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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
Executive Order 13985, as the consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer LGBTQ+ persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality. 26 We note that this definition was recently established by the current administration, and provides a useful, common definition for equity across different areas of government, although numerous other definitions of equity exist.
Our ongoing commitment to closing the equity gap in CMS quality programs is demonstrated by a portfolio of programs aimed at making information on the quality of health care providers and services, including disparities, more transparent to consumers and providers.
The CMS Equity Plan for Improving Quality in Medicare outlines a path to equity which aims to support Quality Improvement Networks and Quality Improvement Organizations QINQIOs in their efforts to engage with and assist providers that care for vulnerable populations; Federal, state, local, and tribal organizations; providers;
researchers; policymakers; beneficiaries and their families; and other stakeholders in activities to achieve health equity.27 The CMS Equity Plan for Improving Quality in Medicare focuses on three core priority areas which inform our policies and programs: 1 Increasing understanding and awareness of health disparities; 2
developing and disseminating solutions to achieve health equity; and 3
implementing sustainable actions to achieve health equity.28 The CMS
Quality Strategy 29 and Meaningful
Measures Framework 30 include elimination of racial and ethnic disparities as a central principle. Our efforts aimed at closing the health equity gap to date have included providing transparency about health disparities, supporting providers with evidence-informed solutions to achieve health equity, and reporting to providers on gaps in quality through the following reports and programs:
The CMS Mapping Medicare Disparities Tool, which is an interactive map that identifies areas of disparities and a starting point to understand and investigate geographical, racial and ethnic differences in health outcomes for Medicare patients.31
The Racial, Ethnic, and Gender Disparities in Health Care in Medicare Advantage Stratified Report, which highlights racial and ethnic differences in health care experiences and clinical care, compares quality of care for women and men, and looks at racial and ethnic differences in quality of care among women and men separately for Medicare Advantage plans.32
The Rural-Urban Disparities in Health Care in Medicare Report, which details rural-urban differences in health care experiences and clinical care.33
The Standardized Patient Assessment Data Elements for certain post-acute care Quality Reporting Programs, which now includes data reporting for race and ethnicity and preferred language, in addition to screening questions for social needs 84
FR 42536 through 42588.
The CMS Innovation Centers Accountable Health Communities Model, which include standardized data collection of health-related social needs data.
The Guide to Reducing Disparities which provides an overview of key issues related to disparities in readmissions and reviews sets of activities that can help hospital leaders
reduce readmissions in diverse populations.34
The CMS Disparity Methods, which provide hospital-level confidential results stratified by dual eligibility for condition-specific readmission measures currently included in the Hospital Readmission Reduction Program 84 FR 42496 through 42500.
These programs are informed by reports by the National Academies of Science, Engineering and Medicine NASEM 35 and the Office of the Assistant Secretary for Planning and Evaluation ASPE 36 which have examined the influence of social risk factors on several of our quality programs. In this RFI, we addressed only the seventh initiative listed, the CMS Disparity Methods, which we have implemented for measures in the Hospital Readmissions Reduction Program and are considering in other programs, including the IPFQR Program.
We discussed the implementation of these methods to date and present considerations for continuing to improve and expand these methods to provide providers and ultimately consumers with actionable information on disparities in health care quality to support efforts at closing the equity gap.

26 https www.federalregister.gov/documents/
2021/01/25/2021-01753/advancing-racial-equityand-support-for-underserved-communities-throughthe-Federal-government.
27 Centers for Medicare and Medicaid Services Office of Minority Health. The CMS Equity Plan for Improving Quality in Medicare. 2015. https
www.cms.gov/About-CMS/Agency-Information/
OMH/OMH_Dwnld-CMS_EquityPlanforMedicare_
090615.pdf.
28 Centers for Medicare and Medicaid Services Office of Minority Health. The CMS Equity Plan for Improving Quality in Medicare. 2015. https
www.cms.gov/About-CMS/Agency-Information/
OMH/OMH_Dwnld-CMS_EquityPlanforMedicare_
090615.pdf.
29 Centers for Medicare Services. CMS Quality Strategy. 2016. https www.cms.gov/Medicare/

Quality-Initiatives-Patient-Assessment-Instruments/
QualityInitiativesGenInfo/Downloads/CMS-QualityStrategy.pdf.
30 https www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/
QualityInitiativesGenInfo/MMF/General-info-SubPage.
31 https www.cms.gov/About-CMS/AgencyInformation/OMH/OMH-Mapping-MedicareDisparities.
32 https www.cms.gov/About-CMS/AgencyInformation/OMH/research-and-data/statistics-anddata/stratified-reporting.
33 Centers for Medicare and Medicaid Services.
Rural-Urban Disparities in Health Care in Medicare.
2019. https www.cms.gov/About-CMS/AgencyInformation/OMH/Downloads/Rural-UrbanDisparities-in-Health-Care-in-Medicare-Report.pdf.

34 Guide to Reducing Disparities in Readmissions.
CMS Office of Minority Health. Revised August 2018. Available at: https www.cms.gov/AboutCMS/Agency-Information/OMH/Downloads/OMH_
Readmissions_Guide.pdf.
35 National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. https doi.org/10.17226/21858.
36 https aspe.hhs.gov/pdf-report/reportcongress-social-risk-factors-and-performanceunder-medicares-value-based-purchasingprograms.
37 https aspe.hhs.gov/pdf-report/reportcongress-social-risk-factors-and-performanceunder-medicares-value-based-purchasingprograms.

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2. Current CMS Disparity Methods We first sought public comment on potential confidential and public reporting of IPFQR program measure data stratified by social risk factors in the FY 2018 IPPS/LTCH PPS proposed rule 82 FR 20121. We initially focused on stratification by dual eligibility, which is consistent with recommendations from ASPEs First Report to Congress which was required by the Improving Medicare Post-Acute Care Transformation IMPACT Act of 2014 Pub. L. 113185.37 This report found that in the context of value-based purchasing VBP programs, dual eligibility was among the most powerful predictors of poor health outcomes
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