As stated in the FY 2022 Hospice proposed rule (86 FR 19718 through 19719) and above, for purposes of calculating the IRC and GIP compensation cost weights, we excluded providers that reported costs greater than zero on Worksheet A-3, column 7, line 25 (Inpatient CareContracted) for IRC and Worksheet A-4, column 7, line 25 (Inpatient CareContracted) for GIP. However, we found that using fewer than 8 quarters of data would have two important negative impacts on public reporting. 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. After the data extract is created after the 90-day run-off, it takes several months to incorporate other data needed for the calculations. This two-stage approach allows for calculation of stable cut-points that reflect the full range of hospice performance. The following sections provide the results of our testing and explain how we used the results to develop a plan that we believe allows us to achieve these objectives as best as possible. Methods that commenters or their organizations use in employing data to reduce disparities and improve patient outcomes, including the source(s) of data used, as appropriate. Each HCI indicator is scored based on comparative performance, with hospices receiving a point based on their performance relative to a national percentile threshold. 553 authorize the agency to waive these procedures, however, if the agency for good cause finds that notice and comment procedures are impracticable, unnecessary, or contrary to the public interest and incorporates a statement of the finding and its reasons in the rule issued. The interdisciplinary, holistic scope of the HIS Comprehensive Assessment Measure aligns with the public's expectations for hospice care. 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.). CMS also finalized a service intensity add-on (SIA) payment payable for certain services during the last 7 days of the beneficiary's life. Public Reporting of HIS-based Measures With Fewer Than Standard Numbers of Quarters Due to COVID-19 PHE Exemption in February 2022, (4). A summary of the comments we received on this proposal and our responses to those comments appear below: Comment: We received many comments supporting HH QRP reporting to resume beginning January 2022. In the FY 2020 Hospice Wage Index and Payment Rate Update final rule (84 FR 38484), we finalized the proposal to migrate our systems for submitting and processing assessment data. The statute defines the productivity adjustment to be equal to the 10-year moving average of changes in annual economy-wide private nonfarm business multifactor productivity (MFP). First, CMS codified the policy that if the National Quality Forum (NQF) made non-substantive changes to specifications for HQRP measures as part of the NQF's re-endorsement process, CMS would continue to utilize the measure in its new endorsed status, without going through new notice-and-comment rulemaking. Aide competency evaluations should be conducted in a way that identifies and meets training needs of the aide as well as the patient's needs. For the last six years, Medicare's Hospice Compare has served as the cornerstone for publicizing quality care information for patients, family caregivers, consumers, and the healthcare community. As discussed earlier, the HIS V3.00 PRA Submission, CMS-10390 (OMB control number: 0938-1153), finalized the proposal to replace the HVWDII measure pair with a re-specified version called HVLDL, which is a single measure based on Medicare claims. One commenter stated that it is difficult to attract nurses to their geographic area because of the increase in the median home price between January 2021 and May 2021. In that final rule, we noted that the procedures for HHAs to review and correct their data on a quarterly basis is performed through CASPER along with our procedure to post the data for the public on our Care Compare website. We finalized the FY 2020 proposal to reduce the RHC payment rates by 2.72 percent to offset the increases to CHC, IRC, and GIP payment rates to implement this policy in a budget-neutral manner in accordance with section 1814(i)(6) of the Act (84 FR 38496). Comment: The majority of commenters supported the removal of the seven HIS process measures no earlier than May 2022. (2020, March 27). 14. Until the ACFR grants it official status, the XML We identify skilled nursing visits and medical social service visits by the presence of revenue code 055x (Skilled Nursing) and 056x (Medical Social Services) on the claim. PDF Medicare Advantage Organizations (MAOs) - HHS.gov We further proposed to calculate a summary or overall CAHPS Hospice Survey Star Rating by averaging the Star Ratings across the 8 measures, with a weight of 1/2 for Rating of the Hospice, a weight of 1/2 for Willingness to Recommend the Hospice, and a weight of 1 for each of the other measures, and then rounding to a whole number. Obtaining the required signatures on the election statement has been a longstanding regulatory requirement. We may retain the November 2020 refresh for HVWDII Measure 1 for one or more refreshes in 2022, when there will be no HIS Section O data, if doing so will allow us to consolidate changes and thus operate more efficiently. In 2019, we added the Hospice Visits When Death is Imminent (Measure 1) to the website. The Meaningful Measure Initiative areas are intended to increase measure alignment across programs and other public and private initiatives. Currently, only Medicare-certified hospices with more than 20 patient stays each year have quality measure results publicly available on Care Compare. 19(6):681-687. doi:10.1634/theoncologist.2013-0457. Live discharges are assigned to a particular reporting period based on the date of the live discharge (which corresponds to the through date on the claim). They ask us to consider a more gradual transition to new quality initiatives, staggered and prioritized. Section 418.3 is amended by adding definitions for Pseudo-patient and Simulation in alphabetical order to read as follows: Pseudo-patient means a person trained to participate in a role-play situation, or a computer-based mannequin device. Hospice rates were to be updated by a factor equal to the inpatient hospital market basket percentage increase set out under section 1886(b)(3)(B)(iii) of the Act, minus 1 percentage point. Response: Similar to other CMS CAHPS star ratings, we propose that the cut-points used to determine CAHPS Hospice Survey stars be constructed using statistical clustering procedures that minimize the score differences within a star category and maximize the differences across star categories. 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). Any reduction based on failure to comply with the reporting requirements, as required by section 1814(i)(5)(B) of the Act, would apply only for the specified year. As with the NOE, the claims processing system must be notified of a beneficiary's discharge from hospice or hospice benefit revocation within 5 calendar days after the effective date of the discharge/revocation (unless the hospice has already filed a final claim) through the submission of a final claim or a Notice of Termination or Revocation (NOTR). We identify RHC days by the presence of revenue code 0651 on the hospice claim. In addition to Physician Administrative Services (line 15), we identified one additional overhead cost center where contract labor costs for patient care are reported and not reflected in the labor shares for each level of care: Nursing Administration (line 9). Fewer hospices, 2,328 (46.2 percent), would have had 30+ completes if 4 quarters of data were used to calculate scores and 1,970 (39.1 percent) would have 30+ completes if 3 quarters were used to calculate scores. If a hospice does not have enough survey completes to reliably measure performance, the star ratings would be picking up more noise than true performance. Comment: Many commenters expressed concern about the timeframe for implementing CAHPS Hospice Survey star ratings. As a result of this rule, the HQRP will contain four quality measures that capture care across the hospice stay, including a new measure called the Hospice Care Index. regulatory information on FederalRegister.gov with the objective of Star ratings benefit the public in that they can be easier for some to understand than absolute measure scores, and they make comparisons between hospices more straightforward. 29. The points are earned without weighting to recognize the tradeoffs for each indicator's specifications. The commenter claimed that the proposed methodology only captures salaries and benefits of physicians, nurse practitioners, RNs and hospice aides. These component indicators reflect various elements and outcomes of care provided between admission and discharge. CDT is a trademark of the ADA. Other patient care salaries are those salaries attributable to patient services including but not limited to patient transportation, labs, and imaging services. Recommendations for quality measures, or measurement domains that address health equity, for use in the HQRP. Consistent with the Meaningful Measure Initiative, we conducted a number of information gathering activities to identify informational gaps. The 'Wage Index' links contain the listing of Core Based Statistical Area (CBSA) codes and the corresponding wage index. End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). We observed that the quality data submission rate for Q4 2019 was in fact 0.4 percent higher than the previous calendar year (Q4 2018). The final FY 2022 hospice wage index will not include a cap on wage index decreases and would not take into account any geographic reclassification of hospitals, including those in accordance with section 1886(d)(8)(B) or 1886(d)(10) of the Act. This information will be published publicly on our website, such as Care Compare, in a manner that is easily accessible, readily understandable, and searchable no later than October 1, 2022. We also received six comments on the use of the labor share standardization factor including hospices, national industry associations. Hospice Aide Training and EvaluationUsing Pseudo-Patients, 3. Hospices are only considered compliant if they meet the standards for HIS and CAHPS reporting, as codified in 418.312. MedPAC. 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. Thus, these measure removal factors identify how measures are removed from the HQRP. However, in the preamble of the FY 2022 Hospice proposed rule (86 FR 19700) and in this final rule is a description for each indicator including the rationale, numerator, denominator, exclusion criterion, and data sources. Omnibus Budget Reconciliation Act of 1989, 8. In September 2020, we launched Care Compare, a streamlined redesign of eight existing CMS healthcare compare tools available on Medicare.gov, including Hospice Compare. This could include collecting information on race, ethnicity, and certain SDOH, including preferred language, interpreter services, health literacy, transportation and social isolation. 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. Live discharges occur when the patient discharge status code does not equal a value from the following list: 30, 40, 41, 42, 50, 51. 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. Prior to COVID-19 PHE, the CAHPS Hospice Survey publicly reported the most recent eight rolling quarters of data. Instead, progress on HCI will occur over longer time frames, and annual updates are sufficient to support hospices' efforts to improve. We will continue to evaluate the flexibilities to determine if additional changes are warranted in the future. Closing the Health Equity Gap in the Hospice Quality Reporting Program Request for Information (RFI). 100-04 Medicare Claims Processing Transmittal 10929, Change Request 12354 dated August 4, 2021. Further, the HIS Comprehensive Assessment Measure reflects the Hospice CoPs for comprehensive assessments performed at admission, which is a critical time to determine the plan of care. Background: COVID-19 Public Health Emergency Temporary Exemption and Its Impact on the Public Reporting Schedule, (2). documents in the last year, 19 Comment: Another specific concern raised by the commenters was that there are inconsistencies in reporting medical supply and pharmacy costs on line 10 and line 14 of Worksheet A. As a result of the changes mandated by Division CC, section 404 of the CAA 2021, we proposed conforming regulation text changes at 418.309 to reflect the new language added to section 1814(i)(2)(B) of the Act. In the FY 2020 Hospice Wage Index and Rate Update final rule (84 FR 38484), we finalized rebased payment rates for CHC and GIP and set those rates equal to their average estimated FY 2019 costs per day. Those excepted quarters cannot be publicly displayed and resulted in the freezing of the public display using Q1 2019 through Q4 2019 data for the refreshes that would have occurred from October 2020 through October 2021, as shown in Table 24. L. 105-33) provides that the area wage index applicable to any hospital that is located in an urban area of a state may not be less than the area wage index applicable to hospitals located in rural areas in that state. (3) For the CAHPS Hospice Survey, the Reference Year is the CY prior to the Data Collection Year. 0938-0758) for 2018. Federal government websites often end in .gov or .mil. We note that Q4 2019 ended before the onset of the COVID-19 PHE in the United States (U.S.). Response: As stated in the FY 2022 hospice proposed rule (86 FR 19717 through 19719) as well as above, we proposed that Direct patient care salaries and contract labor costs 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 (86 FR 19718). Journal of Pain and Symptom Management, 50, 548-552. doi: 10.1016/j.jpainsymman.2015.05.001. In effect, the hospice payment update percentage for FY 2022 is 2.0%. Under the Medicare hospice benefit, the election of hospice care is a patient choice and once a terminally ill patient elects to receive hospice care, a hospice interdisciplinary group is essential in the seamless provision of primarily home-based services. 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 this section, we presented three proposals related to calculating and reporting claims-based measures, with specific application to HVLDL and HCI. Response: We thank commenters for their support of this proposal on public reporting for refreshes affected by the exceptions. 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http://www.qualityforum.org/Publications/2020/02/MAP_2020_Considerations_for_Implementing_Measures_Final_Report_-_PAC_LTC.aspx, https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensions-quality-reporting-and-value-based-purchasing-programs.pdf, https://www.phe.gov/emergency/news/healthactions/section1135/Pages/covid19-13March20.aspx, http://medpac.gov/docs/default-source/reports/mar20_medpac_ch12_sec.pdf?sfvrsn=0. 661 0 obj <>stream (b) 40660 The SIA Claim may cover up to the last seven days of life and include the date of death. Many commenters stated that while the structure of the hospice benefit and approach to care at the end of life remain unchanged, changes in the characteristics of patients served (particularly the shift from predominantly cancer patients to those with end-stage neurological and other conditions) is largely responsible for driving changes in utilization trends and hospice practice over recent decades.
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hospice rates 2022 by county and cbsa