Table 22 and Table 23 summarize the comparison between the original schedule for public reporting with the revised schedule (that is, frozen data) and also with the proposed public display schedule under the CAR scenario (that is, using 3 quarters in the January 2022 refresh), for OASIS- and claims-based measures respectively. When deficient aide skills are noted during a supervisory visit, the RN determines the deficient skills and all related skills that may be impacted. [3] We note that any future revisions to the hospice labor shares will be proposed and subject to public comments in future rulemaking. We will publicly report the HVLDL no earlier than May 2022. We use four rolling quarters of data to publicly display Home Health Care Consumer Assessment of Healthcare Providers and Systems (HH CAHPS) Survey measures on Care Compare. Medicare hospice: Use of general inpatient care. Claims are a rich and comprehensive source of many care processes and aspects of health care utilization. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. http://medpac.gov/docs/default-source/reports/mar20_medpac_ch12_sec.pdf. The commenter also claimed that if it is based on no days being reported as contracted on Worksheet S-1, this assumption is also in error. establishing the XML-based Federal Register as an ACFR-sanctioned for CMS to publicly report, or a requirement included in the hospice CoPs. We stated that we would continue to expect that the hospice would note the date furnished in the patient's medical record and on the addendum, if the hospice has already completed the addendum, as well as an explanation in the patient's medical record noting that the patient died, revoked, or was discharged prior to signing the addendum (86 FR 19725). Comment: One commenter stated that given the inherent differences in the provision of the hospice benefit between different types of hospice providers, they would recommend that CMS monitor any significant disparities in the distribution of labor and non-labor inputs across the hospice industry by program characteristics. Because we excepted HHAs from the HH QRP reporting requirements for Q1 and Q2 2020, we did not use OASIS, claims, or HH CAHPS data from these quarters. Comment: One commenter recommended CMS broaden its view of nurses to include licensed practical nurses (LPNs) for conducting aide supervisory visits. Comment: Several comments requested that CMS clarify how the last three days of life would be calculated. Final Decision: We are finalizing the proposal to add composite HCI measures to the HQRP as of FY 2022 and will monitor the measure. For purposes of the RFA, we consider all hospices as small entities as that term is used in the RFA. While we stated in the FY 2020 Hospice Wage Index and Payment Rate Update final rule, that if the beneficiary requests the election statement addendum at the time of hospice election but dies within 5 days, the hospice would not be required to furnish the addendum as the requirement would be deemed as being met in this circumstance (84 FR 38521), this policy was not codified in regulation. (2014). Hospice PUF data are available for CY 2014 through CY 2016. Final Decision: We are finalizing as proposed to publicly report the HCI and HVLDL beginning no earlier than May 2022, and to include it in the Preview Reports no sooner than the May 2022 refresh. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues: We are revising the provisions at 418.306(b)(2) to change the payment reduction for failing to meet hospice quality reporting requirements from 2 to 4 percentage points. documents in the last year, 125 (2013). This indicator identifies whether a hospice is above the 10th percentile in terms of the average number of skilled nursing minutes provided on RHC days during the reporting period examined. Final Rule Action: We are finalizing as proposed at 418.76(c)(1) our policy that hospices may conduct competency testing by observing an aide's Start Printed Page 42552performance of the task with a patient or pseudo-patient. A gap of at least 1 day without hospice ends the sequence. A hospice is awarded a point for meeting each criterion for each of the 10 indicators. Information defining the last three days has been included in the HIS Manuals since 2017. Background: COVID-19 Public Health Emergency Temporary Exemption and Its Impact on the Public Reporting Schedule, (2). We are revising the hospice aide requirements to allow the use of the pseudo-patient for conducting hospice aide competency evaluations. The Department may not cite, use, or rely on any guidance that is not posted Use the QPS tool and search for NQF number 2651. daily Federal Register on FederalRegister.gov will remain an unofficial Those changes and their respective histories and background information are discussed in the rule. Denominator: The total number of all live discharge from the hospice within a reporting period. This indicator identifies whether a hospice is below the 90th percentile in terms of how often hospice stays of at least 30 days contain at least one gap of eight or more days without a nursing visit. This helps hospices apply quality improvement processes to continue improving their performance on the HIS Comprehensive Assessment Measure. [343536] Physical symptoms of actively dying can often be identified within three days of death in some patients.[37]. This indicator reflects hospice live discharge followed by hospitalization within 2 days with the patient dying in the hospital, referred to as Type 2 burdensome transitions. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. The commenters stated that many of these hospices providers have some of the best accounting records in the industry and the proposed methodology for calculating the labor components eliminates the costs of these facilities from consideration. Many commenters noted that there is a great deal of variation among FHIR systems, which could impede the adoption of a standard system across hospices. The stars would range from one star (worst) to five stars (best). The specifications for Indicator Seven, Per-Beneficiary Medicare Spending, are as follows: Medicare Hospice CoPs require a member of the interdisciplinary team to ensure ongoing assessment of patient and caregiver needs. (2020). Our analyses showed that the HCI as currently defined does differentiate between hospices, as the range of HCI scores across hospices was found to be sufficiently large to highlight very high performing hospices, as well as identify the need for improvement in others. from 40 agencies. 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. The ADA is a third-party beneficiary to this Agreement. 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). Indicator Six: Burdensome Transitions (Type 2)Live Discharges From Hospice Followed by Hospitalization With the Patient Dying in the Hospital, (7). Accessible via: http://www.medpac.gov/docs/default-source/reports/Mar09_Ch06.pdf?sfvrsn=0. Response: We appreciate the commenters' concerns on the accuracy of the IRC and GIP cost data on the MCR. As required by OMB Circular A-4 (available at https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/circulars/A4/a-4.pdf), in Table 26, we have prepared an accounting statement showing the classification of the expenditures associated with the provisions of this final rule. A pseudo-patient must be capable of responding to and interacting with the hospice aide trainee, and must demonstrate the general characteristics of the primary patient population served by the hospice in key areas such as age, frailty, functional status, cognitive status and care goals. These lines include Medical Social Services (line 33), Spiritual Counseling (line 34), Dietary Counseling (line 25), and Counseling Other (line 36). However, providers with substantially higher percent of live discharge than their peers could signal a potential concern with quality of care or program integrity. Their response confirmed our understanding that the data included in HCI will be useful for patients and families as they compare and select hospice providers. Both the use of the pseudo-patient and targeted aide training align requirements between these two providers, home health and hospice, affording the opportunity for efficiency in implementation for many agencies that are Medicare certified to provide both services. We believe that this will benefit the hospice and the patient by allowing new aide trainees and aides requiring remedial training and competency testing to begin serving patients more quickly while protecting patient health and safety. Some commenters questioned whether services provided by LPNs would be accounted for in the HCI indicators and many commenters requested that CMS clarify whether code 055X would be further differentiated between RN visits versus LPN visits for the indicators. We make that assumption instead of looking at the visits directly because Medicare does not require hospices to record all visits on the claim for the GIP level of care. Section 418.76 is amended by revising paragraphs (c)(1) and (h)(1)(iii) to read as follows: (1) The competency evaluation must address each of the subjects listed in paragraph (b)(3) of this section. Regarding the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey, CMS finalized a policy that hospices that receive their CMS Certification Number (CCN) after January 1, 2017 for the FY 2019 Annual Payment Update (APU) and January 1, 2018 for the FY 2020 APU will be exempted from the Hospice CAHPS requirements due to newness (81 FR 52182). We will include state average scores to further ensure any regional differences in the impact of the Start Printed Page 42582COVID-19 PHE on hospices are captured for consumers. We received several on the transition to iQIES. 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. Effective Federal Fiscal Year 2023 (October 1 - September 30), there were no counties that changed their status, CBSA name and/or CBSA number. We identify RHC days by the presence of revenue code 0651 on the hospice claim. We refer the public to the FY 2017 Hospice Wage Index and Payment Rate Update final rule (81 FR 52144) for a detailed discussion. Response: As stated previously, we recommend that hospices use data from their vendors for quality improvement, rather than wait for publicly-reported data. Section III.E makes permanent selected regulatory blanket waivers that were issued to Medicare-participating hospice agencies during the COVID-19 PHE. documents in the last year, by the National Oceanic and Atmospheric Administration documents in the last year, 29 The President of the United States manages the operations of the Executive branch of Government through Executive orders. This rule takes effect October 1, 2021. Section 418.306 is amended by revising paragraph (b)(2) to read as follows: (2) For fiscal years 2014 and through 2023, in accordance with section 1814(i)(5)(A)(i) of the Act, in the case of a Medicare-certified hospice that does not submit hospice quality data, as specified by the Secretary, the payment rates are equal to the rates for the previous fiscal year increased by the applicable hospice payment update percentage increase, minus 2 percentage points. Thirty-one unique stakeholders submitted their comments on the proposed clarifications to the election statement addendum. The AMA does not directly or indirectly practice medicine or dispense medical services. the Medicare Payment Advisory Commission,[414243] by peer reviewed articles, and our technical expert panel (TEP). Furthermore, we believe 3 calendar days, rather than 3 business days continues to be appropriate, as hospice care is provided around the clock rather than only during business days and hours. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen. If the beneficiary (or representative) refuses to sign the addendum, the hospice must document on the addendum the reason the addendum was not signed and the addendum would become part of the patient's medical record. 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. To calculate the reliability results, we restricted the HHAs included in the SPR Scenario to those included in the CAR Scenario.Start Printed Page 42594. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. The FY 2022 hospice payment updates also include an update to the statutory aggregate cap amount, which limits the overall payments per patient that are made to a hospice annually. We appreciate all the comments and interest in this topic. To locate a nursing facility's reimbursement rate sheet for an individual living in a nursing facility, go to https://dch.georgia.gov/providers/provider-types/nursing-home-providers. 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. That is, how do hospices define what is unrelated to the terminal illness and related conditions when establishing a hospice plan of care. to the Medicare Learning Network (MLN) Connects Newsletter and Other Program-Specific Listserv Recipients,[49] Identification of the beneficiary's terminal illness and related conditions; 5. 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).
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