The SBNF is used to reduce the overall RHC rate to ensure that SIA payments are budget-neutral. The final hospice rate increase for FY 2022 is 2.0%. Numerator: The total number of live discharges from the hospice occurring on or after 180 days of enrollment in hospice within a reporting period. 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. Response: If a non-hospice provider requests the addendum, the hospice must furnish the addendum, however, the non-hospice provider is not required to sign the addendum. As finalized in the FY 2020 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements final rule (84 FR 38484), Start Printed Page 42569we are developing a hospice patient assessment instrument identified as HOPE. 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. We solicited public comment on this proposal to remove the seven HIS process measures from public reporting on Care Compare. As a result of the changes mandated by Division CC, section 404 of the Consolidated Appropriations Act, 2021 (CAA 2021), this rule finalizes conforming regulation text changes at 418.309 to reflect the new language added to section 1814(i)(2)(B) of the Act, which extends the years that the cap amount is updated by the hospice payment update percentage rather than the consumer price index. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. 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. The division will pay the hospice in accordance with the usual Medicaid reimbursement for physician services (such as direct patient care services) when these services are provided by hospice employees or physicians under agreement with the hospice. One commenter opposed the public reporting of any quality data collected during the COVID-19 PHE (not just the Q1 and Q2 2020 which were subject to the exemptions), because of the impact COVID-19 had on hospice processes and operations. Denominator: The total number of elections with the hospice, excluding hospice elections where the patient elected hospice for less than 30 days within a reporting period. Numerator: The number of decedent beneficiaries receiving a visit by a skilled nurse or social worker for the hospice in the last 3 days of the beneficiary's life within a reporting period. As such, HCI scores are consistent with CAHPS Hospice caregiver ratings, supporting the index as a valid measurement of hospice care. Final Decision: We are finalizing the hospice payment update percentage of 2.0 percent for FY 2022. This analysis must conform to the provisions of section 604 of the RFA. We do not have a policy for `exceptional circumstances' (that is floods, hurricanes, etc.) Accessible via: https://oig.hhs.gov/oei/reports/oei-02-10-00490.asp. We are finalizing our proposal that, in the COVID-19 PHE, we would use 3 quarters of HIS data for the final affected refresh, the February 2022 public reporting refresh of Care Compare for the Hospice setting. In addition, we finalized a provision to align the cap accounting year for both the inpatient cap and the hospice aggregate cap with the FY for FY 2017 and thereafter. Although we stated in the FY 2020 Hospice Wage Index and Payment Rate Update that hospices may develop their own election statement addendum (84 FR 38507), we posted a modified model election statement and addendum on the Hospice web page,[6] We continue to encourage hospice providers to report accurate and complete data on the cost reports. We will also continue to monitor the hospice labor shares as more recent data become available. We proposed that hospice star ratings for each measure be assigned based on where the hospice-level measure score falls within these cut-points. http://medpac.gov/docs/default-source/reports/mar20_medpac_ch12_sec.pdf. 39. Comment: While the majority of commenters supported the proposed changes; one commenter did not support the use of the pseudo-patient or targeted competency testing. We also required that IRC direct patient care salaries and contract labor costs per day would be greater than 1. The public's familiarity with a 1 through 5 star rating system, given its use by other programs, is also a benefit to using this system. The addendum must list those items, services, and drugs the hospice has determined to be unrelated to the terminal illness and related conditions, increasing coverage transparency for beneficiaries under a hospice election. In addition to the Preview Report, we will also include claims-based measure scores in the Hospice Agency-Level QM Report in CASPER. For CHC, we proposed to then multiply this ratio by other patient care total costs for CHC (Worksheet A-1 column 7, lines 38 through 46). We will take into consideration the option of starting the stars display when all data will be after the COVID-exempted quarters. Commenters also encouraged CMS to provide early testing and education for providers on HIT and to provide a structured FHIR transition framework for key stakeholders. Additionally, other provider types, such as IPPS hospitals, home health agencies (HHAs), SNFs, IRFs, and the dialysis facilities all use CBSAs to define their labor market areas. In the FY 2017 Hospice Wage Index and Payment Rate Update final rule (81 FR 52143), we stated that we would continue CAHPS reporting with eight rolling quarters on an ongoing basis. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. In fact, these findings were one of the primary reasons we have transitioned from Hospice Compare and the other individual compare sites to Care Compare. 27. This would allow sufficient time to complete the activities related, which is what we normally aim to give providers to understand and prepare for public reporting of a new measure, if we publicly report in May 2022. 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 SIA payment is provided for visits of a minimum of 15 minutes and a maximum of 4 hours per day (80 FR 47172). One commenter acknowledged the rationale for using hospice cost report data, but stated that this will reduce reimbursement for many of their members, particularly those who provide more GIP than average. The standard of practice for hospice is that care and services are provided on an in-person basis based on needs identified in the comprehensive assessment and services ordered by the IDG and outlined in the plan of care. Also, the relatively high number of hospices that meet the public reporting threshold in the CAR scenario, relative to the SPR scenario, with just 3 quarters of data justify the use of 3 quarters in the unusual circumstances of the COVID-19 PHE and its associated exemptions. The day occurs during the last sevendays of the patient's life, and the patient is discharged. Our simulations indicate that the hospices that only meet the reporting threshold when using 2 years of data have performance scores substantially lower than average. 6. 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. This means providers seeking a size exemption for CAHPS in CY 2022 would base it on their hospice size in CY 2021. Therefore, the proposed hospice payment update percentage for FY 2022 was 2.3 percent. along with the publication of the FY 2021 Hospice Wage Index and Payment Rate Update final rule (85 FR 47070). They complement each other and further support the need for each measure in the HQRP. 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). One commenter stated that it is important that CMS address this frequency so that hospices and cost report preparers can ensure that the data submitted on the cost report can be used for the labor share calculations. The FY 2022 final wage index value for Hinesville-Fort Stewart, Georgia is 0.8635. One commenter stated that there are no checks and balances on whether cost reporting data are accurate. Our testing results indicate we can achieve these positive impacts while maintaining high standards for reportability and reliability. . We also consider this work in coordination with planned future HOPE implementation and ensuring that the HQRP now covers the entire hospice stay with these 4 measures rather than just admission and discharge. These markup elements allow the user to see how the document follows the However, we recognized that there might be rare instances in which the beneficiary (or representative) refuses to sign the addendum, and noted that we would consider whether this issue would require future rulemaking. We then calculated the change in the number of hospices which achieved the minimum reporting standard. 4. Specifically, we required the following costs to be greater than zero: Fixed capital costs (Worksheet B, column 0, line 1), movable capital costs (Worksheet B, column 0, line 2), employee benefits (Worksheet B, column 0, line 3), administrative and general (Worksheet B, column 0, line 4), volunteer service coordination (Worksheet B, column 0, line 13), pharmacy and drugs charged to patients (sum of Worksheet B, column 0, line 14 and Worksheet A, column 7, line 42.50), registered nurse costs (Worksheet A, column 7, line 28), medical social service costs (Worksheet A, column 7, line 33), hospice aide and homemaker services costs (Worksheet A, column 7, line 37), and durable medical equipment (Worksheet A, column 7, line 38). Several existing measures, such as the HIS-based HVWDII measure and its replacement HVLDL, also do not differentiate refused visits. 804(2). This process will be necessary for each IP address you wish to access the site from, requests are valid for approximately one quarter (three months) after which the process may need to be repeated. We have used CBSAs for determining hospice payments since FY 2006. As stated above, in order to calculate the labor share standardization factor, we simulate total payments using FY 2020 hospice utilization claims data with the FY 2022 hospice wage index and the current labor shares and compare it to our simulation of total payments using the FY 2022 hospice wage index with the final revised labor shares. To assess hospice service availability, this indicator includes minutes of care provided by skilled nurses on weekend RHC days. In 2019, we added the Hospice Visits When Death is Imminent (Measure 1) to the website. The specifications for Indicator Six, Burdensome Transitions Type 2, are as follows: Estimates of per-beneficiary spending are endorsed by NQF (#2158)[29] Consolidated Appropriations Act, 2021, A. Hospice Utilization and Spending Patterns, 1. However, we continue to believe that the OMB's geographic area delineations represent a useful proxy for differentiating between labor markets and that the geographic area delineations are appropriate for use in determining Medicare hospice payments. Applying these Level I edits to the 2018 freestanding hospice MCRs resulted in 3,345 providers that passed the edits (four were excluded). A list of the approved vendors can be found on the CAHPS Hospice Survey website: www.hospicecahpssurvey.org. To address the inclusion of administrative data, such as Medicare claims used for hospice claims-based measures like the HVLDL and HCI in the HQRP and correct technical errors identified in the FY 2016 and 2019 Hospice Wage Index and Payment Rate Update final rules, we proposed and finalize in this rule the regulation at 418.312(b) by adding paragraphs (b)(1) through (3). rendition of the daily Federal Register on FederalRegister.gov does not Additionally, we are finalizing definitions for both pseudo-patient and simulation at 418.3. Numerator: Total Medicare hospice payments received by a hospice within a reporting period. FY 2022 Medicaid Hospice Rates Released. 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. We disagree with commenters that notices should be posted on Care Compare regarding the inclusion of data from the COVID-19 PHE as such notice would not help consumers distinguish between hospices in their region. The FY 2010 Hospice Wage Index and Rate Update final rule (74 FR 39384) instituted an incremental 7-year phase-out of the BNAF beginning in FY 2010 through FY 2016. However, this increase would likely impact hospices in a region similarly, and thus will not impact a hospice's score relative to local competitors. Patients electing to receive hospice services should expect quality care and a comprehensive assessment of their needs at admission, which the HIS Comprehensive Assessment Measure reflects. Comment: Several commenters expressed concerns that the HCI will overlap with, or be duplicative of, HOPE-based measures. The PDC now makes quality datasets available through an improved Application Programming Interface (API), allowing innovators in the field to easily access and analyze the CMS publicly-reported data and make it useful for patients. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. 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. Lastly, one commenter suggested that since an electronically sent addendum could be tracked, a signature should not be required. These will be effective no earlier than May 2022. Therefore for the COVID-19 Affected Reporting (CAR) Scenario, we excluded data for patient stays with admission dates in Q1 2019. 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.
