The Hospice QRP was established in FY 2012. This indicator identifies whether a hospice is below the 90th percentile in terms of the percentage of live Start Printed Page 42561discharges that are followed by a hospitalization (within two days of hospice discharge) and then the patient dies in the hospital. 2023 Hospice Rates (with nursing facility rates effective 7/ 1/2023-6/30/2024) Page 2 of 2 Room and board for nursing facility residents on hospice (per diem): To receive reimbursement for nursing facility room and board provided on Routine Home Care (651 or 650) and Continuous Home Care 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. Clinical Services Hospice Myers and Stauffer is the long-term care rate-setting contractor that sets the Indiana Health Coverage Programs (IHCP) rates for nursing facilities and group homes. Hospices receive a single HCI score, which reflects the information from all ten indicators. These specifications will now be contained in the revised HQRP QM User's Manual V4.00 located on the CMS HQRP Current measures web page. B. Indicator Four: Late Live Discharges, (5). Further, 5 U.S.C. The final hospice wage index applicable for FY 2022 (October 1, 2021 through September 30, 2022) is available on our website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/Hospice-Wage-Index.html. L. 105-33) established that updates to the hospice payment rates beginning FY 2002 and subsequent FYs be the hospital market basket percentage increase for the FY. [343536] Physical symptoms of actively dying can often be identified within three days of death in some patients.[37]. We proposed to require that the date furnished be within the required timeframe, rather than the signature date, to mitigate any undue strain on the beneficiary or representative in returning the addendum to the hospice by a specified date. March 2011 Report to the Congress: Medicare Payment Policy, Chapter 11: Hospice. March 15, 2011. Because the HIS Comprehensive Assessment Measure is a more broadly applicable measure, we are finalizing our proposal to remove the seven individual HIS process measures from the HQRP, no longer publicly reporting them as individual measures on Care Compare beginning with FY 2022. Sections 1812(d), 1813(a)(4), 1814(a)(7), 1814(i), and 1861(dd) of the Act, and the regulations in 42 CFR part 418, establish eligibility requirements, payment standards and procedures; define covered services; and delineate the conditions a hospice must meet to be approved for participation in the Medicare program. We are also considering developing hybrid quality measures that would be calculated using claims, assessment (HOPE), or other data sources. More information about the Meaningful Measures initiative can be found at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/MMF/General-info-Sub-Page.html. The Preview Reports will reflect the HCI as publicly reported. Response: As mentioned previously, we plan to display stars no sooner than FY 2022. We intend to submit additional claims-based measures for future consideration and solicit public comment. The HCI will provide more information to better reflect several processes of care during a hospice stay, and better empower patients and family caregivers to make informed health care decisions. PDF PROVIDER BULLETIN NURSING FACILITY AND HOSPICE - Missouri Department of In addition, we finalized a policy to use the current year's pre-floor, pre-reclassified hospital inpatient wage index as the wage adjustment to the labor portion of the hospice rates. Comment: Many commenters requested making the proposed clarifications to the hospice election statement addendum retroactive to the implementation date of October 1, 2020. While we did not propose any of these recommendations we could consider them for future rulemaking. Our regulations at 418.306(c) require each labor market to be established using the most current hospital wage data available, including any changes made by the Office of Management and Budget (OMB) to the Metropolitan Statistical Areas (MSAs) definitions. Characteristics of hospice programs with problematic live discharges. . This addressed five of the six COVID-19 PHE-affected quarters for HIS-based measures, and five of the 11 COVID-19 PHE-affected quarters of CAHPS-based measures. We obtained the Hospice-aggregate CAHPS Hospice Survey outcome data via: https://data.cms.gov/provider-data. Section III.E makes permanent selected regulatory blanket waivers that were issued to Medicare-participating hospice agencies during the COVID-19 PHE. Information about this document as published in the Federal Register. We refer readers to FY 2020 Hospice Wage Index and Payment Rate Update final rule (84 FR 38512) to learn more about the usage of the ABN. Territories and Possessions are set by the Department of Defense. We propose that starting with the February 2022 refresh, CMS will display the most recent 8 quarters of CAHPS Hospice Survey data, excluding Q1 and Q2 2020. The HCI will add value to the HQRP by filling measurement gaps using existing data sources. The commenter stated CMS should see value in potentially adding these worksheets if, in fact, it intends to calculate labor components for these levels of care based on cost report data going forward. The FY 2021 hospice payment rates are shown in Tables 1 and 2 below. Additionally, the commenter raised concerns regarding instances when multiple areas of deficient practice are noted and if a full competency would be done these instances. They also requested clarification on the logistics of the reporting processin particular, when specifications would be available. As previously announced, we will not publicly report this measure at this time to allow for further testing to determine if changes to the measure specifications or how it is displayed on Hospice Compare are needed. 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. The reduction in provider burden and costs occurred when we replaced the HIS-based HVWDII quality measure via the HIS-information collection request (ICR) -CMS-10390 (OMB Control Number: 0938-1153 (Expiration date: February 29, 2024). Section 1814(a)(7)(B) of the Act requires that a written plan for providing hospice care to a beneficiary who is a hospice patient be established before care is provided by, or under arrangements made by, the hospice program; and that the written plan be periodically reviewed by the beneficiary's attending physician (if any), the hospice medical director, and an interdisciplinary group (section 1861(dd)(2)(B) of the Act). Final Decision: We are implementing the updates to hospice payment rates as discussed in the proposed rule. Annual update of the payment rates and adjustment for area wage differences. Family caregiver perspectives on symptoms and treatments for patients dying from complications of cystic fibrosis. They encouraged CMS to conduct further analyses before finalizing the measure. The response to those comments follows: Comment: Commenters were overwhelmingly supportive of the provisions to permit the use of pseudo-patients and simulation when conducting hospice aide competency training and for retraining of deficient skills. For example, if a beneficiary (or representative) requests the addendum on February 22nd, then the hospice will have until February 25th to furnish the addendum, regardless of what time the addendum was requested on February Start Printed Page 4254822nd. We also received six comments on the use of the labor share standardization factor including hospices, national industry associations. Commenters included individuals, hospice agencies, state hospice associations, national provider organizations, and patient advocacy groups. A summary of these comment and our responses to those comments appear below: Comment: We received several comments suggesting concepts for future quality measures in the HQRP such as measures related to postmortem service, plan of care goal achievement, spiritual care, psychosocial care, veteran services, volunteer activities, visit activity at the time of admission, change of level of care, change of physical location, safety culture, and workforce engagement, and patient and family care needs. The final definitions are as follows: These changes will allow hospices to utilize pseudo-patients, such as a person trained to participate in a role-play situation or a computer-based mannequin device, instead of actual patients, in the competency testing of hospice aides for those tasks that must be observed being performed on a patient. Public Display of Quality Measures and Other Hospice Data for the HQRP, b. The HIS Comprehensive Assessment Measure is a composite measure that serves to ensure all hospice patients receive a comprehensive assessment for both physical and psychosocial needs at admission. We note that any future revisions to the hospice labor shares will be proposed and subject to public comments in future rulemaking. Response: We appreciate commenters' concerns regarding the administrative burden in quality reporting. better and aid in comparing the online edition to the print edition. The ABN transfers potential financial liability to the Medicare beneficiary in certain instances, whereas the addendum (upon request) informs terminally ill beneficiaries (or their representative) only of items, services, or drugs the hospice will not be providing because the hospice has determined them to be unrelated to the terminal illness and related conditions. 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). Both RN and LPN visits are included on the hospice claim under revenue code 055X and as such, the HCI does include LPN visits for the indicator for all indicators that use revenue code 055X for consistency. The hospice must note the reason the addendum was not furnished to the patient and the addendum would become part of the patient's medical record if the hospice has completed it at the time of discharge, revocation, or death. Reportability analyses found a high proportion of hospices (over 85 percent) that would yield reportable measure scores over 1 year (for more on reportability analysis, see section (2) Update on Use of Q4 2019 Data and Data Freeze for Refreshes in 2021.). Response: The labor share standardization factor is applied to the FY 2022 hospice payment rates so that the aggregate payments do not increase or decrease due to changes in the labor share values. We will consider using multiple avenues for communication, including this rule, the Medicare Claims Manual, the HQRP website, such as the HQRP Requirements and Best Practices web page at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/HQRP-Requirements-and-Best-Practices and the Training and Education Library page at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-Quality-Reporting-Training-Training-and-Education-Library. On August 13, 2020, we sought public comment in an information collection request to remove Section O Service Utilization (hereafter referred to as Section O) of the HIS discharge assessment. Form, Manner and Timing of Data Collection and Submission, we have provided and will consolidate in the Users' Manual specifications for HCI and HVLDL in time to meet commenters' stated needs. Beginning with CY 2017 data, hospice PUF data are public as part of the Post-Acute Care and Hospice Provider Utilization and Payment PUF (hereafter PAC PUF). If the CAHPS Data Collection year is CY 2022, then the HIS reporting year is also CY 2022. The third column shows the effect of using the FY 2022 updated wage index data. Specifically, we will refresh claims-based measure scores on Care Compare, in preview reports, and in the confidential CASPER QM preview reports annually. The proposed methodology for calculating the labor shares cited by the commenter of using Worksheet A-1 and A-2 column 7, lines 26 through 37 for total labor costs reflects only one component of the proposed calculation of the labor share. As CMS proceeds with field testing HOPE, we will continue to engage with stakeholders through sub-regulatory channels. Recommendations to minimize the information collection burden on the affected public, including automated collection techniques. 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. The HCI will help to identify whether hospices have aggregate performance trends that indicate higher or lower quality of care relative to other hospices. In that same final rule, we discussed that we will issue public notice, through rulemaking, of measures under consideration for removal, suspension, or replacement. While we acknowledged in that rule the limitations with using claims data as a source for measure development, there are several advantages to using claims data as part of a robust HQRP as discussed previously in the FY 2020 rule. One commenter stated that they do not believe hospice cost reports are historically very accurate. https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensions-quality-reporting-and-value-based-purchasing-programs.pdf. Register, and does not replace the official print version or the official A key point of contention was that CMS used 2019 data to calculate the 2023 rate, including wages and cost reports. Numerator: Total Medicare hospice payments received by a hospice within a reporting period. Response: We thank commenters for raising points for CMS to consider in advance of HOPE implementation. Such comparative star ratings, as proposed by CMS, help consumers identify high and low performing hospices. 36. The quality, utility, and clarity of the information to be collected. They stated in some instances, Medical Directors are employees and salaries would be reported; however, other hospices contract for this position. Some commenters stated that the measure should recognize telehealth visits in the last days of life, as circumstances such as the recent COVID-19 PHE may make in-person visits impossible or undesirable for patients or families. Palliative & Supportive Care, 13(2): 211-216. doi: 10.1017/S1478951513001144. Several other commenters also suggested posting a disclaimer that the HIS Comprehensive measure only comes from the admission item set and may not be reflective of subsequent care. This rate is the highest in 40 years. However, due to the COVID-19 PHE, we looked at using the previous fiscal year's hospice claims data (FY 2019) to determine if there were significant differences between utilizing 2019 and 2020 claims data. They complement each other and further support the need for each measure in the HQRP. We received a comment indicating some hospice agencies never hit the cap amount and recommend for CMS to utilize available claims and quality data to target hospices with questionable practices to avoid exceeding the cap amount. Our proposal to use the 2018 MCR data recognizes that providers have had 4 years to familiarize themselves with the form and, thereby, improve the accuracy of the data. Hospices are only considered compliant if they meet the standards for HIS and CAHPS reporting, as codified in 418.312. The following sections provide the results of our testing for OASIS and claims and explain how we used the results to inform a proposal for accommodating excepted data in public reporting. Home or inpatient physician visits made by a hospice physician are reimbursed outside the per-diem rate. 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 standardized data items, known as the HIS, that support the following NQF-endorsed measures: These measures were adopted to increase public awareness of key components of hospice care, such as pain and symptom management and non-clinical care needs. Update on Quality Measure Development for Future Years, 8. For FY 2022, two of the four measures we proposed to add were claims-based measures which do not increase burden to providers. See an update on HOPE development in section III.F.6, Update regarding the Hospice Outcomes & Patient Evaluation (HOPE) development. (2) The APU is subsequently applied to FY payments based on compliance in the corresponding Reporting Year/Data Collection Year. MedPAC. 31. We refer the public to the FY 2017 Hospice Wage Index and Payment Rate Update final rule (81 FR 52144) for a detailed discussion.

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