hospice rates 2022 by county and cbsa

All refreshes, during which we decided to hold this 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. We also received some comments which expressed that standardized data elements for patient assessment does not currently capture the current understanding of SDOH. However, population-based measures such as indicators on the HCI allow for hospice variation for an indicator while offering opportunities to earn points on other indicators. If the CAHPS Data Collection year is CY 2022, then the HIS reporting year is also CY 2022. These specifications list all the information required to calculate each indicator, including the numerator and denominator definitions, different thresholds for receiving credit toward the overall HCI score, and explanations for those thresholds. One commenter stated that the service intensity add-on (SIA) payment has been one of the greatest improvements in the hospice benefit in recent years. The indicators required to calculate the single composite are discussed in the Specifications for the HCI Indicators Selected section. Using the most recent complete data available at the time of rulemaking, in this case FY 2020 hospice claims data as of January 15, 2021, we apply the current FY 2021 wage index with the current labor shares. To maintain budget neutrality, as required under section 1814(i)(6)(D)(ii) of the Act, the new RHC rates were adjusted by a service intensity add-on budget neutrality factor (SBNF). The HCI will help to identify whether hospices have aggregate performance trends that indicate higher or lower quality of care relative to other hospices. For purposes of the RFA, we consider all hospices as small entities as that term is used in the RFA. Section 1871(b)(2)(C) of the Act and 5 U.S.C. We proposed to use a two-stage approach to calculate these cut-points. #2158 Payment-Standardized Medicare Spending Per Beneficiary (MSPB). For further information about the CAHPS Hospice Survey, we encourage hospices and other entities to visit: https://www.hospiceCAHPSsurvey.org. . The commenter stated that they understand that this reporting is inaccurate; however, there is no existing Level 1 edit that would catch it. In the first stage, we would determine initial cut-points by calculating the clustering algorithm among hospices with 30 or more completed surveys over 2 quarters (that is, 6 months); restricting these calculations to hospices that meet a minimum sample size promotes stability of cut-points. Omnibus Budget Reconciliation Act of 1989, 8. 0938-0758) for 2018. IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. The President of the United States issues other types of documents, including but not limited to; memoranda, notices, determinations, letters, messages, and orders. Comment: Several commenters requested that CMS communicate widely and display prominently notices and information about the increase in the penalty for failure to comply with HQRP requirements. 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. Comment: A few commenters requested more details about if and how we will include patient-mix adjustment. Comment: One specific concern of the commenters regarding the proposed methodology was on the data used from Worksheet A-1 and A-2 column 7, lines 26 through 37 for total labor costs associated with each respective level of care. 2. 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. Each indicator equally affects the single HCI score, reflecting the equal importance of each aspect of care delivered from admission to discharge. Over 93 percent of hospices remain in the same quintile, suggesting that the ranking of hospices is fairly stable between the SPR and CAR scenarios. In that same final rule, we discussed that we will issue public notice, through rulemaking, of measures under consideration for removal, suspension, or replacement. The Division will reimburse the hospice provider an inpatient per diem rate for routine home care and continuous home care days of service that are furnished to a hospice resident living in a nursing facility. 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. Catherine Howden, DirectorMedia Inquiries Form Response: We appreciate the commenters highlighting the use of pseudo-patients and simulation techniques in other healthcare setting and agree that the use of these techniques is standard of practice in many formal nursing assistant programs. Specifically, they contain information on utilization, payment (Medicare payment and standard payment), submitted charges, primary diagnoses, sites of service, and beneficiary demographics organized by CCN (6-digit provider identification number) and state. These changes included a new condition for payment requiring a hospice, upon request, to provide the beneficiary (or representative) an election statement addendum (hereafter called the addendum) outlining the items, services, and drugs that the hospice has determined are unrelated to the terminal illness and related conditions. Table 24 summarizes this discussion. 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. For example, the commenters provided that some hospices track mileage allowances enabling them to be reported on Worksheet A-1 and A-2 while other hospices allocate these mileage reimbursement costs via Worksheet B and B-1 using miles traveled. Third, we estimated reliability scores. In the FY 2008 Hospice Wage Index final rule (72 FR 50217 through 50218), we implemented a methodology to update the hospice wage index for rural areas without hospital wage data. Report to Congress: Medicare Payment Policy (March 2019) MEDPAC. Application of the COVID-19 PHE Affected Reporting (CAR) Scenario To Publicly Display Certain HH QRP Measures (Beginning in January 2022 Through July 2024), 6. 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. We encourage hospices who want to use CAHPS data for quality improvement to talk to their vendors about the reports and data that may be available shortly after data collection. Therefore, the hospice payment update percentage for FY 2022, based on more recent data, is 2.0 percent. This final regulation is subject to the Congressional Review Act provisions of the Small Business Regulatory Enforcement Fairness Act of 1996 (5 U.S.C. 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. We are finalizing our proposal to remove the seven HIS process measures from the HQRP as individual measures, and no longer applying them to the FY 2024 APU and thereafter. In the FY 2021 Hospice Wage Index final rule (85 FR 47070) we stated that if appropriate, we would propose any updates from OMB Bulletin No. We discuss the impact to the OASIS and claims here, and discuss to the HH CAHPS further in section III.G. These other settings utilize a clustering algorithm such that providers within a cluster are more alike than providers across clusters. Background: COVID-19 Public Health Emergency Temporary Exemption and Its Impact on the Public Reporting Schedule, (2). These evaluations are a critical part of providing safe, quality care. We received many comments about the HOPE update. The utilization and application of these waivers pushed us to consider whether permanent changes would be beneficial to patients, providers, and professionals. of delivery would work best in furnishing the addendum. Response: We will ensure that the confidential QM reports continue to include the seven HIS process measures, in addition to the HIS Comprehensive Assessment Measure. 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. In addition to the hospice payment reform changes discussed, the FY 2016 Hospice Wage Index and Rate Update final rule implemented changes mandated by the IMPACT Act, in which the cap amount for accounting years that end after September 30, 2016 and before October 1, 2025 would be updated by the hospice payment update percentage rather than using the CPI-U (80 FR 47186). We will continue to engage all stakeholders throughout this process. Response: We appreciate the commenters' support for this proposal. Notice and comment are unnecessary because we are conforming the regulation to statute and there is no discretion on the part of the Secretary. Kehl, K.A., et al. Further information about these requirements may be found at: http://www.hhs.gov/ocr/civilrights. Registered Nurses Did Not Always Visit Medicare Beneficiaries Homes at Least Once Every 14 Days to Assess the Quality of Care and Services Provided by Hospice Aides. We also appreciate the concern that we avoid duplicating measures in the development of new measures based on assessment data, claims, or other available data sources. We tentatively plan to rebase the hospice labor shares on a similar schedule as the other payment systems under Medicare. In accordance with the provisions of Executive Order 12866, this regulation was reviewed by OMB. 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. Alcona County or Statistical Equivalent Lake Erie Coastline CBSA boundaries and names are as of February 2013. For example, Gaps in Skilled Nursing Visits have a criterion of lower than the 90th percentile, and supports the hospice CoPs that require an assessment of the patient and caregiver needs as well as Start Printed Page 42557implementation of the plans of care. We count skilled nursing visits where the corresponding revenue center date overlaps with one of the days of RHC previously identified. The final definitions are as follows: These changes will allow hospices to utilize pseudo-patients, such as a person trained to participate in a role-play situation or a computer-based mannequin device, instead of actual patients, in the competency testing of hospice aides for those tasks that must be observed being performed on a patient. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a MSA and has fewer than 100 beds. As stated previously, we will continue to monitor the labor shares over time and propose revisions to these shares to reflect a more recent cost structure and mix of providers. We used 10 quarters of HH QRP data from CY 2017 to 2019 to calculate the CAR scenario for the potentially preventable readmissions claims-based measure. Specifically, the Act requires that, beginning with FY 2014 through FY 2023, the Secretary shall reduce the market basket update by 2 percentage points and beginning with the FY 2024 APU and for each subsequent year, the Secretary shall reduce the market basket update by 4 percentage points for any hospice that does not comply with the quality data submission requirements for that FY. We will continue to apply ideas shared by the Caregiver Workgroup participants as we refine plans for the measure's public display to minimize the risk of misinterpretation. Comment: Many commenters expressed concern about the timeframe for implementing CAHPS Hospice Survey star ratings. 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. provide legal notice to the public or judicial notice to the courts. Accessed June 13, 2021. Therefore, the HIS Comprehensive Assessment Measure continues to encourage hospices to improve and maintain high performance in all seven processes simultaneously, rather than rely on its component measures to demonstrate quality hospice care in a way that may be hard to interpret for consumers. This information will help consumers understand relative performance at national and local levels in light of the COVID-19 PHE. They stated that the number of hospices that do not pass level 1 edits is also of concern. 23. As we prepare to update Care Compare for their removal, we will consider ways to revise the measure description for the HIS Comprehensive Measure on Care Compare so that it adequately explains the elements contained in the measure. We appreciate the industry's and national associations' engagement in providing input through information sharing activities, including listening sessions, expert interviews, key stakeholder interviews, and focus groups to support HOPE development. A summary of the comments we received and our responses those comments are below: Comment: Several comments support the re-specified HVLDL claims-based measure and the resulting reduction of burden, but expressed concern that the measure is limited to RN and medical social worker. 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. FY 2022 Routine Annual Rate Setting Changes. We found a stronger correlation coefficient with CAHPS would recommend scores for HVLDL than for HVWDII. These raw wage index values are subject to application of the hospice floor to compute the hospice wage index used to determine payments to hospices. GIP must be provided in a Medicare-certified hospice freestanding facility, skilled nursing facility, or hospital. informational resource until the Administrative Committee of the Federal In addition, section 407(a)(2) of the CAA 2021 removes the prohibition on public disclosure of hospice surveys performed be a national accreditation agency in section 1865(b) of the Act, thus allowing the Secretary to disclose such accreditation surveys. Response: As stated in the proposed rule, we will display CAHPS Hospice Survey star ratings no sooner than FY 2022. This single measure differentiates hospices and holds them accountable for completing all seven process measures to ensure core services of the hospice comprehensive assessment are completed for all hospice patients. Additionally, the rule finalizes the addition of the claims-based Hospice Visits in the Last Days of Life (HVLDL) measure for public reporting, which supports patient empowerment and transparency of hospice performance. We proposed and finalizing in the rule to begin reporting this measure using existing data items no earlier than May 2022. MedPAC. CBSA Code CBSA Name CBSA Type; 10100: Aberdeen, SD: Micropolitan: 10140: Aberdeen, WA: Micropolitan: 10180: Abilene, TX: Metropolitan: 10220: Ada, OK: Micropolitan: 10260 Using percentile rankings derived from national performance, it is very unlikely for all hospices to receive the same score. 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. The SBNF is used to reduce the overall RHC rate to ensure that SIA payments are budget-neutral. This means that we will no longer report HVWDII with patient stays and will start publicly reporting HVLDL no earlier than May 2022. [4] In order to be counted, the from date of the hospitalization had to occur no more than 2 days after the date of hospice live discharge.

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