For example, see: Teno J.M., Bowman, J., Plotzke, M., Gozalo, P.L., Christian, T., Miller, S.C., Williams, C., & Mor, V. (2015). Accessible via: http://www.medpac.gov/docs/default-source/reports/Mar11_Ch11.pdf?sfvrsn=0. Commenters emphasized that performance measures should be used to measure program integrity, but should not be publicly reported. For more information, please visit the PAC PUF web page at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/PAC2017. 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. We identify the dates of those visits by the revenue center date for those revenue codes. For example, FY 2019 covers claims with dates of services on or between October 1, 2018 and September 30, 2019. Comment: A few commenters requested specifically for an explanation for using top-box scoring of individual level responses for the star ratings. We proposed to define direct patient care salaries and contract labor costs to be equal to costs reported on Worksheet A-1 (for CHC) or Worksheet A-2 (for RHC) or Worksheet A-3 (for IRC) or Worksheet A-4 (for GIP), column 7, for lines 26 through 37. For each level of care, we proposed to use the same methodology to derive the components; however, for the (1) direct patient care salaries and (3) other patient care salaries, we proposed to use the MCR worksheet that is specific to that level of care (that is, Worksheet A-1 for CHC, Worksheet A-2 for RHC, Worksheet A-3 for IRC, and Worksheet A-4 for GIP). The Public Inspection page The commenter stated that they understand that this reporting is inaccurate; however, there is no existing Level 1 edit that would catch it. click here to see all U.S. Government Rights Provisions, 26 Century Blvd Ste ST610, Nashville, TN 37214-3685. National implementation of the CAHPS Hospice Survey commenced January 1, 2015, as stated in the FY 2015 Hospice Wage Index and Payment Rate Update final rule (79 FR 50452). As a few commenters noted, Each hospice is afforded the opportunity to achieve excellent ratings on the CAHPS Hospice Survey. Days of hospice service are identified based on the presence of revenue center codes 0651 (routine home care (RHC)), 0652 (CHC), 0655 (inpatient respite care (IRC)), and 0656 (GIP) on hospice claims. In conjunction with the Care Compare launch, we have made additional improvements to other CMS data tools, to help Medicare beneficiaries compare costs. We would note that the freestanding hospice providers account for about 85 percent of hospice providers and therefore, we believe our proposal to use only the freestanding hospice MCR data to revise the labor shares is reasonable and a technical improvement over the current labor shares. The final hospice cap amount for FY23 is $32,486.92. Open for Comment, Applications for New Awards-American History and Civics Education National Activities Program, Economic Sanctions & Foreign Assets Control, National Oceanic and Atmospheric Administration, Salmonella in Not-Ready-To-Eat Breaded Stuffed Chicken Products, Authority To Order the Ready Reserve of the Armed Forces to Active Duty To Address International Drug Trafficking, Revitalizing Our Nation's Commitment to Environmental Justice for All, B. 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 . 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. The HCI will add value to the HQRP by filling measurement gaps using existing data sources. As discussed in the FY 2022 Hospice proposed rule (86 FR 19718) and above, we proposed to derive Direct patient care salaries and contract labor costs using (for CHC as an example) Worksheet A-1 column 7, lines 26 through 37 on the cost report, which would capture any staff transportation costs reported in these cost centers on Worksheet A-1. While the HIS is a standardized mechanism for abstracting medical record data, it is not a patient assessment tool because HIS data are not collected during a patient assessment. This analysis must conform to the provisions of section 604 of the RFA. Calculating and Publicly Reporting Claims-Based Measure as Part of the HQRP, (3). 2020. Response: Our analyses of existing CAHPS Hospice Survey data demonstrate that hospices with high scores would overwhelmingly receive 4 and 5 stars. We then simultaneously removed those providers whose total IRC costs per day fall in the top and bottom one percent of total IRC costs per day for all IRC providers as well remove those providers whose compensation cost weight falls in the top and bottom five percent of compensation cost weights for all IRC providers. Please. For example, an average consumer might misinterpret higher scores for live discharges or avoidance of general inpatient care as favorable. We received comments from various stakeholders on the proposals and updates including a consumer advocacy group, health care providers, hospice provider organizations, hospice trade groups, including those focused on rural providers, consultants, EHR vendors, and MedPAC. This final regulation is subject to the Congressional Review Act provisions of the Small Business Regulatory Enforcement Fairness Act of 1996 (5 U.S.C. 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). 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. 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. Additionally, we summarize the comments on the requests for information (RFI) on advancing to digital quality measurement and the use of FHIR and on addressing the White House Executive Order related to health equity in the HQRP. The appropriate wage index value is applied to the labor portion of the payment rate based on the geographic location of the facility for beneficiaries receiving GIP or IRC. 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. The points are earned without weighting to recognize the tradeoffs for each indicator's specifications. Table 16 summarizes the comparison between the original schedule for public reporting with the revised schedule (that is, frozen data) and with the proposed schedule that is, using 3 quarters in the February 2022 refresh. CMS' sub-regulatory Quality Measure Users' Manual on the CMS HQRP Current Measures web page will include specifications for each indicator and scoring for HVLDL, and the HIS Comprehensive Assessment measure (NQF #3235). The hospice CoPs at 418.104(a)(2) state that the patient's record must include signed copies of the notice of patient rights in accordance with 418.52. Likewise, since the addendum is part of the election statement as set forth in 418.24(b)(6), then it is required to be part of the patient's record (if requested by the beneficiary or representative). An unusually high rate of live discharges could indicate that a hospice provider is not meeting the needs of patients and families or is admitting patients who do not meet the eligibility criteria., Our live discharge indicators included in the HCI, like MedPAC's, comprise discharges for all reasons. CMS has traditionally used a reportability threshold of 70 percent, meaning at least 70 percent of HHAs are able to report at least 20 episodes for a given measure, as the standard to determine whether a measure should be publicly reported. Response: Our practice across all PAC settings has been to allow the use of claims data originating from before the finalization of a proposal to adopt a claims-based measure. IHCP bulletin BT202194 OCTOBER 21, 2021 Page 2 of 6 In FFY 2021, the updated hospice wage . Stakeholders also suggested several valuable exploratory analyses, improvements for the indicators presented, and ideas for eventual public display for CMS to consider. Prior to enactment of this provision, the hospice cap update was set to revert to the original methodology of updating the annual cap amount by the CPI-U beginning on October 1, 2025. (10) Date the hospice furnished the addendum. Direct patient care salaries and contract labor costs are costs associated with medical services provided by medical personnel including but not limited to physician services, nurse practitioners, RNs, and hospice aides. Comment: A few commenters stated that the survey is too long. We noted in the FY 2021 Hospice Wage Index & Payment Rate Update final rule that because the beneficiary signature is an acknowledgement of receipt of the addendum, this means the beneficiary would sign the addendum when the hospice provides it, in writing, to the beneficiary or representative (85 FR 47092). Similar to other CAHPS programs, we proposed that the cut-points used to determine the stars be constructed using statistical clustering procedures that minimize the score differences within a star category and maximize the differences across star categories. Comment: A few commenters supported the proposal to rebase the labor share for the four levels of care based on the 2018 MCR data. References to any relevant clinical practice, policy, or coverage guidelines; 9. 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. Comment: Several commenters expressed concern about the public's ability to understand the meaning of the HIS Comprehensive Measure without being able to see the seven component measures. Effective Federal Fiscal Year 2023 (October 1 - September 30), there were no counties that changed their status, CBSA name and/or CBSA number. Response: The proposed regulatory policies to implement the hospice survey and enforcement provisions in section 407 of CAA, 2021 were included in CY 2022 Home Health Prospective Payment System proposed rule with the comment period found here: https://www.govinfo.gov/content/pkg/FR-2021-07-07/pdf/2021-13763.pdf. For these reasons, adding disclaimer text as suggested would not help consumers seeking information make decisions about care options. Response: We appreciate commenters' concerns that hospice providers continue to recognize and address the unique circumstances of hospice patients. Go tohttps://www.mmis.georgia.gov/portal/to access the Hospice Manual. A more broadly applicable measure (across settings, populations, or conditions) for the particular topic is available; 5. We used 10 quarters of HH QRP data from CY 2017 to 2019 to calculate the CAR scenario for the potentially preventable readmissions claims-based measure. The specifications for Indicator Nine, Skilled Nursing Minutes on Weekends, are as follows: The end of life is typically the period in the terminal illness trajectory with the highest symptom burden. Note: The comment period closes on August 27, 2021. Office of Inspector General. The commenter stated that they are forced to outsource many nursing functions at high cost, along with paying retention bonuses to current staff. The purpose of this Change Request (CR) is to update the hospice payment rates, hospice wage index, and Pricer for FY 2023. Pseudo-patient means a person trained to participate in a role-play situation, or a computer-based mannequin device. The data must be submitted in a form, manner, and at a time specified by the Secretary. As for Q1 and Q2 2020, we determined that we would not use HIS or CAHPS data from these quarters for public reporting given the timing of the COVID-19 PHE onset. For each level of care, we proposed to calculate noncapital overhead costs for each level of care to be equal to Worksheet B, column 18, less the sum of Worksheet B, columns 0 through 2, for line 50 (CHC), or line 51 (RHC) or line 52 (IRC) or line 53 (GIP). MedPAC. We do not have a policy for `exceptional circumstances' (that is floods, hurricanes, etc.) We performed analyses using Stata/MP Version 16.1. We solicited public comments on the proposal to use the CAR scenario to publicly report HH OASIS in January 2022 and claims-based measures beginning with the January 2022 through July 2024 refreshes. Section 418.24(c)(9) requires the beneficiary's signature (or his/her representative's signature) as well as the date the document was signed.

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