Clustering methodology assigns cut points by minimizing differences within star categories and maximizing differences across star categories. (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. One commenter also stated that they were interested in how the percentage of hospices that operate inpatient facilities can be increased and all costs, including contracted costs, can be included. Nursing services require initial and ongoing assessment of patient family needs to ensure the successful preparation, implementation, and refinements for the plan of care. Response: We will post an updated model election statement addendum on the Hospice web page,[7] For a measure composed of multiple items, the hospice-level measure score would be the average of the hospice-level scores for each item within the measure. Response: We thank all the commenters for their thoughtful suggestions and feedback related to future of quality measure development for the HQRP. We believe that this transition was sufficient in order to mitigate the resulting short-term instability and negative impacts on certain providers after the implementation of the new OMB labor market delineations. One commenter suggested that we should identify the key 1 or 2 questions in each survey domain and use them instead. The sixth column shows the effect of all the proposed changes on FY 2022 hospice payments. Numerator: The total number of live discharges from the hospice occurring on or after 180 days of enrollment in hospice within a reporting period. The FY 2022 RHC rates are shown in Table 2. The estimated compensation costs related to medical supply and pharmacy costs would be reflected in the Other Patient Care Salaries, Overhead Salaries, and Overhead Benefits categories. 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. l92d12$XOxaI#J^00Lh[Ty This rule also removes seven individual Hospice Item Set (HIS) measures because a more broadly applicable measure, the Hospice Comprehensive Assessment Measure (NQF # 3235), for the particular topic is available and already publicly reported. They also requested that Care Compare provide information to users explaining that the published data included pre-COVID quarters. Additionally, we are finalizing as proposed at 418.3 the definitions of pseudo-patient and simulation. These results serve as evidence of the measure's reliability by indicating that a hospice's HCI scores would not normally fluctuate a great deal from one year to the next. [3] (1) If the addendum is requested within the first 5 days of a hospice election (that is, in the first 5 days of the hospice election date), the hospice must provide this information, in writing, to the individual (or representative), non-hospice provider, or Medicare contractor within 5 days from the date of the request. These salaries reflecting all levels of care are reported on Worksheet A, column 1, lines 38 through 46 and then are further disaggregated for CHC, RHC, IRC, and GIP on Worksheets A-1, A-2, A-3, and A-4, respectively, on column 1 (salaries), lines 38 through 46. We noted in the FY 2021 Hospice Wage Index & Payment Rate Update final rule that because the beneficiary signature is an acknowledgement of receipt of the addendum, this means the beneficiary would sign the addendum when the hospice provides it, in writing, to the beneficiary or representative (85 FR 47092). We recognize that there are many regional variations in care delivery trends. [19] Therefore using 3 quarters of data for the HIS Comprehensive Assessment Measure would achieve acceptable reportability shown in Table 14. 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. (b) 40660 The SIA Claim may cover up to the last seven days of life and include the date of death. In that memo, which applies to HIS and CAHPS Hospice Survey, CMS granted an exemption to the HQRP reporting requirements for Quarter 4 (Q4) 2019 (October 1, 2019 through December 31, 2019), Quarter 1 (Q1) 2020 (January 1, Start Printed Page 425782020 through March 30, 2020), and Quarter 2 (Q2) 2020 (April 1, 2020 through June 30, 2020). (2010). Response: Our proposal to update annually reflects our understanding that claims measures reflect business practices that are slow to change. The overhead salaries includes those reported in the staff transportation cost center (reported in Worksheet A, column 1, line 12) and the overhead benefits for the staff transportation cost center (Worksheet B, column 3, line 12). Likewise, the proposal to publicly report the claims-based HVLDL quality measure would not result in reduced provider burden and related costs. At the same time, reporting claims-based measures does require additional labor. 51. This rule rebases the hospice labor shares and clarifies certain aspects of the hospice election statement addendum requirements. Index Earned Point Criterion: Hospices earn a point towards the HCI if their individual hospice score for Type 2 burdensome transitions falls below the 90th percentile ranking among hospices nationally. Response: The exclusion criteria used for HVWDII and now HVLDL criteria remain the same. Comment: We received several comments out of scope of the proposal suggesting CMS allow for use of the spiritual care HCPCS code approved for Veteran Administration use. These comments also suggested including these disciplines in future claims-based measures to recognize the multi-disciplinary nature of hospice care. Since its implementation on October 1, 2020, CMS has received additional inquiries from stakeholders asking for clarification on certain aspects of the addendum. 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. To address the inclusion of administrative data, such as Medicare claims used for hospice claims-based measures like the HVLDL and HCI in the HQRP and correct technical errors identified in the FY 2016 and 2019 Hospice Wage Index and Payment Rate Update final rules, we proposed and finalize in this rule the regulation at 418.312(b) by adding paragraphs (b)(1) through (3). better and aid in comparing the online edition to the print edition. Medicare fee-for-service (FFS) hospice claims with through dates on and between October 1, 2016 and September 30, 2019 to determine information such as hospice days by level of care, provision of visits, live discharges, hospice payments, and dates of hospice election. documents in the last year, 29 CY 2022 data submissions compliance impacts FY 2024 APU. 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. Section 418.312(b)(3) would include the eight measure removal factors as follows: CMS may remove a quality measure from the Hospice QRP based on one or more of the following factors: (1) Measure performance among hospices is so high and unvarying that meaningful distinctions in improvements in performance can no longer be made. CAHPS Hospice Survey to examine alignment between the survey outcomes and the HCI. The MCR captures total overhead costs (including but not limited to administrative and general, plant operations and maintenance, and housekeeping) attributable to each of the four levels of care. In this final rule, we made correcting amendments to 42 CFR 418.312 to correct technical errors identified in the FY 2016 Hospice Wage Index and Payment Rate Update final rule. The labor shares showing the revised methodology are provided in Table 1. Response: Although Care Compare already notes that for Hospice CAHPS the user is comparing . 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. While hospice is not included in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act of 2014) (Pub. NQF #1617 Patients Treated with an Opioid who are Given a Bowel Regimen, NQF #1647 Beliefs/Values Addressed (if desired by the patient). We established our HH QRP Public Display Policy in the CY 2016 HH PPS final rule (80 FR 68709 through 68710). of delivery would work best in furnishing the addendum. daily Federal Register on FederalRegister.gov will remain an unofficial The HIS V3.00 became effective on February 16, 2021 and expires on February 29, 2024; OMB control number 0938-1153. Finally, some commenters recommended both removing the seven individual HIS process measures and retiring the HIS Comprehensive Assessment measure. One commenter stated that there are no checks and balances on whether cost reporting data are accurate. How do you currently share information with other providers and are there specific industry best practices for integrating SDOH screening into EHR's? The HCI will add value to the HQRP by filling measurement gaps using existing data sources. In the FY 2019 Hospice Wage Index and Rate Update final rule (83 FR 38622), we also adopted an eighth factor for removal of a measure. We proposed allowing the hospice to furnish the addendum within 5 days from the date of a beneficiary or representative request, if the request is within 5 days from the date of a hospice election. On April 6, 2020, we published an interim final rule Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (85 FR 19230). http://medpac.gov/docs/default-source/reports/mar20_medpac_ch12_sec.pdf. Other commenters expressed concern that the HCI indicators do not take patient preferences into account, and that the HCI might incentivize hospices to standardize the types and amount of services provided rather than considering personal patient circumstances. [33] We stated that in some instances, this may mean that the hospice must furnish the addendum prior to completion of the comprehensive assessment. endstream endobj 600 0 obj <. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. Results for both HCI and HVLDL indicate that using 2 years of data increases reportability. Indeed, they noted that Questions such as How often did your family member get the help he or she needed for trouble breathing or How often did your family member get the help he or she needed for constipation are difficult for family members to answer if their loved one did not experience issues with those symptoms.. At this time, the HCPCS code for spiritual care is not used on the hospice claim form (no revenue center exists to correspond to such code), and as such, cannot be applied to the HCI. Others noted that the delay could allow time for additional analysis of the measure, and for more transparency about the rationale for it. The comments pointed out that the process for providers to adapt to the new tool requires at least 6 months or more. documents in the last year, 24 Live discharges occur when the patient discharge status code does not equal a value from the following list: 30, 40, 41, 42, 50, 51. Our analyses suggest that the scoring criteria ensure distributions of HCI scores that allow for differentiation between hospices in any given year. We define a hospice stay by a sequence of consecutive days for a particular beneficiary that are billed under the hospice benefit. To sign up for updates or to access your subscriber preferences, please enter your contact information below. In particular, claims do not fully capture patients' clinical conditions, patient and caregiver preferences, or hospice activities such as telehealth, chaplain visits, and specialized services such as massage or music therapy. Several commenters noted the potential for overlap in quality measures from HOPE and HCI or future measures. They stated that the number of hospices that do not pass level 1 edits is also of concern. FY 2020 Hospice Wage Index and Payment Rate Update Final Rule, 12. One commenter stated that their hospice revisited the way relatedness is defined, and realized that many diagnoses that were previously thought to be unrelated were related. Indicator Seven: Per-Beneficiary Medicare Spending, (8). The remaining subject areas may be evaluated through written examination, oral examination, or after observation of a hospice aide with a patient or a pseudo-patient during a simulation. The ten indicators, aggregated into a single HCI score, convey a broad overview of the quality of the provision of hospice care services and validates well with CAHPS Willingness to Recommend and Rating of this Hospice. 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. Thus, we will publicly report claims data for care delivered in Q4 2019 and Q3 2020 onward, but we will not publicly report claims data for care delivered Q1 and Q2 of 2020. CMS issued a final rule, CMS-1629-F, which created two routine home care daily payment rates. Fast Healthcare Interoperability Resources (FHIR) in Support of the Hospice Quality Reporting Program RFI. We also proposed to exclude those providers whose CHC compensation costs were greater than total CHC costs. Comment: Another specific concern stated by the commenters was that the determination of the labor share for GIP and IRC is based on Worksheet A-3 and A-4; however, any hospices reporting costs on line 25 (contracted services) were not included in the sample used for setting the labor share.
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