The HIS Comprehensive Assessment Measure's all or none criterion requires hospices to perform all seven care processes in order to receive credit. hereafter referred to as the March 27, 2020 CMS Guidance Memorandum. End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). Rolling up eight quarters of data instead of four ensures that measure scores are available for many more hospices, which improves the usefulness of the Compare web tools for hospice consumers. Additionally, the rule finalizes the addition of the claims-based Hospice Visits in the Last Days of Life (HVLDL) measure for public reporting, which supports patient empowerment and transparency of hospice performance. We believe it is important to support consumers by sharing information on the performance of hospices that have lower scores, and to incentivize those hospices to improve. One of these commenters expressed support for making the reporting more inclusive of smaller hospices, to encourage them to also improve the quality of care they provide. documents in the last year, by the Food Safety and Inspection Service We solicited comments on these proposals for CAHPS Star Ratings and the public reporting of star ratings no sooner than FY 2022.Start Printed Page 42573. Submit Online Form. In general, OMB issues major revisions to statistical areas every 10 years, based on the results of the decennial census. Register, and does not replace the official print version or the official This reimbursement is in addition to the per diem rate. Thus, the reportability of the actual data used is likely to be better than this simulation. This measure does not recognize visits during CHC and GIP because these higher levels of care inherently require skilled visits per the COPs in accordance with 418.110 and 418.302. Claims are a rich and comprehensive source of many care processes and aspects of health care utilization. documents in the last year, 83 Hospice care is a comprehensive, holistic approach to treatment that recognizes the impending death of a terminally ill individual and warrants a change in the focus from curative care to palliative care for relief of pain and for symptom management. Another commenter stated that completing a full competency test takes the focus away from the identified deficiency and is not effective. The final hospice rate increase for FY 2022 is 2.0%. Table 10 restates the data submission dates for FY 2023 through FY 2025. 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. Section 4443 of the BBA amended sections 1812(a)(4) and 1812(d)(1) of the Act to provide for hospice benefit periods of two 90-day periods, followed by an unlimited number of 60-day periods. [30] 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. Response: We are currently conducting an experiment to test a shorter version of the CAHPS Hospice Survey. The commenter stated that this disregards the essence of the hospice interdisciplinary team which cares for the patient and family as a unit of care. As stated in the FY 2019 Hospice Wage Index and Rate Update final rule (83 FR 38622), we launched the Meaningful Measures initiative (which identifies high priority areas for quality measurement and improvement) to improve outcomes for patients, their families, and providers while also reducing burden on clinicians and providers. This rule updates the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2022 as required under section 1814(i) of the Social Security Act (the Act). We want hospices to be successful with meeting the HQRP requirements. 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. However, unlike PEPPER reports that are issued to hospices to support their compliance efforts related to potential improper payments, as part of the HQRP, the HCI will become information on Care Compare that beneficiaries, caregivers, or other stakeholders may consider as they make choices about end-of-life care. We recognize that there are many regional variations in care delivery trends. Thus, it is important that hospices ensure the completeness and correctness of their claims prior to the claims snapshot.. 33. In the March 27, 2020 Guidance Memorandum, we stated that we should not include any post-acute care (PAC) quality data that are greatly impacted by the exemption in the quality reporting programs. have brought to light the potential role hospices could play in medical aid in dying (MAID) where such practices have been legalized in certain states, we wish to remind hospices that The Assisted Suicide Funding Restriction Act of 1997 (Pub. At 418.24(c)(10), we proposed that the hospice would include the date furnished in the patient's medical record and on the addendum itself. Before proceeding with the November 2020 refresh, we conducted testing to ensure that, even though we made an exception to reporting requirements for Q4 2019 in March 2020, public reporting would still allow us to publicly report data for a similar number of hospice providers, as compared to standard reporting. Update on Use of Q4 2019 HH QRP Data and Data Freeze for Refreshes in 2021, 5. (2020). However, we found that using fewer than 8 quarters of data would have two important negative impacts on public reporting. 48. Hospice Utilization and Spending Patterns, 2. This pattern of transitions may be associated with a discharge process that does not appropriately assess the stability of a hospice patient's conditions prior to live discharge.[28]. Hospice providers, must report HIS data used for the HIS Comprehensive Assessment Measure, in order to meet the requirements for compliance with the HQRP. We believe when a deficient area(s) in the aide's care is assessed by the RN, there may be additional related competencies that may also lead to additional deficient practice areas and thus would require that those skills be included in the targeted competency evaluation. 25. Moreover, because we proposed to change the timeframe requirements to correspond with the date furnished rather than the signature date, we disagree that this timeframe would be burdensome to beneficiaries. Comment: Several comments requested that CMS clarify how the last three days of life would be calculated. This indicator identifies whether a hospice is at or above the 10th percentile in terms of the percentage of beneficiaries with a RN, LPN, and/or medical social services visit in the last 3 days of life. Update Regarding the Hospice Outcomes & Patient Evaluation (HOPE) Development, 7. While the commenter commended CMS for using hospice-specific data, they were also concerned about the accuracy of the data submitted by providers. Comment: MedPAC recommended the hospice cap amount be reduced by 20 percent as a way to focus payment reductions on providers with particularly high margins. We plan to continue working with other agencies and stakeholders to coordinate and to inform our Start Printed Page 42599transformation to dQMs leveraging health IT standards. The 2.0 hospice payment update percentage is based on the 2.7 percent inpatient hospital market basket update, reduced by a 0.7 percentage point productivity adjustment. We will consider other star ratings as applicable. The base payments are adjusted for geographic differences in wages by multiplying the labor share, which varies by category, of each base rate by the applicable hospice wage index. This methodology does not force a set number of hospices into each star category. the material on FederalRegister.gov is accurately displayed, consistent with The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. Comment: Some commenters expressed concern that the request from a non-hospice provider for the election statement addendum does not require a signature. Under section 1135 of the Act, the Secretary may temporarily waive or modify certain Medicare, Medicaid, and Children's Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the programs in the emergency area and time periods, and that providers who furnish such services in good faith, but who are unable to comply with one or more requirements as described under section 1135(b) of the Act, can be reimbursed and exempted from sanctions for violations of waived provisions (absent any determination of fraud or abuse). de la Cruz, M., et al. Overlapping inpatient claims were combined to determine the full length of a hospitalization (looking at the earliest from date and latest through date from a series of overlapping inpatient claims for a beneficiary). Hospice Start Printed Page 42547providers are only able to discern what items, services, and drugs they will not cover once they have a beneficiary's comprehensive assessment. In this final rule, we are not making any revisions to the HIS Comprehensive Assessment Measure because the single measure continues to show sufficient variability and therefore provides value to patients, their families, and providers. (2) The APU is subsequently applied to FY payments based on compliance in the corresponding Reporting Year/Data Collection Year. Table 7 indicates the number of hospice days, hospice claims, beneficiaries enrolled in hospices and hospices with at least one claim represented in each year of our analysis. Collectively these indicators represent different aspects of hospice service and thereby characterize hospices comprehensively, rather than on just a single care dimension. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. One noted that this time is needed in particular because visits on claims have not previously impacted hospice quality scores or payment. Additionally, we acknowledged that hospices have noted that there is not a timeframe in regulations regarding the patient signature on the addendum. . The 2022 Hospice Financial Management Academy, September 19-20, 2022, is in final planning. As finalized in the FY 2016 Hospice Wage Index and Payment Rate Update final rule (80 FR 47192), hospices' compliance with HIS requirements beginning with the FY 2020 APU determination (that is, based on HIS-Admission and Discharge records submitted in CY 2018) are based on a timeliness threshold of 90 percent. The commenter also recommended that CMS could add a question to the cost report asking whether the hospice operates a freestanding inpatient and/or inpatient respite care facility. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically on NARA's archives.gov. 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.