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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
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BILLING CODE 412001C

We also used the results presented in Table 16 to assess the option of reporting Q4 2019, Q3 2020, Q4 2020, and Q1 2021 for the February 2022
refresh. This option maintains requirements in the FY 2017 Hospice Wage Index and Payment Update final rule for publicly reporting 4 quarters of data, but it requires using some data that are more than 2 years old. Also, the relatively high number of hospices that meet the public reporting threshold in the CAR scenario, relative to the SPR
scenario, with just 3 quarters of data justify the use of 3 quarters in the unusual circumstances of the COVID19
PHE and its associated exemptions.
We are finalizing our proposal that, in the COVID19 PHE, we would use 3
quarters of HIS data for the final affected refresh, the February 2022 public reporting refresh of Care Compare for the Hospice setting. Using 3 quarters of data for the February 2022 refresh would allow us to begin displaying Q3
2020, Q4 2020, and Q1 2021 data in February 2022, rather than continue displaying November 2020 data Q1
2019 through Q4 2019. We believe that updating the data in February 2022 by more than a year relative to the November 2020 freeze data would assist consumers by providing more relevant quality data and allow hospices to demonstrate more recent performance.
Our testing results indicate we can achieve these positive impacts while maintaining high standards for reportability and reliability. Table 16
summarizes the comparison between the original schedule for public reporting with the revised schedule that is, frozen data and with the proposed schedule that is, using 3
quarters in the February 2022 refresh.
We solicited public comment on this proposal to use 3 quarters of HIS data for the February 2022 public reporting refresh. We received many comments this proposal on related questions about publicly reporting claims-based measures using data from the COVID19
PHE. A summary of the comments received regarding public reporting and our responses those comments appear below.
Comment: We received several comments supporting our proposal to begin public reporting in February 2022
using Q3 and Q4 of 2020 and Q1 of 2021. These commenters also suggested that CMS post a statement that the data displayed include care provided during the COVID19 PHE on Care Compare until August 2023. One commenter opposed the public reporting of any quality data collected during the COVID19 PHE not just the Q1 and Q2

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2020 which were subject to the exemptions, because of the impact COVID19 had on hospice processes and operations.
Response: We appreciate the commenters support for this proposal.
In response to the commenter who did not support this proposal, we would like to emphasize that, while we recognize that the impact of COVID19
has impacted the hospice community, we also believe that we have a responsibility to consumers to make informed decisions about selecting care.
Providing information for decisionmaking is all the more important during and in the wake of a COVID19 PHE, when our health as a nation has been shaken.
We disagree with commenters that notices should be posted on Care Compare regarding the inclusion of data from the COVID19 PHE as such notice would not help consumers distinguish between hospices in their region.
Instead, we will continue to post national averages for quality measures, and will add state scores for all measures no earlier than May 2022. This information will help consumers understand relative performance at national and local levels in light of the COVID19 PHE.
Given the overall positive response to our proposal, we believe that the proposed approach balances fairness to providers with a commitment to transparency and information for consumers.
Comment: Several commenters expressed concern about publicly reporting claims-based measures using data from care provided during the COVID19 PHE. Specifically, they stated that claims from the COVID19
PHE would not reflect typical hospice services. Comments specific to HCI
noted that abnormalities due to the COVID19 PHE would affect all of the indicators, while those for HVLDL
indicated that the number of in-person visits likely fell during the COVID19
PHE due to patient and caregiver preferences, with implications for quality measurement. The commenters recommended that CMS post a notice on Care Compare to ensure consumers understand the context, with particular attention to the fact that telehealth visits are not captured in claims reporting.
Response: We appreciate commenters concerns about publicly reporting claims from the COVID19 PHE. As stated earlier, we pre-emptively issued the March 27, 2020 CMS Guidance Memorandum making 2019 Q4 and Q1
and Q2 2020 exempt from reporting requirements. In that Memorandum, we stated that we would not include any
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post acute care PAC quality data that are greatly impacted by the exemption in the quality reporting programs. Given the timing of the COVID19 PHE onset in the U.S., we determined that we would use data that were submitted for Q4 2019. We will apply the principles of this Memorandum to new claimsbased measures for hospice. Thus, we will publicly report claims data for care delivered in Q4 2019 and Q3 2020
onward, but we will not publicly report claims data for care delivered Q1 and Q2 of 2020. This approach aligns with what we are doing for the other PAC
setting Quality Reporting Programs, including home health see section III.G.
We acknowledge that the COVID19
PHE did not end at the beginning of Q3
2020. Our testing indicates that claims data from the COVID19 PHE are generally stable. Although the number of visits in did visibly decline in 2020, we remain committed to re-initiating publicly reporting of claims data beginning in Q3 2020 for the following reasons: i We believe that we have an important commitment to consumers of hospice care to empower them to make informed decisions. This is particularly important during the COVID19 PHE;
ii With annual reporting of claims data, we can reasonably state that the COVID19 PHE affected hospices nationally in a similar way. Given that HCI is scored relative to the national average, scores will be accounted for as part of the measure calculation. To the extent there have been regional differences, we will also provide state scores for both HCI and HVLDL no earlier than May 2022, so that consumers can benchmark to more local realities.
We respectfully disagree with commenters who have requested that we post a notice on Care Compare alerting consumers to potential abnormalities in claims data wholly or partially coming from COVID19 PHE
excluding Q1 and Q2 2020. Despite the COVID19 PHE, we would expect that hospices would still provide comprehensive care to hospice patients during the pandemic, and believe that telehealth visits are not full substitutes for care provided in person, particularly in the case of the visits measured in the HVLDL and HCI measures. We acknowledge that there may have been an increase in refusals during the COVID19 PHE. However, this increase would likely impact hospices in a region similarly, and thus will not impact a hospices score relative to local competitors. We will include state average scores to further ensure any regional differences in the impact of the
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