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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
Response: While we recognize that the data may not fully represent all activities to prevent and control infections, we believe that the data would be useful to consumers in choosing IPFs, including making comparisons between facilities. We note that we do not currently have a validation process for any measures in the IPFQR Program and refer readers to section IV.J.3 of this final rule where we discuss considerations for a validation program for the IPFQR Program.
Comment: Some commenters recommended deferring the measure until it has been fully tested and NQF
endorsed. One commenter observed that the MAP reviewed the measure concept, not the full measure, and therefore it is premature to include it in the IPFQR
Program without further review.
Another commenter observed that such rapid measure adoption may set a precedent for future rapid measure adoption.
Response: We believe that given the current COVID19 PHE, it is important to adopt this measure as quickly as possible to allow tracking and reporting of COVID19 Vaccination Coverage Among HCP in IPFs. This tracking would provide consumers with important information. We refer readers to FY 2022 IPF PPS proposed rule where we discuss our consideration of NQF endorsed measures on the topic of COVID19 vaccination coverage among healthcare personnel for additional information 86 FR 19503 through 19504. We note that the MAP had the opportunity to review and provide feedback on the full measure in the March 15th meeting. The CDC, in collaboration with CMS, is planning to submit the measure for consideration in the NQF Fall 2021 measure cycle.
Finally, we evaluate all measures on a case-by-case basis and therefore the pace at which we propose to adopt one measure is dependent on the measure and the purpose for adopting it.
Comment: One commenter requested clarification for the reporting frequency.
Response: We recognize that the proposed required frequency for reporting, may have been unclear because we referred to annual reporting periods two times in the proposed rule. Specifically, we referenced annual reporting periods in the first paragraph of section IV.E.2.c 86 FR 19504 and in our burden estimate for the measure 86 FR 19519.
Our description of data submission under IV.J.2.a in which we stated that facilities would be required to report the vaccination data to the NHSN for at least one week each month and that if they reported more than one week, the
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most recent weeks data would be used 86 FR 19513 is correct. In that section, we further noted that the CDC would calculate a single quarterly result for summarizing the data reported monthly.
In summary, the measure would require monthly reporting of at least one weeks data per month. This would be calculated into quarterly results. We note that IPFs are required to report to NHSN sufficient data that is, vaccination data for at least one week in each month per quarter to calculate four quarterly results per year, except for the first performance period which depends on only one quarter of data the vaccination data for at least one week in each month in Q1 of FY 2022. While IPFs can report data to the NHSN at any time, they must report by 4.5 months following the preceding quarter for the purposes of measure calculation. For the first performance period for this measure that is Q1 of FY 2022, 4.5
months following the end of the quarter is May 15, 2022.
Comment: One commenter requested clarification on which provider types are considered healthcare personnel.
Response: The provider types that are considered healthcare personnel, along with the specifications for this measure, are available at https www.cdc.gov/
nhsn/nqf/index.html. The categories of HCP included in this measure are ancillary services employees; nurse employees; aide, assistant, and technician employees; therapist employees; physician and licensed independent practitioner employees;
and other HCP. For more detail about each of these categories we refer readers to the Table of Instructions for Completion of the Weekly Healthcare Personnel COVID19 Cumulative Vaccination Summary Form for NonLong-Term Care Facilities available at https www.cdc.gov/nhsn/forms/instr/
57.220-toi-508.pdf.
Comment: One commenter observed that the definition of location for measure calculation is unclear.
Response: CDCs guidance for entering data requires submission of HCP count at the IPF level, not at the location level within the IPF.124
After consideration of the public comments, we are finalizing the COVD
19 Vaccination Coverage Among Healthcare Personnel measure as proposed for the FY 2023 payment determination and subsequent years.
124 COVID19 Vaccination Non-LTC Healthcare Personnel TOI cdc.gov.

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3. Follow-Up After Psychiatric Hospitalization FAPH Measure for the FY 2024 Payment Determination and Subsequent Years a. Background We proposed one new measure, Follow-Up After Psychiatric Hospitalization FAPH, for the FY 2024
payment determination and subsequent years. The FAPH measure would use Medicare fee-for-service FFS claims to determine the percentage of inpatient discharges from an inpatient psychiatric facility IPF stay with a principal diagnosis of select mental illness or substance use disorders SUDs for which the patient received a follow-up visit for treatment of mental illness or SUD. Two rates would be calculated for this measure: 1 The percentage of discharges for which the patient received follow-up within 7 days of discharge; and 2 the percentage of discharges for which the patient received follow-up within 30 days of discharge.
The FAPH measure is an expanded and enhanced version of the Follow-Up After Hospitalization for Mental Illness FUH, NQF 0576 measure currently in the IPFQR Program. We proposed to adopt the FAPH measure and replace the FUH measure and refer readers to section IV.F.2.d of the FY 2022 IPF PPS
proposed rule for our proposal to remove the FUH measure contingent on adoption of the FAPH measure 86 FR
19510. The FUH NQF 0576 measure uses Medicare FFS claims to determine the percentage of inpatient discharges from an IPF stay with a principal diagnosis of select mental illness diagnoses for which the patient received a follow-up visit for treatment of mental illness, and it excludes patients with primary substance use diagnoses.
During the 2017 comprehensive review of NQF 0576, the NQF Behavioral Health Standing Committee BHSC
recommended expanding the measure population to include patients hospitalized for drug and alcohol disorders, because these patients also require follow-up care after they are discharged.
In 2018, CMS began development of a measure to expand the IPFQR FUH
population to include patients with principal SUD diagnoses to address the NQF BHSC recommendation and the CMS Meaningful Measures priority to promote treatment of SUDs. The FAPH
measure would expand the number of discharges in the denominator by about 35 percent over the current FUH
measure by adding patients with SUD or dementia as principal diagnoses including patients with any
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