Comment: Many commenters offered suggestions regarding additional aspects of the election statement addendum for which we did not propose clarifying changes. NQF #1617 Patients Treated with an Opioid who are Given a Bowel Regimen, NQF #1647 Beliefs/Values Addressed (if desired by the patient). Having only the most recent data can also help incentivize hospices with lower scores to make changes and have the results of their effort be reflected in better scores. documents in the last year, 494 Specifically, we compared submission rates in Q4 2019 to average rates in other quarters to assess the extent to which HHAs had taken advantage of the exception, and thus the extent to which data and measure scores might be affected. and has been transmitted to the Congress and the Comptroller General for review. We count skilled nursing visits where the corresponding revenue center date overlaps with one of the days of RHC previously identified. Email | We found a stronger correlation coefficient with CAHPS would recommend scores for HVLDL than for HVWDII. One commenter also expressed a desire to include permanent telehealth provisions in the QRP, as that would help improve rural healthcare access. Hospice providers, must report HIS data used for the HIS Comprehensive Assessment Measure, in order to meet the requirements for compliance with the HQRP. Moreover, the current measure set does not directly address the full range of hospice services or outcomes. They commented that these data could be skewed by the public health emergency. Therefore, we are finalizing changes to permit skill competencies to be assessed by observing an aide performing the skill with either a patient or a pseudo-patient as part of a simulation. One commenter stated that the hospice per diem structure severely limits the amounts they can spend on staff. While CMS agrees that all patient visits are meaningful, based on our analyses, we found that RN and medical social worker visits correlate well with the CAHPS quality measures for would recommend the hospice. We also received several comments explaining the various EHR/HIT systems currently in use, as well as discussions surrounding health information exchange with other providers. A third commenter stated that topic-specific evaluations will significantly reduce time and allow hospices to concentrate on the specific deficient skills with additional practice and training. The commenter claimed that the proposed methodology only captures salaries and benefits of physicians, nurse practitioners, RNs and hospice aides. Other commenters stated that chaplain or spiritual services may be as important to patients as nursing services. Hospices would need to make sure the date furnished' on the addendum is within the required timeframe (3 or 5 days, depending upon when the request was made). The ten indicators, aggregated into a single HCI score, convey a broad overview of the quality of the provision of hospice care services and validates well with CAHPS Willingness to Recommend and Rating of this Hospice. 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). Our proposal for using the 90-day run-off strikes a balance between allowing time for hospices to make corrections to their claims, while also seeking to post more rather than less up-to-date information. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. 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. For example, for the Home Health QRP, we finalized the Potentially Preventable 30-Day Post-Discharge Readmission Measure in the CY 2017 Home Health QRP Rule (81 FR 76770 through 76775) for reporting with three consecutive years of claims data beginning with the CY 2018 Home Health QRP. 0938-0758). Comment: One commenter recommended CMS institute a policy that no hospice be paid below the rural floor for their state, allow hospices and other post-acute providers to utilize a reclassification board similar to hospitals, and consider working with the Congress on policies to reform the wage index such as revisiting MedPAC's 2007 proposal which recommended that the Congress repeal the existing hospital wage index statute, including reclassifications and exceptions, and give the Secretary authority to establish new wage index systems. However, the prohibition does not pertain to the provision of an item or service for the purpose of alleviating pain or discomfort, even if such use may increase the risk of death, so long as the item or service is not furnished for the specific purpose of causing or accelerating death. The RFA requires agencies to analyze options for regulatory relief of small businesses if a rule has a significant impact on a substantial number of small entities. Because we excepted HHAs from the HH QRP reporting requirements for Q1 and Q2 2020, we did not use OASIS, claims, or HH CAHPS data from these quarters. (3) A measure does not align with current clinical guidelines or practice. Future updates and engagement opportunities regarding HOPE can be found at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/HOPE.html. We received several comments from various stakeholders on this proposal. 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. 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. National Quality Forum. Comment: One commenter stated that many of the hospice cost reports filed in 2018 failed to report contracted GIP days and contracted IRC care days on Worksheet S-1. (3) For the CAHPS Hospice Survey, the Reference Year is the CY prior to the Data Collection Year. We tabulate the resulting payments according to the classifications (for example, provider type, geographic region, facility size), and compare the difference between current and future payments to determine the overall impact. We will continue to take all concerns, comments, and suggestions into consideration for future development and expansion of our health equity quality measurement efforts. For this final rule, based on IHS Global Inc.'s (IGI) second quarter 2021 forecast with historical data through the first quarter 2021 of the inpatient hospital market basket update, the market basket percentage increase for FY 2022 is 2.7 percent. Enhancements for mobile use will give practical benefits like accessing the tool using a smartphone that can initiate phone calls to providers simply by clicking on the provider's phone number. Thirty-one unique stakeholders submitted their comments on the proposed clarifications to the election statement addendum. 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. Condition of participation: Hospice aide and homemaker services. We also do not believe it would be appropriate to allow hospices to opt for or be assigned a higher CBSA designation based on subdivided metropolitan divisions. During measure testing, we observed that hospices achieved scores between three and ten. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/index. 10. We also discussed developing the Hospice Outcomes & Patient Evaluation (HOPE), a new patient assessment instrument that is planned to replace the HIS. Comment: A few commenters supported the proposal to rebase the labor share for the four levels of care based on the 2018 MCR data. One commenter also stated that they were interested in how the percentage of hospices that operate inpatient facilities can be increased and all costs, including contracted costs, can be included. 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. Because the indicators comprising the HCI differ in data source from the HIS Comprehensive Measure, the HCI and the HIS Comprehensive Measure can together provide a meaningful and efficient way to inform patients and family caregivers while supporting their selection of hospice care providers. We adopted 8 survey based measures for the CY 2018 data collection period and for subsequent years. 3. Medicare Payment Advisory Commission. L. 113-185), we sought comment on the possibility of revising measure development, and the collection of other data that address gaps in health equity in HQRP (86 FR 19766). Several commenters indicated that the changes will facilitate a more time-efficient process in the evaluation of aide skills. In addition, in that final rule, we implemented a SIA payment for RHC when direct patient care is provided by an RN or social worker during the last 7 days of the beneficiary's life. We are finalizing the labor portion of the payment rates to be for CHC, 75.2 percent; for RHC, 66.0 percent; for GIP, 63.5 percent; and for IRC, 61.0 percent. It is projected that aggregate payments would increase by 2.0 percent; assuming hospices do not change their billing practices.
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