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Centers for Medicare & Medicaid Services Hospice Programs ...

DEPARTMENT OF health AND HUMAN SERVICESC enters for Medicare & Medicaid Services42 CFR Parts 409, 424, 483, 484, 488, 489, and 498[CMS-1747-F and CMS-5531-F]RINs 0938-AU37 and 0938-AU32 Medicare and Medicaid Programs ; CY 2022 home health Prospective Payment System Rate Update; home health Value-Based Purchasing Model Requirements and Model Expansion; home health and Other Quality Reporting Program Requirements; home Infusion Therapy Services Requirements; Survey and Enforcement Requirements for Hospice Programs ; Medicare Provider Enrollment Requirements; and COVID-19 Reporting Requirements for Long-Term care FacilitiesAGENCY: Centers for Medicare & Medicaid Services (CMS), Department of health and Human Services (HHS).

regulatory blanket waivers related to home health aide supervision that we extended to Medicare participating home health agencies during the COVID–19 PHE. Blanket waivers to Medicare requirements were issued to provide flexibilities to make sure beneficiaries continue to have access to the health care they need while reducing burden to HHAs.

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Transcription of Centers for Medicare & Medicaid Services Hospice Programs ...

1 DEPARTMENT OF health AND HUMAN SERVICESC enters for Medicare & Medicaid Services42 CFR Parts 409, 424, 483, 484, 488, 489, and 498[CMS-1747-F and CMS-5531-F]RINs 0938-AU37 and 0938-AU32 Medicare and Medicaid Programs ; CY 2022 home health Prospective Payment System Rate Update; home health Value-Based Purchasing Model Requirements and Model Expansion; home health and Other Quality Reporting Program Requirements; home Infusion Therapy Services Requirements; Survey and Enforcement Requirements for Hospice Programs ; Medicare Provider Enrollment Requirements; and COVID-19 Reporting Requirements for Long-Term care FacilitiesAGENCY: Centers for Medicare & Medicaid Services (CMS), Department of health and Human Services (HHS).

2 ACTION: Final : This final rule updates the home health and home infusion therapy Services payment rates for calendar year (CY) 2022 in accordance with existing statutory and regulatory requirements. This rule also finalizes recalibration of the case-mix weights and updates the functional impairment levels, and comorbidity adjustment subgroups while maintaining the current low utilization payment adjustment (LUPA) thresholds for CY 2022. Additionally, this rule finalizes a policy to utilize the physical therapy LUPA add-on factor to establish the occupational therapy add-on factor for the LUPA add-on payment amounts and makes conforming regulations text changes to reflect that allowed practitioners are able to establish and review the plan of care .

3 It also finalizes proposed changes to the home health Quality Reporting Program (QRP) including finalizing proposed measure removals and adoptions, public reporting, and modification of effective dates. It also finalizes proposed modifications to the effective date for the reporting of measures and certain standardized patient assessment data in the Inpatient This document is scheduled to be published in theFederal Register on 11/09/2021 and available online , and Facility (IRF) QRP and Long-Term care Hospital (LTCH) QRP. In addition, this final rule codifies certain Medicare provider and supplier enrollment policies. It also makes permanent selected regulatory blanket waivers related to home health aide supervision that were issued to Medicare participating home health agencies during the COVID-19 public health emergency (PHE), and updates the home health conditions of participation regarding occupational therapists assessment completion to implement provisions of the Consolidated Appropriations Act, 2021 (CAA 2021).

4 This final rule also finalizes proposals to expand the home health Value-Based Purchasing (HHVBP) Model and to end the original HHVBP Model one year early. Lastly, it establishes survey and enforcement requirements for Hospice Programs as set forth in the CAA 2021; and finalizes revisions to the infection control requirements for long-term care (LTC) facilities ( Medicaid nursing facilities and Medicare skilled nursing facilities, also collectively known as nursing homes ) that will extend the mandatory COVID-19 reporting requirements beyond the current COVID-19 PHE until December 31, 2024. DATES: These regulations are effective on January 1, 2022.

5 FOR FURTHER INFORMATION CONTACT: Brian Slater, (410) 786-5229, for home health and home infusion therapy payment general information about home infusion payment, send your inquiry via email to general information about the home health Prospective Payment System (HH PPS), send your inquiry via email to more information about the home health Value-Based Purchasing Model, COVID Reporting final rule/please visit the HHVBP Model Expansion webpage at information about the home health Quality Reporting Program (HH QRP), send your inquiry via email to information about the home health conditions of participation, contact Mary Rossi-Coajou at: James Cowher at or Jeannine Cramer at provider and supplier enrollment process inquiries: Frank Whelan, (410) information about the survey and enforcement requirements for Hospice Programs , send your inquiry via email to For information about the LTC facility requirements for participation, contact Molly Anderson at: Diane Corning at Kim Roche at or Alpha-Banu Wilson at SUPPLEMENTARY INFORMATION:Table of ContentsI.

6 Executive Summary A. Purpose B. Summary of the Provisions of this Rule C. Summary of Costs, Transfers, and BenefitsII. home health Prospective Payment System A. Overview of the home health Prospective Payment SystemB. Provisions for Payment Under the HH PPS III. home health Value-Based Purchasing (HHVBP) ModelA. Expansion of the HHVBP Model NationwideB. home health Value-Based Purchasing (HHVBP) Original Model IV. home health Quality Reporting Program (HH QRP) and Other home health Related Provisions A. Vaccinations for home health Agency health care Personnel B. Advancing health Information ExchangeC. home health Quality Reporting Program (HH QRP)D.

7 Changes to the home health Conditions of ParticipationV. home Infusion Therapy Services : Annual Payment Updates for CY 2022A. home Infusion Therapy Payment Categories B. Payment Adjustments for CY 2022 home Infusion Therapy ServicesC. CY 2022 Payment Amounts for home Infusion Therapy ServicesVI. Medicare Provider and Supplier Enrollment Changes A. Background Provider and Supplier Enrollment ProcessB. ProvisionsVII. Survey and Enforcement Requirements for Hospice Programs A. BackgroundB. ProvisionsVIII. Requests for InformationA. Fast Healthcare Interoperability Resources (FHIR) in Support of Digital Quality Measurement in Post-Acute care Quality Reporting Programs Request for InformationB.

8 Closing the health Equity Gap in Post-Acute care Quality Reporting Programs Request for InformationIX. Revised Compliance Date for Certain Reporting Requirements Adopted for Inpatient Rehabilitation Facilities (IRF) QRP and Long-Term care Facilities Quality QRPA. Revised Compliance Date for Certain Inpatient Rehabilitation Facility (IRF) QRP Reporting Requirements B. Revised Compliance Date for Certain Long-Term care Hospital (LTCH) QRP Reporting RequirementsX. COVID-19 Reporting Requirements for Long Term care Facilities A. BackgroundB. Statutory Authority and Regulatory BackgroundC. Provisions of the Final Rule and Responses to Public Comments XI.

9 Collection of Information Requirements and Waiver of Proposed Rulemaking A. Statutory Requirement for Solicitation of CommentsB. Collection of Information RequirementsC. Submission of PRA-Related CommentsD. Waiver of Proposed RulemakingXII. Regulatory Impact AnalysisA. Statement of NeedB. Overall Impact C. Detailed Economic AnalysisD. Limitations of Our AnalysisE. Regulatory Review Cost EstimationF. Alternatives ConsideredG. Accounting Statement and Tables H. Regulatory Flexibility Act (RFA)I. Unfunded Mandates Reform Act (UMRA)J. Federalism K. ConclusionL. Executive Order 12866I. Executive Summary A. Purpose 1. home health Prospective Payment System (HH PPS)This final rule updates the payment rates for home health agencies (HHAs) for CY 2022, as required under section 1895(b) of the Social Security Act (the Act).

10 This rule also finalizes recalibration of the case-mix weights under sections 1895(b)(4)(A)(i) and 1895(b)(4)(B) of the Act for 30-day periods of care in CY 2022 while maintaining the CY 2021 LUPA thresholds. This final rule updates the CY 2022 fixed-dollar loss ratio (FDL) for outlier payments (outlier payments as a percentage of estimated total payments are not to exceed percent, as required by section 1895(b)(5)(A) of the Act). Finally, this rule uses the physical therapy (PT) add-on factor to establish the occupational therapy (OT) LUPA add-on factor and finalizes conforming regulations text changes at , ensuring the regulations reflect that allowed practitioners, in addition to physicians, may establish and periodically review the home health plan of home health Value Based Purchasing (HHVBP) ModelIn this rule, we expand the home health Value-Based Purchasing (HHVBP) Model to all Medicare -certified HHAs in the 50 States, Territories, and the District of Columbia beginning January 1, 2022 with CY 2022 as a pre-implementation year.


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