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Both the Hospice and PAC PUFs provide information on services provided to Medicare beneficiaries by hospice providers. If released in May 2022 using eight quarters of data, the HCI and HVLDL measure reporting period would begin with FY2021 (Q1, Q2, and Q3 2021 and Q4 2020). One commenter requested delaying the effective date of the proposed Start Printed Page 42549clarification for the hospice election statement addendum to provide time for software updates in addition to reporting and system alerts. The commenter stated CMS should see value in potentially adding these worksheets if, in fact, it intends to calculate labor components for these levels of care based on cost report data going forward. HOPE will enable CMS and hospices to understand the care needs of people through the dying process, supporting provider care planning and quality improvement efforts, and ensuring the safety and comfort of individuals enrolled in hospice nationwide. We received comments from various stakeholders on the proposals and updates including a consumer advocacy group, health care providers, hospice provider organizations, hospice trade groups, including those focused on rural providers, consultants, EHR vendors, and MedPAC. The final rule also finalizes a Home Health Quality Reporting Program (HH QRP) policy that becomes effective on October 1, 2021, to prepare for public reporting beginning in January 2022. Hospices comply by utilizing a CMS-approved third-party vendor. One commenter noted that the hospice cost report for freestanding providers is being proposed to be used for the first time to determine the labor component of the rates for each level of care. The ABN transfers potential financial liability to the Medicare beneficiary in certain instances, whereas the addendum (upon request) informs terminally ill beneficiaries (or their representative) only of items, services, or drugs the hospice will not be providing because the hospice has determined them to be unrelated to the terminal illness and related conditions. Response: We appreciate commenters' concerns that hospice providers do not believe they could replicate the indicators without more information. The commenters recommended that CMS post a notice on Care Compare to ensure consumers understand the context, with particular attention to the fact that telehealth visits are not captured in claims reporting. Variability analyses confirmed that HCI demonstrates sufficient ability to differentiate hospices. Changes in a hospices' quintile from the SPR to CAR scenario would indicate a re-ranking of hospices when using 3 quarters compared to 4 quarters. While recent news reports[2] Similarly, we proposed to clarify at 418.24(d)(5) that in the event that a beneficiary requests the addendum and the hospice furnishes the addendum within 3 or 5 days (depending upon when the request for the addendum was made), but the beneficiary dies, revokes, or is discharged prior to signing the addendum, a signature from the individual (or representative) is no longer required. Omnibus Budget Reconciliation Act of 1989, 8. Comment: Several commenters expressed concern regarding the impact of COVID-19 on labor costs. CMS issued a final rule, CMS-1629-F, which created two routine home care daily payment rates. Consumers have generally welcomed star ratings. A few commenters stated that if data from the hospice cost report is to be used for calculating the labor component by level of care, revisions to the cost report should be proposed to address current inconsistent, but acceptable, reporting practices. The candidate measure Reduction in Pain Severity reports the percentage of patients who had a reduction in reported pain severity. Journal of Pain & Symptom Management, 40(6): 829-837. doi: 10.1016/j.jpainsymman.2010.03.024. One commenter opposed the public reporting of any quality data collected during the COVID-19 PHE (not just the Q1 and Q2 2020 which were subject to the exemptions), because of the impact COVID-19 had on hospice processes and operations. However, patterns of variation across providers could signal less service provider availability and access for patients on weekends. Issued by: Centers for Medicare & Medicaid Services (CMS). Comment: Several commenters would like more time and information to replicate the analysis for HCI. Journal of Pain and Symptom Management, 50, 548-552. doi: 10.1016/j.jpainsymman.2015.05.001. In response to the concerns raised by those opposing the removal of seven HIS process measures, we would like to emphasize that all but one of the seven HIS measures are topped out individually and one HIS measure is almost topped out and shows insignificant variability between hospices. Specifications for the HCI Indicators Selected, (1). Furthermore, we proposed to clarify at 418.24(d)(4) that if the patient dies, revokes election, or is discharged within the required timeframe (3 or 5 days after a request, depending upon when such request was made), but the hospice has not yet furnished the addendum, the hospice is not required to furnish the addendum. Subject areas specified under paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide's performance of the task with a patient or pseudo-patient. To calculate the compensation costs for each provider, we proposed to then sum each of the costs estimated in steps (1) through (5) to derive total compensation costs for CHC, RHC, IRC, and GIP. Currently, the only rural area without a hospital from which hospital wage data could be derived is Puerto Rico. Table 1 provides the finalized labor share for each level of care based on the compensation cost weights we derived using our revised methodology. One commenter opposed the proposed labor shares, stating that the data in the cost report do not provide adequate or appropriate measures of labor expenses. For this indicator, we identified hospice stays that included 30 or more consecutive days of hospice. We will take into consideration the option of starting the stars display when all data will be after the COVID-exempted quarters. Medicare hospice: Use of general inpatient care. The productivity adjustment for FY 2022, based on IGI's second quarter 2021 forecast, is 0.7 percent.