NHPCO has prepared the FY 2022 MEDICAID Hospice State/County Rate charts with the rates for every county in every state in the country for all levels of care, for use by NHPCO members. For certain claims-based measures, we will use three quarters rather than four quarters of data for refreshes between January 2022 and July 2024. This publicly reported information currently includes diagnoses, location of care, and levels of care provided. One commenter opposed the proposed labor shares, stating that the data in the cost report do not provide adequate or appropriate measures of labor expenses. The calculation of the last three days remain unchanged from the last three days documented in Section O of the HIS V2.00 that was used to calculate the HVWDII. NQF 3235 does not require NQF's endorsements of the previous components to remain valid. This additional information includes hospices' beneficiary characteristics such as the percentage of patients enrolled in Medicare Advantage. For more information about HQRP Requirements, please visit the frequently-updated HQRP website and especially the Best Practice, Education and Training Library, and Help Desk web pages at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Start Printed Page 42577Quality-Reporting. informational resource until the Administrative Committee of the Federal [19] We measure whether a live discharge occurs on or after the 180th day of hospice by looking at a patient's lifetime length of stay in hospice. The 4 quarters included are the most recent data that have gone through Review and Correct processes, have been issued in a provider preview report, and have time allotted for addressing requests for data suppression before being publicly reported. To maintain budget neutrality, as required under section 1814(i)(6)(D)(ii) of the Act, the new RHC rates were adjusted by a service intensity add-on budget neutrality factor (SBNF). Finally, CMS is providing updates regarding its development of a new Hospice Outcome and Patient Evaluation (HOPE) assessment instrument. Response: We appreciate the commenters highlighting the use of pseudo-patients and simulation techniques in other healthcare setting and agree that the use of these techniques is standard of practice in many formal nursing assistant programs. 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. As we prepare to update Care Compare for the removal of the seven measures, we will consider ways to make consumers of Care Compare aware of this additional data, if they are interested in viewing them. for better understanding how a document is structured but We communicated this in a Public Reporting Tip Sheet, which is located at: https://www.cms.gov/files/document/hhqrp-pr-tip-sheet081320final-cx-508.pdf. The hospice wage index for FY 2022 is effective October 1, 2021 through September 30, 2022. As a result of the changes mandated by Division CC, section 404 of the CAA 2021, we proposed conforming regulation text changes at 418.309 to reflect the new language added to section 1814(i)(2)(B) of the Act. Denominator: The number of beneficiaries with at least 1 day of hospice during the last 3 days of life within a reporting period. We also required that IRC direct patient care salaries and contract labor costs per day would be greater than 1. We noted this revised statutory requirement in our proposed rule (86 FR 19726) and are codifying the revision at 418.306(b)(2). Several commenters noted the potential for overlap in quality measures from HOPE and HCI or future measures. While we stated that we would not be responding to specific comments submitted in response to this Request for Information in the FY 2022 Hospice Wage Index final rule, we will actively consider all input as we develop future regulatory proposals or future sub-regulatory policy guidance. 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). Some commenters were concerned about the comparative nature of CAHPS star ratings and a few called for an alternative methodology that would rate hospices against a benchmark. We previously finalized a one-time newness exemption for hospices that meet the criteria as stated in the FY 2017 Hospice Wage Index and Payment Rate Update final rule (81 FR 52181). (2013). The rest of this section presents the component indicators and their specifications. A summary of these comment and our responses to those comments appear below: Comment: We received several comments objecting to the increase in the percentage penalty for failure to provide quality reporting data. Under the Administrative Procedure Act (APA) (5 U.S.C. The documents posted on this site are XML renditions of published Federal Teno J.M., Bowman, J., Plotzke, M., Gozalo, P.L., Christian, T., Miller, S.C., Williams, C., & Mor, V. (2015). This repetition of headings to form internal navigation links Comment: Some commenters stated that the measure specifications would not adequately capture hospices' care activities. We will evaluate and consider any future changes to the hospice cost report that will allow for the collection of data that may improve the calculation of the hospice labor shares. 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. Collection or public reporting of a measure leads to negative unintended consequences; or. Response: We thank the commenter for these recommendations. documents in the last year, by the Environmental Protection Agency The commenter stated that they believe their patients and their representatives would welcome this option; however, it is unclear whether mailing the form is acceptable for CMS. Providing information for decision-making is all the more important during and in the wake of a COVID-19 PHE, when our health as a nation has been shaken. We agree that permitting competency testing of hospice aides utilizing a pseudo-patient will support patient privacy while also assuring a competently trained hospice aide workforce that provide high quality patient care. 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]. Thus, we proceeded with including Q4 2019 data in measure calculations for the October 2020 refresh. 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. Along with nine HIS-based quality measures, the CAHPS Hospice Survey measures are publicly reported on a designated CMS website that is currently Care Compare. Since the HIS Comprehensive Assessment Measure is a composite of the seven HIS process measures, the burden and requirement to report the HIS data remain unchanged in the time, manner, and form finalized in the FY 2017 Hospice Wage Index and Rate Update final rule (81 FR 52144). The current labor shares did not reflect this differential in utilization as the same labor share was used for both levels of care. We will continue to monitor the HIS Comprehensive Assessment Measure performance and consider if removal or refinements would be appropriate in the future. One commenter suggested that we should identify the key 1 or 2 questions in each survey domain and use them instead. Specifically, we required the following costs to be greater than zero: Fixed capital costs (Worksheet B, column 0, line 1), movable capital costs (Worksheet B, column 0, line 2), employee benefits (Worksheet B, column 0, line 3), administrative and general (Worksheet B, column 0, line 4), volunteer service coordination (Worksheet B, column 0, line 13), pharmacy and drugs charged to patients (sum of Worksheet B, column 0, line 14 and Worksheet A, column 7, line 42.50), registered nurse costs (Worksheet A, column 7, line 28), medical social service costs (Worksheet A, column 7, line 33), hospice aide and homemaker services costs (Worksheet A, column 7, line 37), and durable medical equipment (Worksheet A, column 7, line 38). In response to the COVID-19 Public Health Emergency (PHE), CMS issued a number of regulatory waivers in order to support providers and suppliers involved in patient care. Commenters encouraged CMS to only utilize certain aspects of standardized data elements for patient assessment (specifically, Z-codes 55-65) in collecting health equity data. Comment: Several comments suggested that CMS differentiate circumstances in which a patient refused a service measured by the HCI from circumstances in which the hospice did not offer the service to the patient. Email | Under the CAR scenario, the January 2022 refresh data would cover Q3 and Q4 of 2020 and Q1 of 2021, which occur during the flu season. Recommendations to minimize the information collection burden on the affected public, including automated collection techniques. The claims-based measures will utilize eight quarters of data in order to have a larger population for publicly report on small providers, thereby more hospices will be available for consumers to compare. Each HCI indicator is scored based on comparative performance, with hospices receiving a point based on their performance relative to a national percentile threshold. Because the HCI relies on claims data that are already collected by CMS, reporting claims-based measures places no additional burden for hospice providers or other stakeholders. For HIS-based measures, we used quarters Q1 through Q4 2019. a. Revising paragraphs (c) introductory text and (c)(9); c. Redesignating paragraphs (d) through (g) as paragraphs (e) through (h); and. They also requested clarification on the logistics of the reporting processin particular, when specifications would be available. Closing the Health Equity Gap in the Hospice Quality Reporting Program Request for Information (RFI). Many commenters noted a 2019 Abt Associates and RAND Corporation study which excluded hospices from the standardized data elements for patient assessment denominator, citing that hospice patients have a different goal of care which does not align with standardized data elements for patient assessment. We will continue to take all concerns, comments, and suggestions into account as we continue work to address and develop policies on this important topic. Because of the data freeze, HVWDII Measure 1 data from the November 2020 refresh, covering HIS admissions during Q1 through Q4 2019, will be publicly displayed for all calendar year 2021 refreshes. The next four quarters would be Q3 2020 and Q2, Q3, and Q4 of 2019that is, past quarters adding up to eight quarters but omitting Q1 and Q2 of 2020, which were exempt from quality reporting (please see section 10.b. documents in the last year, by the Food Safety and Inspection Service Thus, we do not anticipate service refusals to be concentrated among particular hospices, and as such do not expect refused visits to have an outsized effect on any hospice's performance on this measure. This final rule also updates payment rates for each of the categories of hospice care, described in 418.302(b), for FY 2022 as required under section 1814(i)(1)(C)(ii)(VII) of the Act. Consultant specialty services, when necessary for the palliative care and management of the terminal illness (e.g., radiation for pain relief), are covered separately and are reimbursed only to the elected hospice. We identify the dates of RHC service by the corresponding revenue center date (which identifies the first day of RHC) and the revenue center units (which identifies the number of days of RHC (including the first day of RHC)). o2+XXH3H3'@ cM Since the HIS Comprehensive Assessment Measure captures all seven processes collectively, we believe that public display of the individual component measures is not necessary. MedPAC reported that nearly half of Medicare hospice expenditures are for patients that have had at least 180 or more days on hospice, and expressed a concern that some programs do not appropriately discharge patients whose medical condition makes them no longer eligible for hospice services, or, that hospices selectively enroll patients with non-cancer diagnoses and longer predicted lengths of stay in hospice. 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 hospice wage index utilizes the wage adjustment factors used by the Secretary for purposes of section 1886(d)(3)(E) of the Act for hospital wage adjustments. If we were to provide preview data a year in advance, the publicly reported data would be too old to be a meaningful reflection of the hospice's performance. 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. has no substantive legal effect. Comment: Many commenters stated that focusing the competency training on specific deficient skills provided greater efficiency for hospices. To calculate the percentage, for each hospice we divided the number of live discharges that are followed by a hospitalization (within 2 days of hospice discharge) and then the patient dies in the hospital in a given FY by the number of live discharges in that same reporting period. The third column shows the effect of using the FY 2022 updated wage index data. In addition, the overall reliability of the CAHPS scores would decline with fewer quarters of data. It is our hope to provide additional stratified information to providers related to race and ethnicity if feasible. The HCI indicators will be available by visiting the Provider Data Catalog at https://data.cms.gov/provider-data/topics/hospice-care. The commenters recommended that CMS look further into reporting all pharmacy and medical supply costs as direct patient care costs on future cost reports. [50] [20] This rule provided individuals and entities that provide services to Medicare beneficiaries needed flexibilities to respond effectively to the serious public health threats posed by the spread of COVID-19. We will continue to take all concerns, comments, and suggestions into account as we consider Fast Healthcare Interoperability Resources (FHIR) in support of Digital Quality Measurement in Post-Acute Care Quality Reporting Programs. The HCI uses information from all ten indicators to collectively represent a hospice's ability to address patients' needs, best practices hospices should observe, and/or care outcomes that matter to consumers. These comments also suggested including these disciplines in future claims-based measures to recognize the multi-disciplinary nature of hospice care. 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