand the importance of provider input and involvement in ensuring that this document is effective in increasing coverage transparency for beneficiaries. Comment: Many commenters stated that focusing the competency training on specific deficient skills provided greater efficiency for hospices. Numerator: The total number of live discharges from the hospice followed by a hospitalization within 2 days of live discharge with death in the hospital within a reporting year. By this standard, we consider a decrease of 5.5 percentage points or less scientifically acceptable. As part of developing the HCI, we conducted reportability, variability, and validity testing using claims data from FY 2019. Also, the relatively high number of hospices that meet the public reporting threshold in the CAR scenario, relative to the SPR scenario, with just 3 quarters of data justify the use of 3 quarters in the unusual circumstances of the COVID-19 PHE and its associated exemptions. In addition, consumers will see whether a hospice provided services to Medicare Advantage enrollees or patients who have coverage under both Medicaid and Medicare, also called dual eligible patients. In 2019, we added the Hospice Visits When Death is Imminent (Measure 1) to the website. The analysis found that 83% of hospices had HCI scores that were 0-1 percentage points different in FY2019 relative to their FY2017 scores. The decision to use eight quarters of rolling data for hospices reflects the size of hospices, which differ in size and other dimensions from other types of entities, such as hospitals and Medicare Advantage contracts, for Start Printed Page 42574which CMS publicly reports scores and star ratings. Thus, we proceeded with including Q4 2019 data in measure calculations for the October 2020 refresh. A summary of these comment and our responses to those comment appear below: Comment: Several commenters requested 6-month minimum notice prior to the transition of hospice to the iQIES system. Thus, 42 CFR 418.306(b)(2) has been revised to follow the CAA of 2021 updates for the survey agencies. (2020). 35. Toll Free Call Center: 1-877-696-6775. We count skilled nursing visits where the corresponding revenue center date overlaps with one of the days of RHC previously identified. These process measures may support or complement the outcome measures. This final rule makes changes to the hospice CoPs regarding hospice aide competency evaluation standards. Use the PDF linked in the document sidebar for the official electronic format. Furthermore, we believe 3 calendar days, rather than 3 business days continues to be appropriate, as hospice care is provided around the clock rather than only during business days and hours. As with the NOE, the claims processing system must be notified of a beneficiary's discharge from hospice or hospice benefit revocation within 5 calendar days after the effective date of the discharge/revocation (unless the hospice has already filed a final claim) through the submission of a final claim or a Notice of Termination or Revocation (NOTR). The productivity adjustment for FY 2022, based on IGI's second quarter 2021 forecast, is 0.7 percent. Response: We thank commenters for their support of this proposal on public reporting for refreshes affected by the exceptions. We believe, and other commenters noted, that the use of pseudo-patients and simulation is an accepted standard of practice for training in healthcare, including nurse aide training programs. The specifications for Indicator Four, Late Live Discharges, are as follows: The Type 1 burdensome transitions reflects hospice live discharge with a hospital admission within 2 days of hospice discharge, and then hospice readmission within 2 days of hospital discharge. Days billed as CHC require more than half the hours provided be nursing hours. Accessible via: http://www.medpac.gov/docs/default-source/reports/mar20_medpac_ch12_sec.pdf?sfvrsn=0. The TEP supported further exploration and development of these measures. A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). The hospice benefit is a comprehensive package of services offering palliative care support to terminally ill Minnesota Health Care Programs (MHCP) members and their families. Notice and comment are unnecessary because we are conforming the regulation to statute and there is no discretion on the part of the Secretary. 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). Claims data are readily available and eliminates provider burden for implementation, as opposed to data collection through patient assessments or surveys, which require additional effort from clinicians, patients, and family caregivers before they can be submitted and used by CMS. Many of these commenters requested that CMS wait a year (until 2023) to publicly report the measures, while also requesting to confidential reports with the claims-based measures as soon as possible. This document displays the CCN, name, and address of every hospice that successfully met quality reporting program requirements for the fiscal year. Conversely, the HIS Comprehensive Assessment Measure, which is a single composite measure, differentiates hospices by holding them accountable for completing all seven process measures to ensure these core hospice services are completed for all patients. L. 111-148), required hospices to begin submitting quality data, based on measures specified by the Secretary of the Department of Health and Human Services (the Secretary), for FY 2014 and subsequent FYs. This change will allow the hospice to focus on the hospice aides specific deficient and related skill(s) instead of assessing multiple areas within the competency evaluation.
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