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Federal Register / Vol. 86, No. 154 / Friday, August 13, 2021 / Rules and Regulations reporting period that would run from July 1, 2023 through June 30, 2024, affecting the FY
2026 payment determination and for subsequent years; 3 adopting the COVID19
Vaccination Coverage among HCP measure beginning with a shortened reporting period from October 1, 2021 through December 31, 2021 affecting the FY 2023 payment determination followed by quarterly reporting deadlines affecting the FY 2024
payment determination and subsequent years; 4 adopting two medication-related adverse event eCQMs Hospital Harm-Severe Hypoglycemia eCQM and Hospital HarmSevere Hyperglycemia eCQM beginning with the CY 2023 reporting period/FY 2025
payment determination; 5 removing the Discharged on Statin Medication eCQM
STK06 beginning with the FY 2026
payment determination; 6 removing the Exclusive Breast Milk Feeding PC05
measure beginning with the FY 2026
payment determination; 7 removing the Admit Decision Time to ED Departure Time for Admitted Patients ED2 measure beginning with the FY 2026 payment determination; 8 revising regulations at 42
CFR 412.140a2 by replacing the term QualityNet Administrator with the term QualityNet security official and 42 CFR
412.140e2iii by replacing the term QualityNet system administrator with the term QualityNet security official; 9
revising regulations at 42 CFR 412.140a1
and 42 CFR 412.140c2i to remove references to QualityNet.org and replace with QualityNet website; 10 requiring the 2015 Edition Cures Update of CEHRT for eCQMs and hybrid measures beginning with the FY 2025 payment determination; and 11
extending the effects of educational reviews for fourth quarter data such that if an error is identified during the education review process for fourth quarter data, we will use the corrected quarterly score to compute the final confidence interval used for payment determination beginning with validations affecting the FY 2024 payment determination. We are not finalizing our proposal to remove the Anticoagulation Therapy for Atrial Fibrillation/Flutter eCQM
STK03 or the Death Among Surgical Inpatients with Serious Treatable Complications CMS PSI04 measure.
As shown in summary table in section XII.B.7.k. of the preamble of this final rule, we estimate a total information collection burden increase for 3,300 IPPS hospitals of 2,475 hours at a cost of $101,475 annually associated with our finalized policies and updated burden estimates across a 4-year period from the CY 2022 reporting period/FY
2024 payment determination through the CY
2025 reporting period/FY 2027 payment determination, compared to our currently approved information collection burden estimates. Note that for the CY 2022 reporting period/FY 2024 payment determination, the total burden increase is only 1,375 hours at a cost of $56,375 due to reporting of the Hybrid HWR measure being only for two quarters versus four quarters for the CY 2023
reporting period/FY 2025 payment determination and subsequent years. We refer readers to section XII.B.7. of the preamble of this final rule information
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collection requirements for a detailed discussion of the calculations estimating the changes to the information collection burden for submitting data to the Hospital IQR
Program.
As described in sections IX.C.9.e. and IX.C.9.f. of the preamble of this final rule, as proposed, we are finalizing an update to certification requirements requiring the use of the 2015 Edition Cures Update for eCQMs and hybrid measures beginning with the FY
2025 payment determination. We expect this policy to have no impact on information collection burden for the Hospital IQR
Program because this policy does not require hospitals to submit new data to CMS. With respect to any costs unrelated to data submission, although this finalized policy will require some investment in systems updates, the Medicare Promoting Interoperability Program previously known as the Medicare and Medicaid EHR Incentive Programs previously finalized a requirement that hospitals use the 2015 Edition Cures Update for eCQMs 85 FR 84818 through 84825. Because all hospitals participating in the Hospital IQR Program are subsection d hospitals that also participate in the Medicare Promoting Interoperability Program previously known as the Medicare and Medicaid EHR Incentive Programs, we do not anticipate any additional costs as a result of this finalized policy. This is because the burden and costs involved in updating to the 2015 Edition Cures Update is the same regardless of whether the technology is used for eCQMs or hybrid measures. Hybrid measure data are derived from both claims and clinical EHR data, via submission of QRDA I files, and we already collect and utilize claims data and QRDA I file data for other measures in the Hospital IQR Program measure set. In other words, what hospitals need to do is not measure-dependent.
Therefore, we believe that the Medicare Promoting Interoperability Program has already addressed the additional costs unrelated to data submission through their previously finalized requirements.
We also note that in sections IX.C.5. and IX.C.6 of the preamble of this final rule, we are finalizing our proposals to adopt two new eCQMs and remove three eCQMs. We are not finalizing our proposal to remove Anticoagulation Therapy for Atrial Fibrillation/Flutter eCQM STK03;
however, this retention will not change impacts to hospitals. Similar to the FY 2019
IPPS/LTCH PPS final rule regarding removal of eCQM measures, while there is no change in information collection burden related to those finalized provisions, we believe that costs are multifaceted and include not only the burden associated with reporting but also the costs associated with implementing and maintaining Program measures in hospitals EHR systems for all of the eCQMs available for use in the Hospital IQR Program 83 FR
41771.
In section IX.C.5.c. of the preamble of this final rule, as proposed, we are finalizing our proposal to adopt a COVID19 Vaccination Coverage among HCP measure beginning with a reporting period from October 1 to December 31, 2021 affecting the CY 2021
reporting period/FY 2023 payment
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determination followed by quarterly reporting beginning with the FY 2024
payment determination and subsequent years.1394 Regarding public reporting of this measure, based on public comment, we are finalizing a modification to our proposal.
Under this modification, we will not finalize our plan to add one additional quarter of data during each advancing refresh, until the point that four full quarters of data is reached and then publicly report the measure using four rolling quarters of data. Instead, we will only publicly report the most recent quarter of data. However, this will not change the impacts to hospitals as we are finalizing the data submission requirements as proposed.
Hospitals would submit data through the Centers for Disease Control and Prevention CDC National Healthcare Safety Network NHSN. The NHSN is a secure, internetbased system maintained by the CDC and provided free. Currently the CDC does not estimate burden for COVID19 vaccination reporting under the CDC PRA package approved under OMB control number 0920
1317 because the agency has been granted a waiver under section 321 of the National Childhood Vaccine Injury Act NCVIA.1395
Although the burden associated with the COVID19 Vaccination Coverage among HCP
measure is not accounted for under the CDC
PRA 09201317 or 09200666, the cost and burden information are included in this section. We estimate that it will take each IPPS subsection d hospital, on average, 1
hour per month to collect data for the COVID19 Vaccination Coverage among HCP
measure and enter it into NHSN. We have estimated the time to complete this entire activity, since it could vary based on provider systems and staff availability. This burden is comprised of administrative hours and wages. We believe an Administrative Assistant1396 would spend between 45
minutes and 1 hour and 15 minutes to enter this data into NHSN. For the shortened CY
2021 reporting period, 3 months are required.
For the CY 2021 reporting period/FY 2023
payment determination, IPPS subsection d hospitals would incur an additional burden between 2.25 hours 0.75 hours 3 months and 3.75 hours 1.25 hours 3 months per hospital. For all 3,300 hospitals, the total burden would range from 7,425 hours 2.25
hours 3,300 IPPS hospitals and 12,375
hours 3.75 hours 3,300 IPPS hospitals.
Each hospital would incur an estimated cost of between $27.47 0.75 hours $36.62 and $45.78 1.25 hours $36.62 monthly and 1394 We note that the proposed rule incorrectly read annual reporting periods however the section of the proposed rule on data submission IX.C.5.c. correctly described the data submission process and timelines.
1395 Section 321 of the National Childhood Vaccine Injury Act NCVIA provides the PRA
waiver for activities that come under the NCVIA, including those in the NCVIA at section 2102 of the Public Health Service Act 42 U.S.C. 300aa2.
Section 321 is not codified in the U.S. Code, but can be found in a note at 42 U.S.C. 300aa1.
1396 https www.bls.gov/oes/current/
oes436013.htm accessed on March 30, 2021. The adjusted hourly wage rate of $36.62/hour includes an adjustment of 100 percent of the median hourly wage to account for the cost of overhead, including fringe benefits.

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