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. The MAP conditionally supported the HCI for rulemaking contingent on NQF endorsement. This addressed five of the six COVID-19 PHE-affected quarters for HIS-based measures, and five of the 11 COVID-19 PHE-affected quarters of CAHPS-based measures. 804(2)). [10] We received many comments on future quality measure development aspects. 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. Hospice providers must bill the correct rate for the appropriate period of routine home care days. HOPE will include key items from the HIS and demographics like gender and race. Palliative care is at the core of hospice philosophy and care practices, and is a critical component of the Medicare hospice benefit. They stated that more nurses are retiring, competition for available nurses is fierce, and many hospices are paying premium salaries and bonuses to recruit and retain qualified nursing staff. The table reports the sample size before and after exclusion.[15]. documents in the last year, 494 - Posted 09/27/2022. The intent of this clarification is to better align with the requirement for furnishing an election statement addendum when the addendum is requested within 5 days of the date of election, which also uses days rather than hours. 4, Update on Use of Q4 2019 HH QRP Data and Data Freeze for Refreshes in 2021. As discussed in section III.B of this rule, we are finalizing to rebase and revise the labor shares for CHC, RHC, GIP and IRC using MCR data for freestanding hospices (CMS Form 1984-14, OMB Control Number 0938-0758) for 2018. No single quality measure within the portfolio is expected, or necessarily intended, to provide that view on its own. Section 6005(a) of the Omnibus Budget Reconciliation Act of 1989 (Pub. Index Earned Point Criterion: Hospices earn a point towards the HCI if their individual hospice score for gaps in skilled nursing visits greater than 7 days falls below the 90th percentile ranking among hospices nationally. 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. 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. We then sum the CHC compensation costs and total CHC costs of the remaining providers, yielding a proposed compensation cost weight for CHC. We also proposed to exclude those providers whose CHC compensation costs were greater than total CHC costs. Final Decision: We are finalizing our proposal to resume public reporting of HIS quality measures in February 2022 using data from Q3 and Q4 of 2020 and Q1 of 2021. [4] Some beneficiaries or representatives may have time constraints that prevent them from signing and returning the addendum by a certain deadline, in which case, the date that the hospice furnishes the addendum to the beneficiary may differ from the date that the beneficiary (or representative) signs the addendum. (8) The costs associated with a measure outweigh the benefit of its continued use in the program. We sought public comment on this proposal to publicly report the most-recently available 8 quarters of CAHPS data starting with the February 2022 refresh and going through the May 2023 refresh on Care Compare because we cannot publicly report Q1 2020 and Q2 2020 data due to the COVID-19 PHE. (ii) Performance or improvement on a measure does not result in better patient outcomes. For HCI, combining 2 years of data (FY 2018 to FY 2019 data) allows an additional 277 to report HCI measure scores on Care Compare, or 43.2 percent of the hospices that do not meet the reporting threshold in FY 2019 alone. Response: We appreciate the support by comments recognizing the value HCI brings to consumers by providing more information not previously available about hospices. In the FY 2022 hospice proposed rule, we noted that hospices have reported that beneficiaries or representatives sometimes do not request the addendum at the time of election, but rather within the 5 days after the effective date of the election (86 FR 19724). Table 1: 2023 Medicaid Hospice Rates for Routine Home Care (including the service intensity . The stars would range from one star (worst) to five stars (best). 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. MedPAC, in descriptive analyses of hospices exceeding the Medicare annual payment cap, noted that if some hospices have rates of discharging patients alive that are substantially higher than most other hospices it raises concerns that some hospices may be pursuing business models that seek out patients likely to have long stays who may not meet the hospice eligibility criteria. Based on our estimates, OMB's Office of Information and Regulatory Affairs has determined that this rulemaking is economically significant as measured by the $100 million threshold, and hence also a major rule under Subtitle E of the Small Business Regulatory Enforcement Fairness Act of 1996 (also known as the Congressional Review Act), 5 U.S.C. Response: The labor share standardization factor is applied to the FY 2022 hospice payment rates so that the aggregate payments do not increase or decrease due to changes in the labor share values. We found a stronger correlation coefficient with CAHPS would recommend scores for HVLDL than for HVWDII. This analysis must conform to the provisions of section 604 of the RFA. Instead, they included all these days on line 23 and 33 of Worksheet S-1 but failed to report contracted days on line 40 and 41 of Worksheet S-1. HVLDL is defined for in-person visits. We identify skilled nursing visits by the presence of revenue code 055x (Skilled Nursing) on the claim. This rule finalizes several clarifying regulation text changes on certain aspects of the hospice election statement addendum requirements that were previously finalized for hospice elections beginning on and after October 1, 2020. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. (2010). On March 6, 2020, OMB issued Bulletin No. Effective with services rendered on and after April 1, 1990, the per diem rate is 95% of the nursing facility per diem where the hospice resident resides. For example, if the last discharge date in the applicable period for a measure is December 31, 2022, for data collection January 1, 2022, through December 31, 2022, we would create the data extract on approximately March 31, 2023, at the earliest. 10. As described in the 2020 TEP Summary Report, the TEP generally Start Printed Page 42570supports the following measure concepts that are calculated using HOPE items: Timely Reduction of Pain Impact, Reduction in Pain Severity, and Timely Reduction of Symptoms. 39. We will monitor HCI score trends to identify whether any regional or size-based variations suggest a need for measure revision. Reportability analyses found a high proportion of hospices (over 85 percent) that would yield reportable measure scores over 1 year (for more on reportability analysis, see section (2) Update on Use of Q4 2019 Data and Data Freeze for Refreshes in 2021.). Table 6 lists all quality measures planned for FY 2022 for HQRP. As such, we proposed to clarify in regulation that if a non-hospice provider requests the addendum, rather than the beneficiary or representative, the non-hospice provider is not required to sign the addendum. The second column shows the number of hospices in each of the categories in the first column. The 'Hospice Rates' links contain the standardized Medicare payment amount for each hospice level of care. 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. Font Size: MedPAC. 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. Chapter 12: Hospice Services. The labor shares for IRC and GIP are currently 54.13 percent and 64.01 percent, respectively. Some commenters recommended that CMS align the late penalty for the addendum with the penalty for late submission of the NOE. Second, we finalized two new quality measures for the HQRP for the FY 2019 payment determination and subsequent years: Hospice Visits when Death is Imminent Measure Pair and Hospice and Palliative Care Composite Process Measure-Comprehensive Assessment at Admission (81 FR 52173). Our proposal to use the 2018 MCR data recognizes that providers have had 4 years to familiarize themselves with the form and, thereby, improve the accuracy of the data. Some commenters suggested that CMS formulate a methodology that would include smaller hospices in star ratings. has no substantive legal effect. Such comparative star ratings, as proposed by CMS, help consumers identify high and low performing hospices. https://www.phe.gov/emergency/news/healthactions/section1135/Pages/covid19-13March20.aspx. This could increase the speed of performing competency testing and would allow new aides to begin serving patients more quickly while still protecting patient health and safety. 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. 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. We sought public comment on the technical correction to the regulation at 418.312(b) effective October 1, 2021. In the original schedule (Table 13) the November 2020 refresh includes Q4 2019 data for HIS- and CAHPS-based measures (Q1 through Q4 2019 for HIS data and Q1 2018 through Q4 2019 for CAHPS data) and is the last refresh before Q1 2020 data are included. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Response: We appreciate the commenters' support for this proposal. These evaluations are a critical part of providing safe, quality care. For HCI, several commenters expressed concern about CMS's ability to help consumers interpret it in a way that helps support informed decision-making. 26. 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. One commenter agreed with the increased labor share for CHC and for IRC, but did not agree with lowering the labor share for RHC and GIP. How you know. Hybrid quality measures allow for a more comprehensive set of information about care processes and outcomes than cannot be calculated using claims data alone. HOPE items assessing Symptom Impact, and Patient Desired Tolerance Level for Symptoms or Patient Preferences for Symptom Management were used to calculate this measure. Response: We appreciate the commenter's concern regarding labor hours provided by type of facility. 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 material on FederalRegister.gov is accurately displayed, consistent with Publicly Report the Hospice Care Index and Hospice Visits in the Last Days of Life Claims-based Measures. 51. We believe using updated labor shares based on 2018 data is a technical improvement over the current labor shares as they reflect recent cost data for freestanding hospice providers. If the addendum is completed prior to the comprehensive assessment, the hospice may not have a complete patient profile, which could potentially result in the hospice incorrectly anticipating the extent of covered and non-covered services and lead to an inaccurate election statement addendum. Medicare hospice: Hospices Inappropriately Billed Medicare Over $250 Million for General Inpatient Care. Although these measures represent the first time that hospices are held accountable for visits information in claims, the measures reflect ideas about best practice and compliance that hospices have already known. This excluded two providers and had no impact on the compensation cost weights for both IRC and GIP when rounded to a tenth of a percentage point. This claims-based measure will be publicly reported no earlier than May 2022. We want hospices to be successful with meeting the HQRP requirements. 20. While the transition from the HIS to HOPE will eventually enable the HQRP to be more robust, we should not wait to seek improvement on this composite measure as an indicator of quality. While the commenter commended CMS for using hospice-specific data, they were also concerned about the accuracy of the data submitted by providers. Hospice Care 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. The commenter suggested that more research and data are required on the use of pseudo-patients and changes to competency requirements prior to making a policy decision.