Subsequently, as with HIS-based measures, we will implement a 30-day preview period for claims-based measures, which will serve as the final opportunity for hospices to review their data and alert CMS about any errors in the measure calculations they identify. Each HCI indicator is scored based on comparative performance, with hospices receiving a point based on their performance relative to a national percentile threshold. We plan continue to monitor hospice trends and vulnerabilities within the hospice benefit. 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. Response: On the questionnaire, the respondent is asked if their family member experienced the symptom. The specifications for Indicator Five, Burdensome Transitions Type 1, are as follows: Death in a hospital following live discharge in another concerning pattern in hospice use. (5) If the beneficiary dies, revokes, or is discharged prior to signing the addendum (as outlined in paragraphs (d)(1) and (2) of this section), the addendum would not be required to be signed in order for the hospice to receive payment. 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. 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. 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. For this reason, we proposed to calculate CAHPS Hospice star ratings using top-box scores. Thus, we proceeded with including Q4 2019 data in measure calculations for the October 2020 refresh. 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. MedPAC. CMS froze CAHPS data starting with the November 2020 refresh and concluding with the November 2021 refresh. All other boundaries and names are as of January 1, 2012. Register documents. County Number CBSA FFY 2022 Hospice Wage Index Continuous Home Care Inpatient Respite Care General Inpatient Care Routine Home Care (days 1-60) Routine Home Care (days 61+) Service (5) The availability of a measure that is more proximal in time to desired patient outcomes for the particular topic. In addition, we finalized the Hospice Visits When Death is Imminent measure pair (HVWDII, Measure 1 and Measure 2) in the FY 2017 Hospice Wage Index and Payment Rate Update final rule, effective April 1, 2017. For more information on the policies we have adopted for the HH QRP, we refer readers to the following rules: Section 1895(b)(3)(B)(v)(III) of the Act requires the Secretary to establish procedures for making HH QRP data, including data submitted under sections 1899B(c)(1) and 1899B(d)(1) of the Act, available to the public. For each level of care, we proposed to use the same methodology to derive the components; however, for the (1) direct patient care salaries and (3) other patient care salaries, we proposed to use the MCR worksheet that is specific to that level of care (that is, Worksheet A-1 for CHC, Worksheet A-2 for RHC, Worksheet A-3 for IRC, and Worksheet A-4 for GIP). In addition, the measure supports alignment across our programs and with other public and private initiatives. Hospices with higher HCI scores generally achieve better caregiver ratings as measured by CAHPS Hospice scores, and hospices with lower HCI scores generally achieve poorer CAHPS Hospice scores. These specifications list all the information required to calculate each indicator, including the numerator and denominator definitions, different thresholds for receiving credit toward the overall HCI score, and explanations for those thresholds. 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 does not constitute a change to the requirements of the CoPs. Specifications for the ten indicators required to calculate the single HCI score are described in this section. to the courts under 44 U.S.C. 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. 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 also includes patient and caregiver education and training as appropriate to their responsibilities for the care and services identified in the plan of care. In 2021, that threshold is approximately $158 million. We then calculated the change in the number of hospices which achieved the minimum reporting standard. offers a preview of documents scheduled to appear in the next day's The commenter stated that they never had an opportunity to review the cost report prior to submission to verify the information was accurate and that they believe this is a common occurrence across the country. documents in the last year, 1407 The Oncologist. March 2011 Report to the Congress: Medicare Payment Policy, Chapter 11: Hospice. March 15, 2011. For example, Type 1 burdensome transitions may arise from a deficiency in advance care planning to prevent hospitalizations or a discharge process that does not appropriately identify a hospice patient whose conditions are stabilized prior to discharge.[26]. This measure does not recognize visits during CHC and GIP because these higher levels of care inherently require skilled visits per the COPs in accordance with 418.110 and 418.302. The provision of care would proportionately escalate to meet the increased clinical, emotional, and other needs of the patient and family. We also proposed to remove multiple measures thus leading to a net decrease of total measures. [19] 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? A service intensity add-on payment will be made for the social worker visits and nursing visits provided by a registered nurse (RN), when provided during routine home care in the last 7 days of life. The final rule also finalizes a Home Health Quality Reporting Program (HH QRP) policy that becomes effective on October 1, 2021, to prepare for public reporting beginning in January 2022. Stakeholders were generally supportive of a quality measure based on multiple indicators using claims data for public reporting. Additionally, for the duration of the PHE, we expect that it would be up to the clinical judgment of hospice as to whether such technology can meet the patient's/caregiver's/family's needs and the use of technology should be included on the plan of care for the patient and family. Variability analyses confirmed that HCI demonstrates sufficient ability to differentiate hospices. Before sharing sensitive information, make sure youre on a federal government site. Accordingly, we have prepared a RIA that, to the best of our ability presents the costs and benefits of the rulemaking. Over 93 percent of hospices remain in the same quintile, suggesting that the ranking of hospices is fairly stable between the SPR and CAR scenarios. As stated in section 1814(i)(5)(E) of the Act, we establish procedures for making all quality data submitted by hospices under 418.312 available to the public. Local, state, and federal government websites often end in .gov. We proposed that direct patient care benefits costs for CHC are equal to Worksheet B, column 3, line 50, for RHC are equal to Worksheet B, column 3, line 51, for IRC are equal to Worksheet B, column 3, line 52, and for GIP are equal to Worksheet B, column 3, line 53. (For a copy of this bulletin, we refer readers to the following website: https://www.whitehouse.gov/wp-content/uploads/2020/03/Bulletin-20-01.pdf). In the FY 2017 Hospice Wage Index and Payment Rate Update final rule (81 FR 52143), we stated that we would continue CAHPS reporting with eight rolling quarters on an ongoing basis. The specifications for Indicator Two, Gaps in Skilled Nursing Visits, are as follows: Prior work has identified various concerning patterns of live discharge from hospice. The supervising RN then determines the scope of the competency testing required, which may include a full competency testing of all skills if warranted, such as when multiple areas of deficient practice are noted. After the data extract is created after the 90-day run-off, it takes several months to incorporate other data needed for the calculations. As stated, data source and timing will allow time for hospices to preview their measure scores before they are publicly reported. This license will terminate upon notice to you if you violate the terms of this license. (2013). Fewer hospices, 2,328 (46.2 percent), would have had 30+ completes if 4 quarters of data were used to calculate scores and 1,970 (39.1 percent) would have 30+ completes if 3 quarters were used to calculate scores. The specifications for Indicator Six, Burdensome Transitions Type 2, are as follows: Estimates of per-beneficiary spending are endorsed by NQF (#2158)[29] IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN. Since its implementation on October 1, 2020, CMS has received additional inquiries from stakeholders asking for clarification on certain aspects of the addendum. We also solicited comments on the proposal to add the HCI to the program for public reporting beginning no earlier than May 2022. 40. In fact, these findings were one of the primary reasons we have transitioned from Hospice Compare and the other individual compare sites to Care Compare. Kehl, K.A., et al. We then need to generate and check the calculations before posting for confidential reporting. For each hospice, we divide the number of live discharges that occur on or after the 180th day of hospice by the number of live discharges. On March 13, 2020, the President declared a national state of emergency under the Stafford Act, effective March 1, 2020, allowing the Secretary to invoke section 1135(b) of the Act (42 U.S.C. Response: We appreciate that the presentation of the seven HIS measures helped consumers understand the content of the HIS Comprehensive Measure. The overall economic impact of this final rule is estimated to be $480 million in increased payments to hospices for FY 2022. As a few commenters noted, Each hospice is afforded the opportunity to achieve excellent ratings on the CAHPS Hospice Survey. 2. Index Earned Point Criterion: Hospices earn a point towards the HCI if their individual hospice score for percentage of decedents receiving a visit by a skilled nurse or social worker in the last 3 days of life falls above the 10th percentile ranking among hospices nationally. This indicator includes both RN and LPN visits to recognize the frequency of skilled nursing visits and to maintain consistency in HCI when using revenue center code 055X. We invited public comment on the following: While we stated that we would not be responding to specific comments submitted in response to this RFI in the FY 2022 Hospice Wage Index final rule, we appreciate all of the comments and interest in this topic. Third, we are finalizing our proposal to calculate claims-based measure scores based on one or more years of data. 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. The final rule (CMS-1754-F) can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/current. L. 79-404), 5 U.S.C. While CMS agrees that all patient visits are meaningful, based on our analyses, we found that RN and medical social worker visits correlate well with the CAHPS quality measures for would recommend the hospice. We stated that when the request is within 5 days from the date of a hospice election, and the patient elects hospice on December 1st and requests the addendum on December 3rd, the hospice would have until December 8th to furnish the addendum (86 FR 19724), making December 1st as day zero in this example. Specifications for the HCI Indicators Selected, (1). In order to accommodate the exception of 2020 Q1 and Q2 data, we are proposing to resume public reporting using 3 out of 4 quarters of data for the January 2022 refresh. Comment: We received several comments with a request for CMS to consider quarterly as opposed to annual reporting of claims-based measures to best support continuous quality improvement activities. We received a few comments on this policy. Section 1814(i)(5)(D)(iii) of the Act requires that the Secretary publish selected measures applicable with respect to FY 2014 no later than October 1, 2012. The great majority of hospitals and most other health care providers and suppliers are small entities by meeting the Small Business Administration (SBA) definition of a small business (in the service sector, having revenues of less than $8.0 million to $41.5 million in any 1 year), or being nonprofit organizations. We also proposed to exclude those providers whose CHC compensation costs were greater than total CHC costs. 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. We appreciate commenters' concern for provider and vendor burden in implementing a new tool and encourage all key stakeholders to continue to stay informed and engaged through the HQRP Forums, Quarterly Updates, and listserv notifications. The hospice wage index for FY 2022 is effective October 1, 2021 through September 30, 2022. 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. Response: While these comments are out of scope of the proposed rule, we appreciate and welcome all feedback related to the late penalty; ABN and expansion of the addendum; signatures; exceptional circumstances; and educating hospice providers.