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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations help to inform changes to the survey in the future.
Final Decision: After consideration of the public comments, we are finalizing our proposal to display Hospice CAHPS
Star ratings no sooner than FY 2022. We plan to provide opportunities for interaction with stakeholders to discuss our plans and methodology and to receive feedback prior to the start of star ratings display. We will also explore the feasibility of conducting a dry run of the star ratings with reporting to hospices via preview reports, which would occur prior to the start of the public display of the ratings.
9. Form, Manner, and Timing of Quality Data Submission a. Statutory Penalty for Failure To Report
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Section 1814i5C of the Act requires that each hospice submit data to the Secretary on quality measures specified by the Secretary. Such data must be submitted in a form and manner, and at a time specified by the Secretary. Section 1814i5Ai of the Act was amended by the CAA 2021 and the payment reduction for failing to meet hospice quality reporting requirements is increased from 2
percent to 4 percent beginning with FY
2024. The Act requires that, beginning with FY 2014 through FY 2023, the Secretary shall reduce the market basket update by 2 percentage points and then beginning in FY 2024 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 received a few comments on this policy. A summary of these comment and our responses to those comments appear below:
Comment: We received several comments objecting to the increase in the percentage penalty for failure to provide quality reporting data.
Response: We thank the commenters for their views, but as noted, this provision is required by section 407b of the CAA and does not permit any
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discretion on the part of the Secretary to implement it.
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. They suggested using multiple avenues of communication including the HQRP
website and MLN Connects.
Response: We agree that communicating widely is critically important, to ensure as many hospices as possible are aware not only of the increase in penalty, but also clearly understand the HQRP reporting requirements and the APU process. We will consider using multiple avenues for communication, including this rule, the Medicare Claims Manual, the HQRP
website, such as the HQRP
Requirements and Best Practices web page at: https www.cms.gov/Medicare/
Quality-Initiatives-Patient-AssessmentInstruments/Hospice-Quality-Reporting/
HQRP-Requirements-and-Best-Practices and the Training and Education Library page at: https www.cms.gov/Medicare/
Quality-Initiatives-Patient-AssessmentInstruments/Hospice-Quality-Reporting/
Hospice-Quality-Reporting-TrainingTraining-and-Education-Library. We will also consider opportunities to communicate through webinars, Open Door Forums, and other resources as relevant.
Comment: A few commenters did not agree with the CAA 2021 provision that removes the prohibition on public disclosure of hospice surveys performed by a national accreditation agency in section 1865b of the Act, thus allowing the Secretary to disclose such accreditation surveys. Many commenters also noted the special focused program that requires each state and local survey agency, and each national accreditation body with an approved hospice accreditation program, to submit information respecting any survey or certification made with respect to a hospice program.
Response: The proposed regulatory policies to implement the hospice survey and enforcement provisions in
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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-202107-07/pdf/2021-13763.pdf. We encourage commenters to provide us input and comments on these provisions in response to that rule. The link to the Federal Register can be found here: CMS1747P CY 2022
Home Health Prospective Payment System Rate Update. Note: The comment period closes on August 27, 2021.
b. Compliance HQRP Compliance requires understanding three timeframes for both HIS and CAHPS. 1 The relevant Reporting Year, payment FY and the Reference Year. The Reporting Year HIS/Data Collection Year CAHPS.
This timeframe is based on the CY. It is the same CY for both HIS and CAHPS.
If the CAHPS Data Collection year is CY
2022, then the HIS reporting year is also CY 2022. 2 The APU is subsequently applied to FY payments based on compliance in the corresponding Reporting Year/Data Collection Year. 3
For the CAHPS Hospice Survey, the Reference Year is the CY prior to the Data Collection Year. The Reference Year applies to hospices submitting a size exemption from the CAHPS survey there is no similar exemption for HIS.
For example, for the CY 2022 data collection year, the Reference Year, is CY 2021. This means providers seeking a size exemption for CAHPS in CY 2022
would base it on their hospice size in CY 2021. Submission requirements are codified in 418.312.
For every CY, all Medicare-certified hospices are required to submit HIS and CAHPS data according to the requirements in 418.312. Table 11
summarizes the three timeframes. It illustrates how the CY interacts with the FY payments, covering the CY 2020
through CY 2023 data collection periods and the corresponding APU application from FY 2022 through FY 2025.
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