The MCR data captures detailed labor and non-labor expenses for patient (including but not limited to nursing, physician, therapy and medical supply expenses) and non-patient expenses (such as administrative and general) by level of care. Section 1814(i)(5)(C) of the Act requires that each hospice submit data to the Secretary on quality measures specified by the Secretary. We also appreciate the suggestions to include HCI indicators in PEPPER reports rather than implement HCI. As Figure 2 shows, a larger numbers of hospices among the 277 hospices that only meet the reporting threshold when using 2 years of data had HCI scores between four and eight, while a larger number of hospices in the FY 2019 population had a perfect score of 10. Email | However, for rural Puerto Rico, we would not apply this methodology due to the distinct economic circumstances that exist there (for example, due to the close proximity to one another of almost all of Puerto Rico's various urban and non-urban areas, this methodology would produce a wage index for rural Puerto Rico that is higher than that in half of its urban areas); instead, we would continue to use the most recent wage index previously available for that area. We would note that the freestanding hospice MCR data was used to rebase the hospice payment rates effective for FY 2020 (84 FR 38487 to 38496). In the FY 2014 Hospice Wage Index and Payment Rate Update final rule (78 FR 48234) we stated that reportability of 71 percent through 90 percent is acceptable. For questions regarding the hospice conditions of participation, contact Mary Rossi-Coajou at (410) 786-6051 and CAPT James Cowher at (410) 786-1948. Response: The freestanding hospice MCR form used for the proposed labor shares (CMS-1984-14; OMB NO. 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). We are designating that system as the data submission system for the Hospice QRP. Further, the commenters stated that these changes should be instituted to ensure greater accuracy of the data being used to establish labor shares for GIP and IRC. Because October 2020 refresh data will become increasingly out-of-date and thus less useful for the public, we analyzed whether it would be possible to use fewer quarters of data for one or more refreshes and thus reduce the number of refreshes that continue to display October 2020 data. Form, Manner, and Timing of Quality Data Submission, a. Statutory Penalty for Failure To Report, 10. Consumers can now access the Hospice APU compliance file from Care Compare, enabling them to determine if a particular hospice is compliant with CMS' quality reporting requirements.Start Printed Page 42590. 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. Another commenter stated that very few patients and their representatives have requested the addendum and that the burden of implementation of the addendum outweighs the benefits. We then count the minutes of skilled nursing visits by taking the corresponding revenue center units (that is, one unit is 15 minutes) and multiplying by 15. https://oig.hhs.gov/oei/reports/oei-02-10-00491.pdf. The specifications for Indicator Three, Early Live Discharges, are as follows: The rate of live discharge that occurred 180 days or more after hospice enrollment identifies another potentially concerning pattern of live discharge from hospice. Update on Use of Q4 2019 HH QRP Data and Data Freeze for Refreshes in 2021, 5. Finally, in the FY 2021 Hospice Wage Index and Payment Rate Update final rule (85 FR 47079), we finalized a 1-year transition 5 percent cap on wage index decreases for fiscal year (FY) 2021 only. documents in the last year, by the Food Safety and Inspection Service Live discharges occur when the patient discharge status code on a hospice claim does not equal a code from the following list: 30, 40, 41, 42, 50, 51. Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for Fiscal Year (FY) 2023. The commenter asked whether any consideration was made regarding this inconsistency or other common inconsistencies in the nature of the expenses. Further information about these requirements may be found at: http://www.hhs.gov/ocr/civilrights. Section 1814(a)(7)(D)(i) of the Act, as added by section 3132(b)(2) of the. In the FY 2021 Hospice Wage Index and Payment Rate Update final rule, we addressed a concern regarding a potential situation wherein the beneficiary or representative refuses to sign the addendum (85 FR 47088). Comment: One specific concern of the commenters regarding the proposed methodology was on the data used from Worksheet A-1 and A-2 column 7, lines 26 through 37 for total labor costs associated with each respective level of care. Thus, it is important that hospices ensure the completeness and correctness of their claims prior to the claims snapshot.. Comment: Several commenters stated that the CAHPS Hospice Survey is unlike other CAHPS surveys in that the respondents are family members or friends of the deceasednot the patients themselves. Therefore, in response to public comment, we are revising our methodology for calculating overhead benefits attributable to each level of care. Final Decision: We are finalizing the hospice payment update percentage of 2.0 percent for FY 2022. We noted this revised statutory requirement in our proposed rule (86 FR 19726) and are codifying the revision at 418.306(b)(2). 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. In testing, 37.1 percent of hospices scored ten out of ten, 30.4 percent scored nine out of ten, 17.9 percent scored eight out of ten, 9.6 percent scored seven out of ten, and 5.0 percent scored six or lower, as shown in Figure 1. In order to support provider and supplier communities due to the COVID-19 PHE, CMS has issued an unprecedented number of regulatory waivers under our statutory authority set forth at section 1135 of the Act. on 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. Response: We believe that our proposal to revise the labor shares based on MCR data for hospice providers is a technical improvement to the current labor shares and appreciate the support from the commenters. Standard Public Reporting (SPR) Scenario: We used data from the four quarters of CY 2019, which represent CY 2020 public reporting in the absence of the temporary exemption from the submission of PAC quality data, as the basis for comparing simulated alternatives. 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. The SIA payment is provided for visits of a minimum of 15 minutes and a maximum of 4 hours per day (80 FR 47172). See Condition of participation: Interdisciplinary group, care planning, and coordination of services, Title 42, Chapter IV, Subchapter B, Part 418, 418.56 (https://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=42%3A3.0.1.1.5#se42.3.418_156) and Condition of participation: Hospice aide and homemaker services, Title 42, Chapter IV, Subchapter B, Part 418, 418.76 (https://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=42%3A3.0.1.1.5#se42.3.418_176). This contract is currently held by the National Quality Forum (NQF). The payment rate updates are subject to changes in economy-wide productivity as specified in section 1886(b)(3)(B)(xi)(II) of the Act. (4) The availability of a more broadly applicable (across settings, populations, or conditions) measure for the particular topic. This rule finalizes changes to the Hospice Quality Reporting Program (HQRP), summarizes the comments to the requests for information on advancing to digital quality measurement and the use of Fast Healthcare Interoperability Resources (FHIR) and the White House Executive Order related to health equity in the HQRP. This proposed methodology assumes the ratio of total overhead benefit costs to total noncapital overhead costs is consistent among all four levels of care. 2. At the same time, we want to report measures scores to the public for as many hospices as possible, including small hospices. This factor aims to promote improved health outcomes for beneficiaries while minimizing the overall costs associated with the program. Ninety percent of all required HIS records must be submitted and accepted within the 30-day submission deadline to avoid the statutorily-mandated payment penalty. For this indicator, we first determine if a beneficiary was in hospice for at least 1 day during their last 3 days of life by comparing days of hospice enrollment from hospice claims to their date of death. Chapter 12: Hospice Services. We proposed that the stars be calculated based on top-box scores for each of the eight CAHPS Hospice Survey measures. public reporting will continue to be the most recent 8 quarters of data, excluding the exempted quarters; Quarter 1 and Quarter 2 of CY 2020. 49. We remind stakeholders that the hospice wage index does include the hospice floor which is applicable to all CBSAs, both rural and urban. Response: We appreciate the opportunity to provide clarification. Relatedly, in the HIS V3.00 PRA Submission, CMS-10390 (OMB control number: 0938-1153), we finalized the proposal to remove Section O from the HIS. The revised MCR enabled CMS to collect more detailed data regarding labor costs by level of care. Comment: One commenter stated that if the labor shares are going to have a greater weight on CHC, hospices should Start Printed Page 42539be allowed to use it effectively. CMS is finalizing the use of the pseudo-patient for hospice aide competency training. Comment: We received several comments supporting our proposal to begin public reporting in February 2022 using Q3 and Q4 of 2020 and Q1 of 2021. We encourage hospices to use this website at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-Quality-Reporting-Training-Training-and-Education-Library. The Division will reimburse the hospice provider an inpatient per diem rate for routine home care and continuous home care days of service that are furnished to a hospice resident living in a nursing facility. d. What additional resources or tools would post-acute care settings, including but not limited to hospices and health IT vendors find helpful to support testing, implementation, collection, and reporting of all measures using FHIR standards via secure APIs to reinforce the sharing of patient health information between care settings? Many commenters suggested that CMS provide more detailed analysis of physician billing as it relates to non-hospice spending and a few commenters suggested that CMS release additional data connected to CMS' Part D spending analysis to better inform stakeholders and assist in helping to determine what factors may be contributing to these increased Part D expenditures during a hospice election. 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. We offer many training and education opportunities through our website, which are available 24/7, 365 days per year, to enable hospice staff to learn at the pace and time of their choice. Report to Congress: Medicare Payment Policy (March 2019) MEDPAC. Response: We do not believe that making these clarifications retroactive or delaying the effective date is necessary. Also, you can decide how often you want to get updates. We also received six comments on the use of the labor share standardization factor including hospices, national industry associations. Kehl, K.A., et al. Comment: Many commenters requested clarification related to the use of technology under the Medicare hospice benefit during the PHE. We will continue development of HOPE in accordance with the Blueprint for the CMS Measures Management System. Our proposed methodology utilizes freestanding hospice cost report data reflecting the skilled hospice care provided in 2018 and the associated direct and indirect costs required to provide these services in 2018. for inclusion in the HQRP. o2+XXH3H3'@ cM Unlike process measures, outcome measures capture the results of care as experienced by patients, which can include aspects of a patient's health status and their experiences in the health system. Response: While comments on this topic are out of scope for this rulemaking, we do believe the subject is important to address, given the number of comments on this topic. We estimate that the aggregate impact of the payment provisions in this rule will result in an increase of $480 million in payments to hospices, resulting from the hospice payment update percentage of 2.0 percent for FY 2022. The HQRP will post a revised QM Users' Manual that contains HCI and HVLDL no later than October 1, 2021 at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Current-Measures. The standard of practice for hospice is that care and services are provided on an in-person basis based on needs identified in the comprehensive assessment and services ordered by the IDG and outlined in the plan of care. Methods that commenters or their organizations use in employing data to reduce disparities and improve patient outcomes, including the source(s) of data used, as appropriate. In chapter 6 of the June 2007 Report to Congress, MedPAC recommended the new wage index should: Use wage data from all employers and industry-specific occupational weights, adjust for geographic differences in the ratio of benefits to wages, adjust at the county level and smooth large differences between counties, and be implemented so that large changes in wage index values are phased in over a transition period. Any future changes to the cost report or labor shares would be subject to public comments. The AMA is a third party beneficiary to this license. For example, an average consumer might misinterpret higher scores for live discharges or avoidance of general inpatient care as favorable. 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 then calculated the change in the number of hospices which achieved the minimum reporting standard. Live discharges occur when the patient discharge status code does not equal a value from the following list: 30, 40, 41, 42, 50, 51. By dividing total payments for each level of care (RHC days 1 through 60, RHC days 61+, CHC, IRC, and GIP) using the FY 2021 wage index and payment rates for each level of care by the total payments using the FY 2022 wage index and FY 2021 payment rates, we obtain a wage index standardization factor for each level of care. It is projected that aggregate payments would increase by 2.0 percent; assuming hospices do not change their billing practices. The purpose of this Change Request (CR) is to update the hospice payment rates, hospice wage index, and Pricer for FY 2023. A hospice uses an interdisciplinary approach to deliver medical, nursing, social, psychological, emotional, and spiritual services through a collaboration of professionals and other caregivers, with the goal of making the beneficiary as physically and emotionally comfortable as possible. First, we evaluated measure correlation using the Pearson and Spearman correlation coefficients, which assess the alignment of hospices' HIS Comprehensive Assessment Measure scores between scenarios. If additional data points become available, CMS will consider modifying the measure in light of the new data. Section 418.312 is amended by revising paragraph (b) to read as follows: (b) Submission of Hospice Quality Reporting Program data. Response: As stated in the FY 2022 hospice proposed rule (86 FR 19717 through 19719) as well as above, we proposed that Direct patient care salaries and contract labor costs be equal to costs reported on Worksheet A-1 (for CHC) or Worksheet A-2 (for RHC) or Worksheet A-3 (for IRC) or Worksheet A-4 (for GIP), column 7, for lines 26 through 37 (86 FR 19718). Date: September 30, 2022 . We propose no changes to these requirements going forward. CMS releases new federal hospice rates for federal fiscal year 2022 The Centers for Medicare & Medicaid Services (CMS) released new federal hospice rates for federal fiscal year 2022 . One commenter stated that it is important that CMS address this frequency so that hospices and cost report preparers can ensure that the data submitted on the cost report can be used for the labor share calculations. They requested a justification for using this number. Additionally, we are finalizing as proposed at 418.3 the definitions of pseudo-patient and simulation. We also received several comments responding to how CMS should incentivize the use of HIT. 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. 1320b-5) to waive or modify the requirements of titles XVIII, XIX, and XXI of the Act and regulations to the extent necessary to address the COVID-19 PHE. This means that their scores will not be displayed on Care Compare, and consumers will not have information about them to inform their decisions about selecting a hospice. The COVID-19 PHE Exception applied to Q1 and Q2 of 2020. In the FY 2016 Hospice Wage Index and Rate Update final rule (80 FR 47142), we finalized the policy for retention of HQRP measures adopted for previous payment determinations and seven factors for measure removal. within a FY. The first column shows the breakdown of all hospices by provider type and control (non-profit, for-profit, government, other), facility location, facility size. This could include a special open door forum or other venues for interaction. In general, OMB issues major revisions to statistical areas every 10 years, based on the results of the decennial census. There is one rate for the first 60 days of care and another rate for care beyond 60 days. We believe that the 1-year 5 percent cap transitional policy provided for FY 2021 was an adequate safeguard against any significant payment reductions, allowed for sufficient time to make operational changes for future fiscal years, and provided a reasonable balance between mitigating some short-term instability in hospice payments and improving the accuracy of the payment adjustment for differences in area wage levels. During these meetings, the discussions reflecting on the analysis generally supported the replacement of HVWDII with a claims-based HVLDL measure. Our reweighted compensation cost weights for IRC and GIP were similar (less than one percentage point in absolute terms) to our proposed compensation cost weights for IRC and GIP (as shown in Table 1) and, therefore, we believe our sample is representative of freestanding hospices providing inpatient hospice care. Specifically, we compared submission rates in Q4 2019 to average annual rates (Q4 2018 through Q3 2019) to assess the Start Printed Page 42579extent to which hospices had taken advantage of the exemption, and thus the extent to which data and measure scores might be affected. We do not believe that a 1-year limited increase in hospice wage index payments for hospices specifically in the Montgomery County Metropolitan Divisions is appropriate at this time. They stated that in many healthcare systems someone from the accounting department completed the cost report form with very little input from the hospice program. Comment: A few commenters requested specifically for an explanation for using top-box scoring of individual level responses for the star ratings. We are also proposing in this rule to adopt the HCI into the HQRP for FY2022. of delivery would work best in furnishing the addendum. The FY 2022 hospice payment impacts appear in Table 25. on The Preview Reports will reflect the HCI as publicly reported. Before sharing sensitive information, make sure youre on a federal government site. (2019). 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. We then apply a budget neutrality adjustment so that the aggregate simulated payments do not increase or decrease due to changes in the labor share values. We received several comments from various stakeholders on this proposal. Therefore, we are finalizing changes to permit skill competencies to be assessed by observing an aide performing the skill with either a patient or a pseudo-patient as part of a simulation. Additionally, the initiative points to high priority areas where there may be informational gaps in available quality measures. One commenter indicated that comprehensive competency testing can take up to a full 8-hour day and a targeted approach will save time related to this requirement. This rule takes effect October 1, 2021. Comment: We received seven comments in support of the proposed hospice update percentage of 2.3 percent. They include instances where the patient was no longer found terminally ill and revocations due to the patient's choice. Thus, we would have continued to publicly report HVWDII Measure 1 data through the November 2021 refresh. In addition, we remind providers that when submitting the MCR data they must certify the cost report that to the best of [their] knowledge and belief, [the] report and statement are true, correct, complete and prepared from the books and records of the provider in accordance with applicable instructions, except as noted.. Finally, in the FY 2020 Hospice Wage Index and Rate Update final rule (84 FR 38505), we finalized modifications to the hospice election statement content requirements at 418.24(b) by requiring hospices, upon request, to furnish an election statement addendum effective beginning in FY 2021. Additionally, as the plan of care should identify the conditions or symptoms that the hospice determines to be unrelated, this information should be readily accessible to the hospice in order to allow for the timely completion of the addendum. This interdisciplinary, holistic scope of the HIS Comprehensive Assessment Measure better aligns with the public's expectations for hospice care.

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