hospice rates 2022 by county and cbsa

edition of the Federal Register. Each indicator equally affects the single HCI score, reflecting the equal importance of each aspect of care delivered from admission to discharge. Response: We appreciate the commenters request for future changes to the hospice cost report to allow us to better isolate costs of those facilities that operate an inpatient unit. All refreshes, during which we decided to hold these data constant, included more than 2 quarters of data that were affected by the CMS-issued COVID reporting exceptions; thus we did not have an adequate amount of data to reliably calculate and publicly display provider measures scores. The commenter stated that they would become concerned, for instance, if data indicates that some providers offer significantly fewer hours of professional interdisciplinary team (IDT) care yet make up a disproportionate percentage of providers filing cost reports. Part 418, subpart G, provides for a per diem payment based on one of four prospectively-determined rate categories of hospice care (routine home care (RHC), CHC, IRC, and GIP), based on each day a qualified Medicare beneficiary is under hospice care (once the individual has elected). It more closely aligns with the intent of the Hospice CoPs at Title 42 Part 418.54 that require a comprehensive assessment on each patient. Numerator: The total number of live discharges from the hospice occurring on or after 180 days of enrollment in hospice within a reporting period. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Notice and comment are unnecessary because we are conforming the regulation to statute and there is no discretion on the part of the Secretary. Executive Orders 12866 and 13563 direct agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). While we acknowledge that hospice providers can use different methodologies for reporting data, we believe that our proposed methodology allows for these differences and still results in a reasonable and accurate measure of the cost structures of hospice facilities. If you are using public inspection listings for legal research, you 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. legal research should verify their results against an official edition of This public reporting threshold protects the privacy Start Printed Page 42585of patients who seek care at smaller hospices. First, we are finalizing our proposal to extract claims data to calculate claims-based measures at least 90 days after the last discharge date in the applicable period, which we will use for quality measure calculations and public reporting on Care Compare. In the FY 2021 Hospice Wage Index and Payment Rate Update final rule, we addressed a concern regarding a potential situation wherein the beneficiary or representative refuses to sign the addendum (85 FR 47088). These costs are further subdivided into labor and non-labor costs. Additionally, we are finalizing as proposed at 418.3 the definitions of pseudo-patient and simulation. For more information about HQRP Requirements, please visit the frequently-updated HQRP website and especially the Best Practice, Education and Training Library, and Help Desk web pages at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Start Printed Page 42577Quality-Reporting. We are finalizing the following revisions to the hospice CoPs. Therefore, we proposed to clarify in regulation that the date furnished must be within the required timeframe (that is, 3 or 5 days of the beneficiary or representative request, depending on when such request was made), rather than the signature date. One commenter recommended that CMS explore ways to educate hospice providers about how they can inform their beneficiaries (or representative) when items, services, or drugs are considered related, but non-covered due to reasons such as not reasonable or necessary for the palliation and management of the terminal illness and related conditions. Response: We appreciate commenters' concerns that hospice providers continue to recognize and address the unique circumstances of hospice patients. We proposed and are finalizing these changes to remove the seven HIS process measures as individual measures from HQRP no earlier than May 2022. We believe that a signed addendum indicates the hospice discussed the addendum and its contents with the beneficiary (or representative). https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensions-quality-reporting-and-value-based-purchasing-programs.pdf. The utilization and application of these waivers pushed us to consider whether permanent changes would be beneficial to patients, providers, and professionals. Table 7 indicates the number of hospice days, hospice claims, beneficiaries enrolled in hospices and hospices with at least one claim represented in each year of our analysis. The 'Wage Index' links contain the listing of Core Based Statistical Area (CBSA) codes and the corresponding wage index. A no answer would require reporting contracted days and contracted costs or produce a Level 1 edit. We identify RHC days by the presence of revenue code 0651 on the hospice claim. (1) The relevant Reporting Year, payment FY and the Reference Year. 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. Our proposal to adopt the CAR scenario for the January 2022 refresh would allow us to begin displaying recent data in January 2022, rather than continue displaying October 2020 data (Q1 2019 through Q4 2019). Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. Note: The comment period closes on August 27, 2021. Specifically, we used historical data to calculate HIS-based quality measures under two scenarios: The HIS Comprehensive Assessment Measure is based on the receipt of care processes at the time of admission. Response: We recognize commenters' concern that HQRP measures reflect quality of care rather than program integrity issues. A minimum of 8 hours of nursing care, or nursing and aide care, must be furnished on a particular day to qualify for the continuous home care rate (418.302(e)(4)). Office of Analytics and Program Improvement, Medicaid Promoting Interoperability Program. Assuming an average reading speed of 250 words per minute, it would take approximately 2.4 hours for the staff to review half of it. This timeframe is based on the CY. We are also proposing in this rule to adopt the HCI into the HQRP for FY2022. 7. Journal of Hospice & Palliative Nursing: December 2018Volume 20Issue 6p 507. Table 11 summarizes the three timeframes. An official website of the State of Georgia. For each hospice that reviews the rule, the estimated cost is $274.18 (2.4 hour $114.24). No fee schedules, basic unit, relative values or related listings are included in CPT. Final Decision: We are finalizing our proposal to publicly report the most-recently available 8 quarters of CAHPS data starting with the February 2022 refresh and going through the May 2023 refresh on Care Compare because we cannot publicly report Q1 2020 and Q2 2020 data due to the COVID-19 PHE. documents in the last year, 887 We also stated if more recent data became available after the publication of the proposed rule and before the publication of the final rule (for example, more recent estimates of the inpatient hospital market basket update and/or productivity adjustment), we would use such data to determine the hospice payment update percentage for FY 2022 in the final rule. However, section 1814(i)(5)(D)(ii) of the Act provides that in the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical measure has not been endorsed by the consensus-based entity, the Secretary may specify measures that are not endorsed, as long as due consideration is given to measures that have been endorsed or adopted by a consensus-based organization identified by the Secretary. Finally, the NQF Measures Application Partnership (MAP) met on January 11, 2021 and provided input to CMS. If the CAHPS Data Collection year is CY 2022, then the HIS reporting year is also CY 2022. The final hospice rate increase for FY 2022 is 2.0%. MedPAC explains their rationale for including all discharge as follows:[23], Some stakeholders argue that live discharges initiated by the beneficiarysuch as when the beneficiary revokes his or her hospice enrollmentshould not be included in a live-discharge measure because, some stakeholders assert, these discharges reflect beneficiary preferences and are not in the hospice's control. This measure helps to ensure all hospice patients receive a holistic comprehensive assessment. The costs associated with a measure outweighs the benefit of its continued use in the program. Claims data are readily available and eliminates provider burden for implementation, as opposed to data collection through patient assessments or surveys, which require additional effort from clinicians, patients, and family caregivers before they can be submitted and used by CMS. We have communicated our public display schedule, which supports our Public Display Policy, on our websites whereby the quarters of data included are announced. 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. Public Display of Quality Measures and Other Hospice Data for the HQRP, b. For each scenario, we calculated the reportability as the percent of hospices meeting the 20-case minimum for public reporting (the public reporting threshold). Finally, we proposed to publish the details of the Star Ratings methodology on the CAHPS Hospice Survey website, www.hospicecahpssurvey.org. From there, we found all beneficiaries that ended their hospitalization and were readmitted back to hospice no more than 2 days after the last date of the hospitalization. In Paperwork Reduction Act package (PRA), CMS-10390 (OMB control number: 0938-1153), we provided the HVLDL specifications and also proposed to replace the HVWDII measure pair with the HVLDL. We appreciate the concern that consumers may not know about the component measure scores in the Provider Data Catalogue. Furthermore, we believe 3 calendar days, rather than 3 business days continues to be appropriate, as hospice care is provided around the clock rather than only during business days and hours. Additionally, during the summer of 2020, CMS convened five listening sessions with national hospice provider organizations to discuss the HCI concept with the goals of engaging stakeholders and receiving feedback early in the measure's development. 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). The FY 2022 Hospice final rule revised the labor shares used to wage-adjust hospice payments for each level of care. Response: We appreciate the support for this comment and agree that a targeted approach is both more efficient and will permit greater focus on remediating the deficient skills. HOPE will include key items from the HIS and demographics like gender and race. We maintain transparency since Start Printed Page 42584stakeholders, who are interested in the seven HIS measures, will have access to the Provider Data Catalogue where they can find all HIS component measure scores. It will assess patients in real-time, based on interactions with the patient. We solicited public comment on the aforementioned HOPE- and claims-based quality measures to distinguish between high- and low-quality hospices, support healthcare providers in quality improvement efforts, and provide support to hospice consumers in helping to select a hospice provider. In contrast, the HIS Comprehensive Assessment Measure shows that hospices need to improve on providing a comprehensive set of assessments on each patient at admission and supports why it continues to be a useful HQRP measure. The hospice wage index is used to adjust payment rates for hospices under the Medicare program to reflect local differences in area wage levels, based on the location where services are furnished. 19(6):681-687. doi:10.1634/theoncologist.2013-0457. 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. Hospice Rates for Providers that Have Submitted the Required Quality Data Federal Fiscal Year 2021 Effective October 1, 2020 County Name County Number CBSA These services are paid directly to the provider physician. Hospice providers, must report HIS data used for the HIS Comprehensive Assessment Measure, in order to meet the requirements for compliance with the HQRP. Then, for each level of care separately, we further trimmed the sample of cost reports. 1503 & 1507. The need for the information collection and its usefulness in carrying out the proper functions of our agency. Submit Online Form. We are concerned hospices believe HCI may incentivize hospices to standardize the types or amount of services provided to patients and not individualize beneficiary care on a case-by-case basis at the end of life. Unlike inpatient prospective payment system (IPPS) hospitals, inpatient rehabilitation facilities (IRFs), and skilled nursing facilities . Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen. 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. To assess performance in these scenarios, we calculated the reportability as the percent of HHAs meeting the 20-case minimum for public reporting (the public reporting threshold, or PRT). In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues: We are revising the provisions at 418.306(b)(2) to change the payment reduction for failing to meet hospice quality reporting requirements from 2 to 4 percentage points. We previously finalized survey participation requirements for FY 2022 through FY 2025 as stated in the FY 2018 and FY 2019 Hospice Wage Index and Payment Rate Update final rules (82 FR 36670 and 83 FR 38642 through 38643). Proposal for Public Reporting of CAHPS Hospice Survey-based Measures Due to COVID-19 PHE Exemption, c. Quality Measures To Be Displayed on Care Compare in FY 2022 and Beyond, (1). All other boundaries and names are as of January 1, 2012. 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. While changing the data included in claims is outside the scope of this proposed measure, we believe that using the claims data that currently exists still provides new and useful information not currently available to patients, families, and caregivers with the existing HQRP measures. Taking this public feedback into consideration, we designed the HCI and developed specifications based on simulated reporting periods. To calculate the percentage, for each hospice we divided the number of live discharges that are followed by a hospitalization (within 2 days of hospice discharge) and then followed by a hospice readmission (within 2 days of hospitalization) in a given reporting period by the number of live discharges in that same period. This tool is intended to help hospices better understand care needs throughout the patient's dying process and contribute to the patient's plan of care. MedPAC also recommended wage adjusting the hospice cap amount to make it more equitable across providers. Hybrid quality measures allow for a more comprehensive set of information about care processes and outcomes than cannot be calculated using claims data alone. 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. Hospices comply by utilizing a CMS-approved third-party vendor. CY 2022 data submissions compliance impacts FY 2024 APU. 12. the Medicare Payment Advisory Commission,[414243] by peer reviewed articles, and our technical expert panel (TEP). Response: CMS analyzed existing data to inform the development of star ratings in the hospice setting. CMS currently publishes CAHPS star ratings for several of its public reporting programs including Home Health CAHPS and Hospital CAHPS. 4. Table 1: 2023 Medicaid Hospice Rates for Routine Home Care (including the service intensity . We describe our proposed methodology for deriving the compensation cost weights for each level of care using the MCR data below as well as a summary of the comments received and our responses. Therefore using 3 quarters of data for the HIS Comprehensive Assessment Measure would achieve acceptable reportability shown in Table 14. 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. As of December 2020, the data is no longer reported on the www.medicare.gov' s Home Health Compare website. One way to approach this would be to use state survey data to identify hospices that are deficient and do not have contracts to provide GIP. For certain claims-based measures, we will use three quarters rather than four quarters of data for refreshes between January 2022 and July 2024. Rolling up eight quarters of data instead of four ensures that measure scores are available for many more hospices, which improves the usefulness of the Compare web tools for hospice consumers. http://medpac.gov/docs/default-source/reports/mar20_medpac_ch12_sec.pdf. Medscape Nurses. Many commenters recommended that CMS modify the SIA payments to include any visits which could be counted toward end-of-life care, not just skilled visits (for example, chaplain and spiritual care or hospice aide). This estimate is based on the data for 4,995 hospices in our impact analysis file, which was constructed using FY 2020 claims available in May 2021. HOPE will support quality improvement activities and calculate outcome and other types of quality measures in a way that mitigates burden on hospice providers and patients. 04/28/2023, 858 After pooling data using FY 2018 to FY 2019, 326 additional hospices met the reportability threshold, or 33.8 percent of those previously missing. The HOPE tool is now under development. In addition, Table 18 shows the proposed CAHPS public reporting schedule during and after the data freeze. We have reviewed this rule under these criteria of Executive Order 13132, and have determined that it will not impose substantial direct costs on state or local governments. Thus, it is important that hospices ensure the completeness and correctness of their claims prior to the claims snapshot.. Hospice Utilization and Spending Patterns, 2. Palliative & Supportive Care, 13(2): 211-216. doi: 10.1017/S1478951513001144. While we acknowledged in that rule the limitations with using claims data as a source for measure development, there are several advantages to using claims data as part of a robust HQRP as discussed previously in the FY 2020 rule. on Response: We appreciate commenters' concerns about publicly reporting claims from the COVID-19 PHE. Another exclusion was made prior to reporting the numbers in Table B.1. Federal Register issue. CAHPS Hospice Survey to examine alignment between the survey outcomes and the HCI. As such, the implementation of these clarifications on October 1, 2021 would not cause a burden for software updates. We proposed to use the CAR scenario for the last of the refreshes affecting OASIS-based measures, which will occur in January 2022. The commenter stated that this disregards the essence of the hospice interdisciplinary team which cares for the patient and family as a unit of care. !Y,$d Ezg`"LA$' Furthermore, the person-centered, family, and caregiver perspective align with the domains identified by the CoPs and the National Consensus Project[8] The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. as patients and their family caregivers also place value on physical symptom management and spiritual/psychosocial care as important factors at the end-of-life. Hospice payments per beneficiary are determined by summing together all payments on hospice claims for a particular reporting year for a particular hospice. Many waivers and modifications were made effective as of March 1, 2020 in accordance with the President's declaration.[51]. Teno J.M., Bowman, J., Plotzke, M., Gozalo, P.L., Christian, T., Miller, S.C., Williams, C., & Mor, V. (2015). publication in the future. Chapter 11: Hospice Services. 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). Table 18 specifies the quarters for each refresh. While nothing in the COPs prevent hospices from augmenting in-person visits with technological means, such as telehealth, these are not intended to change the standard of practice or replace in-person visits. FY 2017 Hospice Wage Index and Payment Rate Update Final Rule, 11.

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