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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations reliability score of 0.7 for both the 7-day and the 30-day rate. These analyses revealed that the measure can reliably distinguish differences in performance between IPFs with adequate denominator size.
We evaluated the validity of the measure based on its correlation to two conceptually related measures in the IPFQR Program: The 30-Day All-Cause Unplanned Readmission After Psychiatric Discharge from an IPF IPF
Readmission measure, and the Medication Continuation Following Inpatient Psychiatric Discharge Medication Continuation measure. We observed a weak negative correlation between FAPH and the IPF Readmission measure for both 7-day 0.11 and 30day 0.18 measure rates. This negative correlation is expected because a higher score is indicative of better quality of care for the FAPH, while a lower score is indicative of better quality of care for the IPF readmission measure that is, a lower rate of unplanned readmissions. High rates of follow-up after visits after discharge and low rates of unplanned readmissions both indicate good care coordination during the discharge process. We observed a weak positive correlation between the 7-day FAPH measure rate and the Medication Continuation measure 0.32, and between the 30-day FAPH measure rate and the Medication Continuation measure 0.42. This result is expected because for both the FAPH
and the Medication Continuation measures higher scores are indicative of better-quality care. Follow-up visits after discharge and continuation of medication after discharge both indicate good care coordination during the discharge process. After reviewing these results and the proposed measure specifications, all 13 TEP members who were present agreed that the measure had face validity.148

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3 Review by the Measure Applications Partnership and NQF
Under section 1890Aa2 of the Act, this measure was included in a publicly available document: List of Measures Under Consideration for December 1, 2019, available at: https
www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment148 Face validity is defined as a subjective determination by experts that the measure appears to reflect quality of care, done through a systematic and transparent process, that explicitly addresses whether performance scores resulting from the measure as specified can be used to distinguish good from poor quality, with degree of consensus and any areas of disagreement provided/discussed:
https www.qualityforum.org/Measuring_
Performance/Scientific_Methods_Panel/Docs/
Evaluation_Guidance.aspx.

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Instruments/QualityMeasures/
Downloads/Measures-underConsideration-List-for-2018.pdf.
On January 15, 2020, the MAP
Coordinating Committee rated the measure as Conditional Support for Rulemaking contingent upon NQF
endorsement. We submitted the measure to the NQF for endorsement in the spring 2020 cycle. However, some members of the NQF Behavioral Health and Substance Use Standing Committee were concerned about the measures exclusions for patients who died during the 30-day follow-up period or who were transferred. In addition, some members objected to combining persons with a diagnosis of SUD and those with a diagnosis for a mental health disorder into a single measure of follow-up care.
Therefore, the NQF declined to endorse this measure. We noted that the exclusions for patients who died or who were admitted or transferred to an acute or non-acute inpatient facility during the 30-day follow up period align with the FUH measure currently in the IPFQR Program.
Section 1886s4Dii of the Act authorizes the Secretary to specify a measure for the IPFQR Program that is not endorsed by NQF. The exception to the requirement to specify an endorsed measure states that in the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical measure has not been endorsed by the entity with a contract under section 1890a of the Act, the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization.
The FAPH measure is not NQF
endorsed. We have reviewed NQFendorsed and other consensus-endorsed measures related to follow-up care and identified the FUH measure NQF
0576 currently in the IPFQR Program and Continuity of Care after Inpatient or Residential Treatment for SUD NQF
3453, we believe that the FAPH
measure is an improvement over the current FUH measure and over the Continuity of Care after Inpatient or Residential Treatment of Substance Use Disorder because we believe that it is important to ensure appropriate access to follow-up treatment for the largest patient population possible and the FAPH measure applies to a larger patient population than either of the measures we considered. Therefore, we proposed to adopt the FAPH measure described in this section for the FY 2024
payment determination and subsequent years.

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c. Data Collection, Submission and Reporting FAPH uses Medicare FFS Part A and Part B claims that are received by Medicare for payment purposes. The measure links Medicare FFS claims submitted by IPFs and subsequent outpatient providers for Medicare FFS
IPF discharges. Therefore, no additional data collection would be required from IPFs. For additional information on data submission for this measure, see section IV.J.2.b of this final rule. The performance period used to identify cases in the denominator is 12 months.
Data from this period and 30 days afterward are used to identify follow-up visits in the numerator. Consistent with other claims-based measures in the IPFQR Program, the performance period for this measure is July 1 through June 30. For example, for the FY 2024
payment determination, the performance period would include discharges between July 1, 2021 and June 30, 2022.149
We invited public comment on our proposal to add a new measure, FollowUp After Psychiatric Hospitalization, to the IPFQR Program, beginning with the FY 2024 payment determination and subsequent years.
We received the following comments on our proposal.
Comment: Many commenters supported the adoption of the FAPH
measure. Some commenters expressed that the expanded cohort would improve the measures value. Some commenters expressed that expanding the eligible provider types for the follow-up visit would improve care because of the shortage of psychiatrists.
A few commenters observed that care transitions are important, and that outpatient follow-up serves to improve the value of the inpatient services provided. One commenter expressed that adoption of this measure is timely due to the increased behavioral health needs associated with the COVID19
pandemic. One commenter recommended using this measure at the health system level to better identify care coordination, access, and referral network adequacy.
Response: We thank these commenters for their support. We agree that the expanded definitions would improve the measures applicability and capture more follow-up visits.
Regarding the commenters 149 If data availability or operational issues prevent use of this performance period, we would announce the updated performance period through subregulatory communications including announcement on a CMS website and/or on our applicable listservs.

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