These costs are multifaceted and include the burden associated with complying with the program. Indicator Seven: Per-Beneficiary Medicare Spending, (8). We plan on reviewing the 2020 hospice MCR data when complete information is available that will allow us to consider whether the hospice labor shares based on 2018 data are still appropriate. Direct patient care salaries and contract labor costs are costs associated with medical services provided by medical personnel including but not limited to physician services, nurse practitioners, RNs, and hospice aides. 1. Section 1814(i)(5)(D)(iii) of the Act requires that the Secretary publish selected measures applicable with respect to FY 2014 no later than October 1, 2012. These same requirements were implemented for home health aide supervision in 2019 (see 84 FR 51732 and the associated regulations at 484.80(c)(1)), without any reported adverse impacts noted to-date in CMS survey data or complaints being reported to CMS. The base payments are adjusted for geographic differences in wages by multiplying the labor share, which varies by category, of each base rate by the applicable hospice wage index. In the proposed rule, the denominator description is discussed accurately, as the number of beneficiaries with at least one day of hospice during the last three days of life within a reporting period. Under these circumstances a not applicable is not needed. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. We stated in the final rule that the addendum is intended to complement the Hospice Conditions of Participation (CoPs) at 418.52(c)(7) and (8), which require hospices to verbally inform beneficiaries, at the time of hospice election, of the services covered under the Medicare hospice benefit, as well as the limitations of such services (84 FR 38509). Therefore, the format of the addendum must be usable for the beneficiary and/or representative. CY 2021 data submissions compliance impacts the FY 2023 APU. on We sought public comment on the technical correction to the regulation at 418.312(b) effective October 1, 2021. On March 13, 2020, the President declared a national state of emergency under the Stafford Act, effective March 1, 2020, allowing the Secretary to invoke section 1135(b) of the Act (42 U.S.C. National implementation of the CAHPS Hospice Survey commenced January 1, 2015, as stated in the FY 2015 Hospice Wage Index and Payment Rate Update final rule (79 FR 50452). If we were to delay our data extraction point to 12 months after the last date of the last discharge in the applicable period, we would not be able to deliver the calculations to hospices sooner than 18 to 24 months after the last discharge. This indicator helps the HCI to capture patients' receipt of skilled nursing visits and direct patient care, which is an important aspect of hospice care. We will publicly report the HVLDL no earlier than May 2022. Overall, the TEP supported each candidate measure and agreed that they were viable for distinguishing hospice quality. As noted by the commenter, salaries and benefit costs for employed Medical Directors would be reported in Worksheet A, column 1, line 15 (salaries) and Worksheet B, column 3, line 15 (benefits), which are both included in our proposed methodology as these expenses are reported in overhead salaries and overhead benefits.