we proposed to rebase and revise the IPPS market baskets to reflect a 2018 base year. These same requirements were implemented for home health aide supervision in 2019 (see 84 FR 51732 and the associated regulations at 484.80(c)(1)), without any reported adverse impacts noted to-date in CMS survey data or complaints being reported to CMS. (2020). Performance or improvement on a measure does not result in better patient outcomes; 3. Other commenters requested that this measure recognize visits offered during CHC or GIP care. However, we found that using fewer than 8 quarters of data would have two important negative impacts on public reporting. Thirty-one unique stakeholders submitted their comments on the proposed clarifications to the election statement addendum. We believe that the 1-year 5 percent cap transitional policy provided for FY 2021 was an adequate safeguard against any significant payment reductions, allowed for sufficient time to make operational changes for future fiscal years, and provided a reasonable balance between mitigating some short-term instability in hospice payments and improving the accuracy of the payment adjustment for differences in area wage levels. For more information on the policies we have adopted for the HH QRP, we refer readers to the following rules: Section 1895(b)(3)(B)(v)(III) of the Act requires the Secretary to establish procedures for making HH QRP data, including data submitted under sections 1899B(c)(1) and 1899B(d)(1) of the Act, available to the public. Some commenters suggested that CMS formulate a methodology that would include smaller hospices in star ratings. When deficient aide skills are noted during a supervisory visit, the RN determines the deficient skills and all related skills that may be impacted. Given the importance of structured data and health IT standards for the capture, use, and exchange of relevant health data for improving health equity, the existing challenges providers' encounter for effective capture, use, and exchange of health information, such as data on race, ethnicity, and other social determinants of health, to support care delivery and decision making. In addition to the publicly-reported quality measure data, in 2019 we added to public reporting, information about the hospices' characteristics, taking raw data available from the Medicare Public Use File and other publicly-available government data sources and making them more consumer friendly and accessible for people seeking hospice care for themselves or family members, (83 FR 38649). We believe using updated labor shares based on 2018 data is a technical improvement over the current labor shares as they reflect recent cost data for freestanding hospice providers. 2019: Vulnerabilities in Hospice Care (Office of the Inspector General). 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. This approach parallels the one used by CMS for calculating star ratings for hospitals. This supports why we must remove the 7 HIS measures now in favor of the one more meaningful measure. 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). However, we believe that the single measure currently continues to show sufficient variability to differentiate hospices and therefore provides value to patients, their families, and providers. Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on state and local governments, preempts state law, or otherwise has Federalism implications. We also have a dedicated email account, HospiceAssessment@cms.hhs.gov, for comments about HOPE. Comment: Some commenters raised questions about using 75 completed surveys as the threshold for public reporting of stars. Response: We appreciate the recommendation to permit greater flexibility for hospices in regards to staffing of essential workers. 17. Further, 5 U.S.C. The 90-percent threshold is hereafter referred to as the timeliness compliance threshold. We stated that we would continue to expect that the hospice would note the date furnished in the patient's medical record and on the addendum, if the hospice has already completed the addendum, as well as an explanation in the patient's medical record noting that the patient died, revoked, or was discharged prior to signing the addendum (86 FR 19725). For more details, see section (3). 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. However, several months lead-time is necessary after acquiring the data to conduct the claims-based calculations. The presence of revenue center code 055x (Skilled Nursing) on the hospice claim. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. One commenter supported the proposed methodology of using actual hospice cost report data calculated using all applicable costs as well as including only providers who performed each level of care normalizing for outliers. The purpose of this Change Request (CR) is to update the hospice payment rates, hospice wage index, and Pricer for FY 2023. Index Earned Point Criterion: Hospices earn a point towards the HCI if they provided at least one CHC or GIP service day within a reporting period. tabulated at the CBSA level and applied against non-hospice claim expenditures. In conjunction with the Care Compare launch, we have made additional improvements to other CMS data tools, to help Medicare beneficiaries compare costs. http://www.medpac.gov/docs/default-source/reports/mar21_medpac_report_to_the_congress_sec.pdf?sfvrsn=0. The guidelines were developed by the National Consensus Project for Quality Palliative Care, comprising 16 national organizations with extensive expertise in and experience with palliative care and hospice, and were published by the National Coalition for Hospice and Palliative Care. The final hospice cap amount for FY23 is $32,486.92. the Medicare Payment Advisory Commission,[414243] by peer reviewed articles, and our technical expert panel (TEP). These commenters provided general and specific suggestions about how to display the HIS Comprehensive Measure on Care Compare if the seven HIS measures are removed. For GIP, we proposed to multiply this ratio by total other patient care costs for GIP (Worksheet A-4, column 7, lines 38 through 46). Thus, we believe that indicators five and indicator six of the HCI are necessary to differentiate concerning behaviors affecting patient care. We recognize the approximately 90-day run-out period is shorter than the Medicare program's current timely claims filing policy under which providers have up to 1 year from the date of discharge to submit claims. In 2020, the TEP explored potential quality measure constructs that could be derived from HOPE and their specifications. Response: We appreciate commenters' interest in having the HCI reflect how prepared hospices are to provide key services to patients. Response: We appreciate the commenters' concerns on the accuracy of the IRC and GIP cost data on the MCR. (2019). As we are able to obtain more recent cost report data, we will monitor the labor shares by ownership-type over time. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. For complete information about, and access to, our official publications documents in the last year, 84 In response to the commenter who did not support this proposal, we would like to emphasize that, while we recognize that the impact of COVID-19 has impacted the hospice community, we also believe that we have a responsibility to consumers to make informed decisions about selecting care. We discuss the impact to the OASIS and claims here, and discuss to the HH CAHPS further in section III.G. Claims are a rich and comprehensive source of many care processes and aspects of health care utilization. Commenters expressed concern that definitions were unclear. Denominator: The total number of all live discharge from the hospice within a reporting year. As required by OMB Circular A-4 (available at https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/circulars/A4/a-4.pdf), in Table 26, we have prepared an accounting statement showing the classification of the expenditures associated with the provisions of this final rule. This per diem payment is meant to cover all of the hospice services and items needed to manage the beneficiary's care, as required by section 1861(dd)(1) of the Act. 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). We will continue to evaluate the flexibilities to determine if additional changes are warranted in the future. Those hospices that fail to submit their aggregate cap determinations on a timely basis will have their payments suspended until the determination is completed and received by the Medicare contractor (79 FR 50503). Hospice providers must bill the correct rate for the appropriate period of routine home care days. 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. The purpose of this Change Request (CR) is to update the hospice payment rates, hospice wage index, and Pricer for FY 2023. Finally, the Home Health proposal would not change provider burden or costs since it only affects the number of quarters used in the calculation of certain claims-based measures for the public display for certain refresh cycles. for better understanding how a document is structured but The election statement addendum must include the following: (9) Name and signature of the individual (or representative) and date signed, along with a statement that signing this addendum (or its updates) is only acknowledgement of receipt of the addendum (or its updates) and not the individual's (or representative's) agreement with the hospice's determinations. Specifications for the ten indicators required to calculate the single HCI score are described in this section. Some commenters recommended that CMS align the late penalty for the addendum with the penalty for late submission of the NOE. These comments also suggested including these disciplines in future claims-based measures to recognize the multi-disciplinary nature of hospice care. 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. This final rule consists of approximately 72,000 words. Therefore, hospice providers with larger costs (reflecting larger utilization) would have a larger weight in the proposed labor shares. Public reporting with refreshed data will begin in January 2022. Comment: Several commenters stated that the CAHPS Hospice Survey is unlike other CAHPS surveys in that the respondents are family members or friends of the deceasednot the patients themselves. The comprehensive assessment includes all areas of hospice care related to the palliation and management of a beneficiary's terminal illness. However, as discussed in the CMS-10390 Supporting Statement published October 23, 2020 and HIS V3.00 approved by OMB on February 16, 2021, our analysis comparing HVWDII and HVLDL with CAHPS would recommend scores demonstrates that HVLDL results in higher validity and variability testing results compared to HVWDII. A summary of the comments we received on this proposal and our responses to those comments appear below. 52. Only official editions of the Such comparative star ratings, as proposed by CMS, help consumers identify high and low performing hospices. The final rule also finalizes a Home Health Quality Reporting Program (HH QRP) policy that becomes effective on October 1, The final rule (CMS-1754-F) can be downloaded from the, https://www.federalregister.gov/public-inspection, This rule also finalizes the addition of the Consumer Assessment of Healthcare Providers and Systems, The final rule ([CMS-1754-F)can be downloaded from the, https://www.federalregister.gov/public-inspection/current. Paragraph (b)(1) will include the existing language on the standardized set of admission and discharge items. (1) If the addendum is requested within the first 5 days of a hospice election (that is, in the first 5 days of the hospice election date), the hospice must provide this information, in writing, to the individual (or representative), non-hospice provider, or Medicare contractor within 5 days from the date of the request.