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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
caregiving, housing scarcity, marital status, and socioeconomic status.
Commenters encouraged CMS to stratify quality measures by demographic data, social risk factors, and social determinants of health.
We also noted a comment encouraging CMS to implement a bestpractice assessment for the collection of demographic and SDOH data. A
commenter noted that there is not a standard initial nursing or social worker assessment that currently screens for SDOH.
One commenter also expressed a desire to include permanent telehealth provisions in the QRP, as that would help improve rural healthcare access.
We appreciate all the comments and interest in this topic. We believe that this input is very valuable in the continuing development of the CMS
health equity quality measurement efforts. We will continue to take all concerns, comments, and suggestions into consideration for future development and expansion of our health equity quality measurement efforts.

statement of the finding and its reasons in the rule issued.
We are revising the provisions at 418.306b2 to change the payment reduction for failing to meet hospice quality reporting requirements from 2 to 4 percentage points. This policy will apply beginning with FY 2024 annual payment update APU. 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 noted this revised statutory requirement in our proposed rule 86 FR
19726 and are codifying the revision at 418.306b2. While we received comments, this update is statutorily required and self-implementing. Notice and comment are unnecessary because we are conforming the regulation to statute and there is no discretion on the part of the Secretary.

V. Waiver of Proposed Rulemaking We ordinarily publish a notice of proposed rulemaking in the Federal Register and invite public comment on the proposed rule before the provisions of the rule are finalized, either as proposed or as amended in response to public comments, and take effect, in accordance with the Administrative Procedure Act APA Pub. L. 79404, 5 U.S.C. 553, and, where applicable, section 1871 of the Act. Specifically, 5
U.S.C. 553 requires the agency to publish a notice of the proposed rule in the Federal Register that includes a reference to the legal authority under which the rule is proposed, and the terms and substance of the proposed rule or a description of the subjects and issues involved. Further, 5 U.S.C. 553
requires the agency to give interested parties the opportunity to participate in the rulemaking through public comment before the provisions of the rule take effect. Similarly, section 1871b1 of the Act requires the Secretary to provide for notice of the proposed rule in the Federal Register and a period of not less than 60 days for public comment for rulemaking carrying out the administration of the insurance programs under title XVIII of the Act.
Section 1871b2C of the Act and 5
U.S.C. 553 authorize the agency to waive these procedures, however, if the agency for good cause finds that notice and comment procedures are impracticable, unnecessary, or contrary to the public interest and incorporates a
VI. Collection of Information Requirements Under the Paperwork Reduction Act of 1995, we are required to provide 30day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to OMB for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506c2A of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues:
The need for the information collection and its usefulness in carrying out the proper functions of our agency.
The accuracy of our estimate of the information collection burden.
The quality, utility, and clarity of the information to be collected.
Recommendations to minimize the information collection burden on the affected public, including automated collection techniques.

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A. ICRs Regarding Hospice QRP
We are revising the provisions at 418.306b2 to change the payment reduction for failing to meet hospice quality reporting requirements from 2 to 4 percentage points. This policy will apply beginning with FY 2024 annual payment update APU. 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
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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 noted this revised statutory requirement in our proposed rule 86 FR
19726 and are codifying the revision at 418.306b2. While we received comments, this update is statutorily required and self-implementing. Notice and comment are unnecessary because we are conforming the regulation to statute and there is no discretion on the part of the Secretary. The HQRP
proposals would not change provider burden or costs.
For the proposal to remove the 7
HIS measures from the HQRP, we do not propose any changes to the requirement to submit the HIS admission assessment since we continue to collect the data for these 7 HIS measures in order to calculate the more broadly applicable NQF 3235, the Hospice and Palliative Care Composite Process MeasureHISComprehensive Assessment Measure at Admission.
The proposal to add the HCI also would not change provider burden or costs since it is a claims-based measure that CMS calculates from the Medicare claims data.
Likewise, the proposal to publicly report the claims-based HVLDL quality measure would not result in reduced provider burden and related costs. The reduction in provider burden and costs occurred when we replaced the HISbased HVWDII quality measure via the HIS-information collection request ICR
CMS10390 OMB Control Number:
09381153 Expiration date: February 29, 2024.
Finally, the Home Health proposal would not change provider burden or costs since it only affects the number of quarters used in the calculation of certain claims-based measures for the public display for certain refresh cycles.
B. ICRs Regarding Hospice CoPs We are revising the provisions at 418.76c1 that requires the hospice aide to be evaluated by observing an aides performance of the task with a patient. This revision is subject to the PRA; however, the information collection burden associated with the existing requirements at 418.76c1
are accounted for under the information collection request currently approved OMB control number 09381067
Expiration date: March 31, 2024. We requested public comment in determining if the time and effort necessary to comply with implementing the use of the pseudo-patient for hospice aide training at 418.76c1

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