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. Chapter 12: Hospice Services. Drawing on lessons learned through research and stakeholder feedback, Care Compare includes features and functionalities that appeal to Hospice Compare consumers. The results for HCI similarly show that the hospices with reportable data when using two-pooled years of data had lower HCI scores compared to the national average when using just FY 2019 data. (2010). As discussed in the FY 2016 Hospice Wage Index and Rate Update final rule (80 FR 47172), we implemented two different RHC payment rates, one RHC rate for the first 60 days and a second RHC rate for days 61 and beyond. Because the reclassification provision and the hospital rural floor applies only to hospitals, and not to hospices, we continue to believe the use of the pre-floor and pre-reclassified hospital wage index results in the most appropriate adjustment to the labor portion of the hospice payment rates. Hospice payments per beneficiary are determined by summing together all payments on hospice claims for a particular reporting year for a particular hospice. For example, if County A has a pre-floor, pre-reclassified hospital wage index value of 0.3994, we would multiply 0.3994 by 1.15, which equals 0.4593. For example, FY 2019 covers claims with dates of services on or between October 1, 2018 and September 30, 2019. Claims data are considered a reliable source of standardized data about the services provided, because providers must comply with Medicare payment and claims processing policy. Therefore, we proposed conforming regulations text changes at 418.24(c) to reflect this policy. Any potential health equity data collection or measure reporting within a CMS program that might result from public comments received in response to this solicitation would be addressed through a separate notice-and-comment rulemaking in the future. The commenters stated that certain costs are not consistently reported by hospices despite these costs being in compliance with cost reporting instructions. As discussed in the FY 2017 Hospice Wage Index and Payment Rate Update final rule (81 FR 52183), CMS requires at least 4 quarters of data to establish the scientific acceptability for our HIS-based quality measures. The commenter stated that the contracted payments for Medicare Directors are not included in the proposed calculation of overhead salaries. 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. Based on IHS Global, Inc.'s more recent forecast of the inpatient hospital market basket update and the productivity adjustment, the hospice payment update percentage for FY 2022 will be 2.0 percent for hospices that submit the required quality data and 0.0 percent (FY 2022 hospice payment update of 2.0 percent minus 2.0 percentage points) for hospices that do not submit the required data. While comments were overwhelmingly supportive, we did not receive any comments that would support burden changes. The index design of the HCI simultaneously monitors all ten indicators. As discussed previously, we are finalizing our proposal to publicly report the HCI and HVLDL using 2 years, which is 8 quarters of Medicare claims data. (2) The APU is subsequently applied to FY payments based on compliance in the corresponding Reporting Year/Data Collection Year. This change will allow the hospice to focus on the hospice aides specific deficient and related skill(s) instead of assessing multiple areas within the competency evaluation. Several commenters opposed removing the seven HIS process measures, at least prior to implementation of HOPE. 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. Final Decision: We are finalizing the proposal to implement the hospice labor shares in a budget neutral manner through the use of the labor share standardization factors, so that the aggregate payments do not increase or decrease due to changes in the labor share values. The commenter asked whether any consideration was made regarding this inconsistency or other common inconsistencies in the nature of the expenses. Response: We appreciate commenters' concerns about publicly reporting claims from the COVID-19 PHE. While we are committed to provide time for understanding and preparation, we are not committed to ensuring that all hospices achieve high scores on the new measures before publicly reporting them. Comment: The majority of commenters supported the clarifications and proposed regulation text changes regarding the election statement addendum. 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. We reiterated that if only a non-hospice provider or Medicare contractor requests the addendum (and not the beneficiary or representative) we would not expect a signed copy in the patient's medical record. 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. Third, we estimated reliability scores. In order to be counted, the from date of the hospitalization had to occur no more than 2 days after the date of hospice live discharge. We believe the information provided in the proposed and final rule allows for commenters to replicate, with their own claims data, the indicators, thresholds, and points earned. However, this increase would likely impact hospices in a region similarly, and thus will not impact a hospice's score relative to local competitors. They also requested clarification on the logistics of the reporting processin particular, when specifications would be available. [19] 4. [33] The HQRP seeks to align with the other settings. In the FY 2016 Hospice final rule (80 FR 47186) adopted seven factors for measure removal, and in the FY 2019 Hospice final rule (83 FR 38636) adopted the eighth factor for measure removal. We proposed and finalizing in the rule to begin reporting this measure using existing data items no earlier than May 2022. We expect that hospices would take steps in working with patients and their representatives to better understand which methods (that is, in person, mail, etc.) Our proposal to adopt the CAR scenario for the January 2022 refresh would allow us to begin displaying recent data in January 2022, rather than continue displaying October 2020 data (Q1 2019 through Q4 2019). HVLDL is defined for in-person visits. This website allows consumers, providers, and other stakeholders to search for all Medicare-certified hospice providers and view their information and quality measure scores. HQRP Compliance requires understanding three timeframes for both HIS and CAHPS. In the FY 2014 Hospice Wage Index and Payment Rate Update final rule (78 FR 48234), and in compliance with section 1814(i)(5)(C) of the Act, we finalized the specific collection of data items that support the seven NQF-endorsed hospice measures described in Table 6. County Number CBSA FFY 2021 Hospice Wage Index Continuous Home Care Inpatient Respite Care General Inpatient Care Routine Home Care (days 1-60) Routine Home Care (days 61+) Service . While the impact of some waiver and flexibilities may be more apparent at this time, such as the waivers related to hospice aide supervision, flexibilities associated with other aspects of care are more complex requiring additional time for a complete understanding of their impact. For McLaren, hospice means making the most of your time with your loved ones. Comment: Many commenters offered suggestions regarding additional aspects of the election statement addendum for which we did not propose clarifying changes. Response: The Willingness to Recommend and Overall Rating measures are highly correlated with one another, as both provide global assessments of hospice care. We refer readers to the HQRP website at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Public-Reporting-HIS-Preview-Reports-and-Requests-for-CMS-Review-of-HIS-Data,, which we will revise to include further information on public reporting of claims as well as HIS data. At the beginning of every fiscal year, SIA utilization is compared to the prior year in order calculate a budget neutrality adjustment. Document page views are updated periodically throughout the day and are cumulative counts for this document. In section III.F of this rule, we finalize proposals to the HQRP including the addition of claims-based Hospice Care Index (HCI) measure, and Hospice Visits in the Last Days of Life (HVLDL) measure for public reporting; removal of the seven Hospice Item Set (HIS) measures because a more broadly applicable measure, the NQF #3235 HIS Comprehensive Assessment Measure for the particular topic is available and already publicly reported; and further development of the Hospice Outcome and Patient Evaluation (HOPE) assessment instrument. Skilled nursing visit data for indicators 2, 8, and 9 (described below) uses revenue center code 055X, which includes both RN and LPN visits for consistency with other indications for HCI. We count skilled nursing visits where the corresponding revenue center date overlaps with one of the days of RHC previously identified. We believe additional delays in public reporting of data is not in the interest of the public using Care Compare. Each document posted on the site includes a link to the We appreciate suggestions for new quality measures, as well as comments about the public reporting of quality measures. Most hospices that fail to meet HQRP requirements do so because they miss the 90 percent threshold. Response: We thank commenters for their feedback. The requirements at 418.24(b) and 418.52(a) ensure that beneficiaries are aware of any items, services, or drugs they would have to seek outside of the benefit, as well as their potential out-of-pocket costs for hospice care, such as co-payments and/or coinsurance. We received several on the transition to iQIES. Therefore, we stated that we expect that hospices already have processes and procedures in place to ensure that required signatures are obtained, either from the beneficiary, or from the representative in the event the beneficiary is unable to sign, and we anticipate that hospices would use the same procedures for obtaining signatures on the addendum. CMS DISCLAIMER. The data source for this HCI measure will be Medicare claims data that are already collected and submitted to CMS. In this final rule, we correct this error and replace the description of the denominator accurately as the number of beneficiaries with at least 1 day of hospice during the last 3 days of life within a reporting period. 44. The commenter stated that these labor market challenges will have an impact on the labor shares, which will not necessarily be reflected when the cost report data used is 2 years old. 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. On August 31, 2020, we added correcting language to the FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements; Correcting Amendment (85 FR 53679) hereafter referred to as the FY 2021 HQRP Correcting Amendment. Comment: One commenter recommended that CMS award star ratings in FY 2022, but suppress public reporting in Care Compare until the August 2023 refresh when all the data will be after the COVID-exempted quarters. The FY 2019 Hospice Wage Index and Payment Rate Update final rule (83 FR 38622) introduced the Meaningful Measure Initiative to hospice providers to identify high priority areas for quality measurement and improvement. This rule rebases the hospice labor shares and clarifies certain aspects of the hospice election statement addendum requirements. As of September 2020, HH QRP OASIS, claims-based, and HH CAHPS Survey measures are reported on the www.medicare.gov' s Care Compare website. As described in the August 8, 1997 Hospice Wage Index final rule (62 FR 42860), the pre-floor and pre-reclassified hospital wage index is used as the raw wage index for the hospice benefit. (For example, methods similar or analogous to the CMS Disparity Methods which provide hospital-level confidential results stratified by dual eligibility for condition-specific readmission measures currently included in the Hospital Readmission Reduction Program (. To comply with CMS' quality reporting requirements for CAHPS, hospices are required to collect data monthly using the CAHPS Hospice Survey. Given the timing of the COVID-19 PHE onset, we determined that we would use any data that was submitted for Q4 2019. CMS requires no additional resources to create and display CAHPS star ratings. 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. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610.
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