NAHC Board Chair Selected for Hospice Special Focus Program TEP

The Consolidated Appropriations Act of 2021 required the Centers for Medicare & Medicaid Services (CMS) to implement various hospice survey reforms. In the CY 2022 Home Health Prospective Payment System (HH PPS) final rule, CMS addressed these reforms, including development of a Hospice Special Focus Program (SFP).  NAHC was one of the stakeholders at the time…

CMS Calls for Technical Expert Panel Applicants

The Centers for Medicare & Medicaid Services (CMS) recently announced it is convening two technical expert panels (TEPs):

  • Hospice Special Focus Program Technical Expert Panel
  • Health Equity Structural Measure Technical Expert Panel.

NAHC members may be interested in applying for one or both of these panels.  Details of the TEPs and application/nomination instructions are below.  The deadline to apply or nominate someone is August 12.

HOSPICE SPECIAL FOCUS PROGRAM TECHNICAL EXPERT PANEL

NAHC has been looking for the Hospice Special Focus Program (SFP) TEP announcement since CMS indicated in the FY2023 Hospice Proposed Rule that they intended to convene a TEP on this topic and have the TEP’s work completed in time to include a proposed SFP in the FY2024 Hospice Proposed Rule.  This proposed rule is anticipated to be published in the Federal Register towards the end of April next year.  The Hospice SFP is part of the required hospice survey reforms of the Consolidated Appropriations Act of 2021. Details of the TEP and how to apply are below.

Project Overview:

  • The Centers for Medicare & Medicaid Services (CMS) has contracted with Abt Associates to develop a hospice Special Focus Program (SFP). The contract number is 75FCMC18D0014, Task Order 75FCMC19F0001. As part of the Special Focus Program (SFP) development process, CMS asks contractors to convene groups of stakeholders and experts who contribute feedback and thoughtful input to the contractor during program development.
  • Provisions in the Consolidated Appropriations Act of 2021 direct the Secretary to create a SFP for poor-performing hospice programs, set out authority for imposing enforcement remedies for noncompliant hospice programs, and require the development and implementation of a range of remedies as well as procedures for appealing determinations. In the calendar year 2022 HH PPS final rule, it was stated that additional collaboration would be sought to further develop the methodology for the SFP through a TEP.

Project Objectives:

  • To provide input on the SFP algorithm that will be used to identify hospices that have substantially failed to meet applicable Medicare requirements based on identified criteria and measures.
  • To develop public reporting requirements for the SFP (e.g., candidate list, SFP program participants, graduates, termination, etc.) and to recommend methods to communicate this information in a manner that is prominent, easily accessible, readily understandable, and searchable for the general public.

TEP Expected Time Commitment:

  • Two-to-four hours to review TEP related materials beginning no earlier than August 2022
  • Five-to-seven hours for TEP orientation and facilitated discussion meetings in the Summer/Fall of 2022

TEP Requirements: A TEP of approximately 9-11 individuals will be selected to provide input. The TEP will be composed of individuals with the following areas of expertise and perspectives:

  • National and state hospice associations
  • Consumers and/or patient advocacy organizations
  • Hospice Providers (at least one member of a not-for profit hospice provider)
  • Hospice staff knowledgeable of surveys and audits
  • Knowledge of the CMS Special Focus Facility (SFF) program for nursing homes

Additional information and instructions for applying for this TEP or for nominating someone for the TEP can be found here.

HEALTH EQUITY STRUCTURAL MEASURE TECHNICAL EXPERT PANEL

The concept of a health equity structural measure as part of the quality reporting program was part of the hospice and home health proposed rules this year. Comments for the hospice proposed rule were due earlier this summer and are currently under review by CMS.  Comments for the home health proposed rule are not due until August, but CMS is moving forward with a TEP on the topic.  Details of the TEP and how to apply are below.

Dates:

  • The Technical Expert Panel (TEP) nomination period opens on July 15, 2022 and closes on August 12, 2022. Submit all nomination materials by the closing date.

Project Overview:

  • CMS contracted with Abt Associates, Inc. to provide quality measure maintenance and support including the development of a home health and hospice health equity structural quality measure. The contract name is Measure & Instrument Development and Support (MIDS): Home Health and Hospice Quality Reporting Program Quality Measures and Assessment Instruments Development, Modification and Maintenance, & Quality Reporting Program Oversight Support. The contract number is 5FCMC18D0014, Task Order number 75FCMC19F0001. As part of its measure development process, Abt convenes groups of stakeholders who contribute to the direction and provide thoughtful input to the measure developer during measure development and maintenance.

Seeking the Following Perspectives/Expertise:

  • We are seeking individuals with differing perspectives and areas of expertise, such as representatives from patient advocacy groups, clinical and administrative staff from home health and hospice providers, and health equity experts.
  • Health equity experts may include (but will not be limited to) representatives from diversity, equity, and inclusion initiatives in health care; methodologists and researchers who focus on health equity in clinical settings; and others with expertise in health equity related quality measurement.

TEP Expected Time Commitment:

The total project duration is October 2022 – February 2023.  The Health Equity Technical Expert Panel (HE TEP) will convene no more than twice via teleconference:

  • Meet and Greet Meeting, late October 2022
  • HE TEP 1-Day Meeting, mid-November 2022

Additional TEP time commitments will include:

  • Reviewing materials in preparation for the HE TEP 1-Day Meeting, which will be sent to members one week prior to the meeting (i.e., early November).
  • Providing one round of feedback on the HE TEP summary report, which will be drafted by the

measure developer and distributed to HE TEP members for review in January-February 2023.

Additional information and instructions for applying for this TEP or for nominating someone for the TEP can be found here.

CMS Calls for Technical Expert Panel Applicants

The Centers for Medicare & Medicaid Services (CMS) recently announced it is convening two technical expert panels (TEPs): Hospice Special Focus Program Technical Expert Panel Health Equity Structural Measure Technical Expert Panel. NAHC members may be interested in applying for one or both of these panels.  Details of the TEPs and application/nomination instructions are below. …

Hospice Quality Reporting Program 2021 Information Gathering Report

The Centers for Medicare & Medicaid Services (CMS) has released the Hospice Quality Reporting Program 2021 Information Gathering Report, which provides information from literature reviews and expert interviews that supports expansion of the hospice quality reporting program. Specific topics include treatment of moderate to severe pain, patient preferences, spiritual care, social needs, medication management, and other topics related to hospice quality.

CMS anticipates expanding the Hospice Quality Reporting Program (HQRP) over the next several years to include additional meaningful quality measures to help consumers make informed decisions when selecting a hospice for end-of-life-support. This expansion includes introducing the Hospice Outcomes & Patient Evaluation (HOPE), and may be introduced for possible hospice use for FY2024, although CMS has not provided a date.

There are only a handful of current measures publicly reported as part of the HQRP.  This is slim compared to other provider types and due in part to the lack of a tool for the HQRP that collects data while care is being delivered to the patient, as the HOPE will do.  The Hospice Information Gathering Report supports the efforts to expand the HQRP by reviewing available resources to inform HOPE development and related quality measures. Technical Expert Panel (TEP) deliberations, in addition to discussions with the HOPE development team, the hospice quality measurement development team, and federal stakeholders, identified areas where additional information could support the HQRP expansion.

This Report provides insight into the specific aspects CMS focused on for each of the topics addressed in the Report – treatment of moderate to severe pain, patient preferences, spiritual care, social needs, medication management, and other topics related to hospice quality – why and what was discovered.  Links to all the resources reviewed are available and hospices may find these helpful for understanding how best to address the issues CMS identified in each of the topic areas.

Among its conclusions, CMS found that evidence supports the current HQRP measures under development for treating moderate to severe pain. In other areas (risk adjustment for neuropathic pain, patient and proxy concordance of patient symptom management preferences, and psychosocial outcomes), CMS found limited evidence for the hospice setting.  However, CMS provided information from other settings to support HQRP activities in these instances.

CMS explored evidence for future potential areas of measure development, such as medication management, finding gaps concerning the reasonable use of medications at the end of life and the engagement of patients and caregivers.  Those interested in the future path of the HQRP and its measures should read this report and investigate some of the tools and resources CMS found to be promising for providing/assisting in providing good quality care to patients.

More information about CMS’ efforts to expand the HQRP can be found in the 2019 Information Gathering Report and the  2020 Information Gathering Report.

Hospice Quality Reporting Program 2021 Information Gathering Report

The Centers for Medicare & Medicaid Services (CMS) has released the Hospice Quality Reporting Program 2021 Information Gathering Report, which provides information from literature reviews and expert interviews that supports expansion of the hospice quality reporting program. Specific topics include treatment of moderate to severe pain, patient preferences, spiritual care, social needs, medication management, and other…

Hospice Quality Reporting Program 2021 Information Gathering Report

The Centers for Medicare & Medicaid Services (CMS) has released the Hospice Quality Reporting Program 2021 Information Gathering Report, which provides information from literature reviews and expert interviews that supports expansion of the hospice quality reporting program. Specific topics include treatment of moderate to severe pain, patient preferences, spiritual care, social needs, medication management, and other topics related to hospice quality.

CMS anticipates expanding the Hospice Quality Reporting Program (HQRP) over the next several years to include additional meaningful quality measures to help consumers make informed decisions when selecting a hospice for end-of-life-support. This expansion includes introducing the Hospice Outcomes & Patient Evaluation (HOPE), and may be introduced for possible hospice use for FY2024, although CMS has not provided a date.

There are only a handful of current measures publicly reported as part of the HQRP.  This is slim compared to other provider types and due in part to the lack of a tool for the HQRP that collects data while care is being delivered to the patient, as the HOPE will do.  The Hospice Information Gathering Report supports the efforts to expand the HQRP by reviewing available resources to inform HOPE development and related quality measures. Technical Expert Panel (TEP) deliberations, in addition to discussions with the HOPE development team, the hospice quality measurement development team, and federal stakeholders, identified areas where additional information could support the HQRP expansion.

This Report provides insight into the specific aspects CMS focused on for each of the topics addressed in the Report – treatment of moderate to severe pain, patient preferences, spiritual care, social needs, medication management, and other topics related to hospice quality – why and what was discovered.  Links to all the resources reviewed are available and hospices may find these helpful for understanding how best to address the issues CMS identified in each of the topic areas.

Among its conclusions, CMS found that evidence supports the current HQRP measures under development for treating moderate to severe pain. In other areas (risk adjustment for neuropathic pain, patient and proxy concordance of patient symptom management preferences, and psychosocial outcomes), CMS found limited evidence for the hospice setting.  However, CMS provided information from other settings to support HQRP activities in these instances.

CMS explored evidence for future potential areas of measure development, such as medication management, finding gaps concerning the reasonable use of medications at the end of life and the engagement of patients and caregivers.  Those interested in the future path of the HQRP and its measures should read this report and investigate some of the tools and resources CMS found to be promising for providing/assisting in providing good quality care to patients.

More information about CMS’ efforts to expand the HQRP can be found in the 2019 Information Gathering Report and the  2020 Information Gathering Report.

CMS Proposes to Test New Mode for HHCAHPs and Shortened Survey Tool

The Centers for Medicare & Medicaid Services (CMS) has submitted a proposal to conduct a mode experiment to test the effects of a web-based mode on response rates and scores, to the Office of Management and Budget. The CMS proposal, an information collection request titled The Home Health Care CAHPS® Survey (HHCAHPS) Mode Experiment, would…

CMS Needs People to Serve on Technical Expert Panel

NAHC strongly encourages members to participate! The Centers for Medicare & Medicaid Services (CMS) is looking for candidates to serve on a technical expert panel (TEP) to refine of a cross setting functional measure for Long-term Care Hospitals (LTCH), Inpatient Rehabilitation Facilities (IRF), Skilled Nursing Facilities (SNF)/Nursing Facility (NF), and Home Health Agencies (HHA). The…

NAHC Urges CMS on Implementation of Hospice Survey Reforms

The National Association for Home Care & Hospice (NAHC) wrote to the Centers for Medicare & Medicaid Services (CMS) to provide a series of recommendations related to implementation of the hospice survey reforms enacted as part of the Consolidated Appropriations Act of 2021 in late December. The reforms were triggered by Office of the Inspector…

Hospice Item Set and Manual Updated, 2020 Hospice Technical Expert Panel Report Posted

The final Hospice Item Set (HIS) Manual V3.00 is now available, as is the updated HIS-Admission and HIS-Discharge documents. The updates to the HIS Manual and HIS-Discharge instrument reflect the removal of Section O and associated measures.  The HIS-Admission instrument was updated to reflect the current reporting year dates.  These changes were made to accommodate…