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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
418.306 Annual update of the payment rates and adjustment for area wage differences.

b
2 For fiscal years 2014 and through 2023, in accordance with section 1814i5Ai of the Act, in the case of a Medicare-certified hospice that does not submit hospice quality data, as specified by the Secretary, the payment rates are equal to the rates for the previous fiscal year increased by the applicable hospice payment update percentage increase, minus 2 percentage points. Beginning with fiscal year 2024
and subsequent fiscal years, the reduction increases to 4 percentage points. Any reduction of the percentage change will apply only to the fiscal year involved and will not be taken into account in computing the payment amounts for a subsequent fiscal year.

6. Section 418.309 is amended by revising paragraphs a1 and 2 to read as follows:
418.309

Hospice aggregate cap.

a
1 For accounting years that end on or before September 30, 2016 and end on or after October 1, 2030, the cap amount is adjusted for inflation by using the percentage change in the medical care expenditure category of the Consumer Price Index CPI for urban consumers that is published by the Bureau of Labor Statistics. This adjustment is made using the change in
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the CPI from March 1984 to the fifth month of the cap year.
2 For accounting years that end after September 30, 2016, and before October 1, 2030, the cap amount is the cap amount for the preceding accounting year updated by the percentage update to payment rates for hospice care for services furnished during the fiscal year beginning on the October 1 preceding the beginning of the accounting year as determined pursuant to section 1814i1C of the Act including the application of any productivity or other adjustments to the hospice percentage update.

7. Section 418.312 is amended by revising paragraph b to read as follows:
418.312 Data submission requirements under the hospice quality reporting program.

b Submission of Hospice Quality Reporting Program data. 1
Standardized set of admission and discharge items Hospices are required to complete and submit an admission Hospice Item Set HIS and a discharge HIS for each patient to capture patientlevel data, regardless of payer or patient age. The HIS is a standardized set of items intended to capture patient-level data.
2 Administrative data, such as Medicare claims data, used for hospice quality measures to capture services throughout the hospice stay, are required and fulfill the HQRP
requirements for 418.306b.

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3 CMS may remove a quality measure from the Hospice QRP based on one or more of the following factors:
i Measure performance among hospices is so high and unvarying that meaningful distinctions in improvements in performance can no longer be made.
ii Performance or improvement on a measure does not result in better patient outcomes.
iii A measure does not align with current clinical guidelines or practice.
iv The availability of a more broadly applicable across settings, populations, or conditions measure for the particular topic.
v The availability of a measure that is more proximal in time to desired patient outcomes for the particular topic.
vi The availability of a measure that is more strongly associated with desired patient outcomes for the particular topic.
vii Collection or public reporting of a measure leads to negative unintended consequences other than patient harm.
viii The costs associated with a measure outweigh the benefit of its continued use in the program.

Dated: July 27, 2021.
Xavier Becerra, Secretary, Department of Health and Human Services.
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