Medicare Program; FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements
SUMMARY: This final rule will update the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2018. Additionally, this rule includes new quality measures and provides an update on the hospice quality reporting program.
EFFECTIVE DATE: These regulations are effective on
FOR FURTHER INFORMATION CONTACT:
For general questions about hospice payment policy, please send your inquiry via email to: [email protected].
SUPPLEMENTARY INFORMATION: Wage index addenda will be available only through the internet on the CMS Web site at: (http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/index.html.)
Table of Contents
I. Executive Summary
A. Purpose
B. Summary of the Major Provisions
C. Summary of Impacts
II. Background
A.
B. History of the Medicare Hospice Benefit
C. Services Covered by the Medicare Hospice Benefit
D. Medicare Payment for Hospice Care
1. Omnibus Budget Reconciliation Act of 1989
2. Balanced Budget Act of 1997
3. FY 1998 Hospice Wage Index Final Rule
4. FY 2010 Hospice Wage Index Final Rule
5. The Affordable Care Act
6. FY 2012 Hospice Wage Index Final Rule
7. FY 2015 Hospice Wage Index and Payment Rate Update Final Rule
8. IMPACT Act of 2014
9. FY 2016 Hospice Wage Index and Payment Rate Update Final Rule
10. FY 2017 Hospice Wage Index and Payment Rate Update Final Rule
E. Trends in Medicare Hospice Utilization
III. Provisions of the Final Rule
A. Monitoring for Potential Impacts--Affordable Care Act Hospice Reform
B. FY 2018 Hospice Wage Index and Rates Update
1. FY 2018 Hospice Wage Index
2. FY 2018 Hospice Payment Update Percentage
3. FY 2018 Hospice Payment Rates
4. Hospice Cap Amount for FY 2018
C. Discussion Regarding Sources of Clinical Information for Certifying Terminal Illness
D. Updates to the Hospice Quality Reporting Program (HQRP)
1.
2. General Considerations Used for Selection of Quality Measures for the HQRP
3. Policy for Retention of HQRP Measures Adopted for Previous Payment Determinations
4. Policy for Adopting Changes to Previously Adopted Measures
5. Previously Adopted Quality Measures for FY 2018 Payment Determination and Future Years
6. Removal of Previously Adopted Measures
7. Measure Concepts Under Consideration for Future Years
8. Form, Manner, and Timing of Quality Data Submission
a. Background
b. Policy for New Facilities To Begin Submitting Quality Data
c. Previously Finalized Data Submission Mechanisms, Timelines, and Deadlines
d. New Data Collection and Submission Mechanisms Under Consideration: Hospice Evaluation & Assessment Reporting Tool (HEART)
9. Previously Adopted APU Determination and Compliance Criteria for the HQRP
a. Background
b. Previously Finalized HIS Data Submission Timelines and Compliance Thresholds for FY 2018 Payment Determination and Subsequent Years
c. CAHPS(R) Participation Requirements for FY 2018 APU Determination and Determinations for Subsequent Years
10. HQRP Submission Exemption and Extension Requirements for the FY 2019 Payment Determination and Subsequent Years
a. Extraordinary Circumstances Exemption and Extension
b. Volume-Based Exemption for CAHPS(R) Hospice Survey Data Collection and Reporting Requirements
c. Newness Exemption for CAHPS(R) Hospice Survey Data Collection and Reporting Requirements
11. CAHPS(R) Hospice Survey Participation Requirements for the FY 2020 APU and Subsequent Years
a. Background and Description of the CAHPS(R) Hospice Survey
b. Overview of Proposed Measures
c. Data Sources
i. Requirements for the FY 2020 Annual Payment Update
ii. Requirements for the FY 2021 Annual Payment Update
iii. Requirements for the FY 2022 Annual Payment Update
d. Measure Calculations
i. Composite Survey-Based Measures
ii. Global Survey-Based Measures
iii. Cohort
e. Risk Adjustment
i. Patient-Mix Adjustment
ii. Mode Adjustment
f. For Further Information About the CAHPS(R) Hospice Survey
12. HQRP Reconsideration and Appeals Procedures for the FY 2018 Payment Determination and Subsequent Years
13. Confidential Feedback Reports
14. Public Display of Quality Measures and Other Hospice Data for the HQRP
IV. Collection of Information Requirements
A. Hospice Item Set
B. Summary of CAHPS(R) Hospice Survey Information Collection Requirements (OMB Control Number 0938-1257)
V. Regulatory Impact Analysis
A. Statement of Need
B. Overall Impacts
C. Anticipated Effects
D. Detailed Economic Analysis
E. Accounting Statement
F. Reducing Regulation and Controlling Regulatory Costs
G. Conclusion
Acronyms
Because of the many terms to which we refer by acronym in this final rule, we are listing the acronyms used and their corresponding meanings in alphabetical order:
APU Annual Payment Update
ASPE Assistant Secretary of Planning and Evaluation
BBA Balanced Budget Act of 1997
BIPA Benefits Improvement and Protection Act of 2000
BNAF Budget Neutrality Adjustment Factor
CAHPS(R) Consumer Assessment of Healthcare Providers and Systems
CASPER Certification and Survey Provider Enhanced Reports
CBSA Core-Based Statistical Area
CCN CMS Certification Number
CFR Code of Federal Regulations
CHC Continuous Home Care
CHF Congestive Heart Failure
COPD Chronic Obstructive Pulmonary Disease
CoPs Conditions of Participation
CPI-U Consumer Price Index-Urban Consumers
CVA Cerebral Vascular Accident
CWF Common Working File
CY Calendar Year
DME Durable Medical Equipment
FEHC Family Evaluation of Hospice Care
FY Fiscal Year
GAO Government Accountability Office
GIP General Inpatient Care
HEART Hospice Evaluation & Assessment Reporting Tool
HHS
HIS Hospice Item Set
HQRP Hospice Quality Reporting Program
ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification
ICD-10-CM International Classification of Diseases, Tenth Revision, Clinical Modification
ICR Information Collection Requirement
IMPACT Act Improving Medicare Post-Acute Care Transformation Act of 2014
IPPS Inpatient Prospective Payment System
IRC Inpatient Respite Care
LCD Local Coverage Determination
MAC Medicare Administrative Contractor
MACRA Medicare Access and CHIP Reauthorization Act of 2015
MFP Multifactor Productivity
MLN Medicare Learning Network
MSA Metropolitan Statistical Area
NF Long Term Care Nursing Facility
NOE Notice of Election
NOTR Notice of Termination/Revocation
NP Nurse Practitioner
NPI National Provider Identifier
PRA Paperwork Reduction Act of 1995
PS&R Provider Statistical and Reimbursement Report
Pub. L. Public Law
POC Plan of Care
QAPI Quality Assessment and Performance Improvement
QM Quality Measure
RHC Routine Home Care
RN Registered Nurse
SIA Service Intensity Add-on
SNF Skilled Nursing Facility
TEFRA Tax Equity and Fiscal Responsibility Act of 1982
UHDDS Uniform Hospital Discharge Data Set
U.S.C. United States Code
--This is a summary of a
Final rule.
CFR Part: "42 CFR Part 418"
RIN Number: "RIN 0938-AT00"
Citation: "82 FR 36638"
Document Number: "CMS-1675-F"
Federal Register Page Number: "36638"
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