[Federal Register Volume 80, Number 224 (Friday, November 20, 2015)]
[Notices]
[Pages 72722-72725]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-29622]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-3327-NC]


Medicare Program; Request for Information To Aid in the Design 
and Development of a Survey Regarding Patient and Family Member 
Experiences With Care Received in Long-Term Care Hospitals

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Request for information.

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[[Page 72723]]

SUMMARY: This request for information will aid in the design and 
development of a survey regarding patient and family member experiences 
with the care received in long-term care hospitals (LTCHs).
    Comment Date: To be assured consideration, comments must be 
received at one of the addresses provided below, no later than 5 p.m. 
on January 19, 2016.

ADDRESSES: In commenting, refer to file code CMS-3327-NC. Because of 
staff and resource limitations, we cannot accept comments by facsimile 
(FAX) transmission.
    You may submit comments in one of four ways (please choose only one 
of the ways listed):
    1. Electronically. You may submit electronic comments on this 
regulation to http://www.regulations.gov. Follow the ``Submit a 
comment'' instructions.
    2. By regular mail. You may mail written comments to the following 
address only: Centers for Medicare & Medicaid Services, Department of 
Health and Human Services, Attention: CMS-3327-NC, P.O. Box 8016, 
Baltimore, MD 21244-8016.

    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments to 
the following address only: Centers for Medicare & Medicaid Services, 
Department of Health and Human Services, Attention: CMS-3327-NC, Mail 
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-8016.

    4. By hand or courier. Alternatively, you may deliver (by hand or 
courier) your written comments only to the following addresses:
    a. For delivery in Washington, DC--Centers for Medicare & Medicaid 
Services, Department of Health and Human Services, Room 445-G, Hubert 
H. Humphrey Building, 200 Independence Avenue SW., Washington, DC 
20201.

    (Because access to the interior of the Hubert H. Humphrey Building 
is not readily available to persons without Federal government 
identification, commenters are encouraged to leave their comments in 
the CMS drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain a proof of filing 
by stamping in and retaining an extra copy of the comments being 
filed.)
    b. For delivery in Baltimore, MD--Centers for Medicare & Medicaid 
Services, Department of Health and Human Services, 7500 Security 
Boulevard, Baltimore, MD 21244-8016.

    If you intend to deliver your comments to the Baltimore address, 
call telephone number (410) 786-7195 in advance to schedule your 
arrival with one of our staff members. Comments erroneously mailed to 
the addresses indicated as appropriate for hand or courier delivery may 
be delayed and received after the comment period.

FOR FURTHER INFORMATION CONTACT: Judith Harvilchuck, 410-786-3527.

SUPPLEMENTARY INFORMATION: 
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment. We post all comments 
received before the close of the comment period on the following Web 
site as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that Web site to 
view public comments.
    Comments received timely will also be available for public 
inspection as they are received, generally beginning approximately 3 
weeks after publication of a document, at the headquarters of the 
Centers for Medicare & Medicaid Services, 7500 Security Boulevard, 
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 
a.m. to 4 p.m. To schedule an appointment to view public comments, 
phone 1-800-743-3951.

I. Background

    In accordance with section 3011 of the Affordable Care Act, the 
Department of Health and Human Services (HHS) developed the National 
Quality Strategy (NQS), which is led by the Agency for Healthcare 
Research and Quality (AHRQ), to create national aims and priorities to 
guide local, state, and national efforts to improve the quality of 
health care (http://www.ahrq.gov/workingforquality/). The NQS 
established three aims supported by six priorities.
    The three aims are as follows:
     Better Care: Improve the overall quality, by making health 
care more patient-centered, reliable, accessible, and safe.
     Healthy People/Healthy Communities: Improve the health of 
the U.S. population by supporting proven interventions to address 
behavioral, social, and environmental determinants of health in 
addition to delivering higher-quality care.
     Affordable Care: Reduce the cost of quality health care 
for individuals, families, employers, and government.
    The six priorities are: ``(1) Making care safer by reducing harm 
caused by the delivery of care; (2) ensuring that each person and 
family are engaged as partners in their care; (3) promoting effective 
communication and coordination of care; (4) promoting the most 
effective prevention and treatment practices for the leading causes of 
mortality, starting with cardiovascular disease; (5) working with 
communities to promote wide use of best practices to enable healthy 
living; and (6) making quality care more affordable for individuals, 
families, employers, and governments by developing and spreading new 
health care delivery models.''
    To support the collection of data that can be used to pursue these 
aims and progress on these priorities in the long-term care hospital 
(LTCH) setting, we are developing a survey hereinafter referred to as 
the ``LTCH Patient and Family Member Experience of Care (PEC) Survey,'' 
which supports the NQS goal of Better Care and the priorities of:
     Ensuring that each person and family are engaged as 
partners in their care (priority #2); and
     Promoting effective communication and coordination of care 
(priority #3).
    We plan to collect this information in support of the NQS and, 
under sections 1886(m)(5) and 1890A(e) of the Social Security Act (the 
Act) and develop the LTCH PEC Survey into a quality measure that we may 
consider proposing for adoption in the LTCH Quality Reporting Program 
(QRP) (for details on CMS' measure development process, please see the 
Blueprint at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MeasuresManagementSystemBlueprint.html). We 
will develop the CMS LTCH PEC in accordance with Consumer Assessment of 
Healthcare Providers and Systems (CAHPS[supreg]) Survey Design 
Principles and are developing this survey and plans to submit the 
resulting instrument to AHRQ for recognition as a CAHPS[supreg] survey. 
CAHPS[supreg] Survey Design Principles and implementation instructions 
can be found at (https://www.cahps.ahrq.gov/about-cahps/principles/index.html).
    We have previously implemented a number of nationwide patient 
experience CAHPS[supreg] surveys in both in-patient and out-patient 
settings and for different services. Specifically, we implemented 
CAHPS[supreg] surveys for Medicare health and drug plans, inpatient 
hospitals, home health agencies, in-center dialysis facilities, 
hospices, and Accountable Care Organizations, and recently developed a

[[Page 72724]]

CAHPS[supreg] survey for outpatient and ambulatory surgery centers; and 
we have also begun development of an Inpatient Rehabilitation Facility 
Patient Experience of Care Survey. The planned CMS LTCH PEC Survey 
differs from the other CMS PEC surveys, because the target population 
for the LTCH PEC Survey consists of patients who have complex and 
severe conditions and are in need of critical care-related services for 
an extended period of time.
    Certified as acute-care hospitals, LTCHs furnish care to 
beneficiaries who need hospital-level care for relatively extended 
periods. To qualify as an LTCH for Medicare payment, a facility must 
meet Medicare's conditions of participation for acute care hospitals, 
and its Medicare patients generally must have an average length of stay 
greater than 25 days.\1\ LTCHs provide extended medical and 
rehabilitative hospital-level care to patients that are clinically 
complex, or may suffer from multiple acute or chronic 
conditions.2 3 Services provided typically include: medical 
and nursing care, critical care, comprehensive rehabilitation, wound 
care, respiratory therapy (for example, ventilator support), head 
trauma treatment, pain management, case management, and social 
services.
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    \1\ http://www.medpac.gov/documents/reports/chapter-11-long-term-care-hospital-services-(march-2013-report).pdf?sfvrsn=2.
    \2\ http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/post_acute_care_reform_plan.html.
    \3\ http://www.medicare.gov/Pubs/pdf/11347.pdf.
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    We believe that the following aspects of LTCH care would have to be 
taken into account in the development of the LTCH PEC survey, but we 
invite comment on these considerations as well as any potential 
omissions from this list:
     Complexity and severity of illness is marked for this 
population, resulting in an average inpatient length of stay greater 
than 25 days.
     Patient-centered goals/preferences with a possible need to 
include family as proxies for patients, since LTCH patients are very 
ill and may not be the best source of information for the trajectory of 
their episode of LTCH care.
     Services are often critical care based, due to the 
critical nature of the illness or injury that requires such 
hospitalization.
     Comprehensive array of services and levels of care.
     Interdisciplinary team approach to the delivery of care.
     A higher mortality rate exists among this population 
compared with other settings.
     Consideration of post-LTCH care and transitions to other 
possible care settings.
    Given the unique environment and patient population of LTCH 
facilities, we are exploring the level of adequacy of existing patient 
experience of care instruments for capturing LTCH care experiences. 
Therefore, we are in the process of reviewing potential topic areas (as 
discussed in section II of this RFI), as well as publicly available 
instruments and measures, for the purpose of developing a LTCH Survey 
that will enable objective comparisons of LTCH experiences across the 
country. A rigorous, well-designed LTCH Survey will allow us to 
understand patient experiences throughout their LTCH care, as reported 
by the patients themselves, if possible, or by family members. Should 
we ultimately adopt the LTCH PEC Survey as a quality measure in the 
LTCH QRP, public reporting of data from the measure could help 
consumers make more informed decisions about LTCH settings, as well as 
drive improvements in the quality of LTCH care.

II. Solicitation of Information

    We are soliciting the submission of suggested topic areas such as 
communication with providers, mechanical ventilation, therapy services, 
wound care, pain management/control or non-pain symptom management 
(including offering of alternative non-opioid pain management, 
discussion of safe storage and proper disposal of opioids, screening 
for overdose risk, and review the history of substance use), 
rehabilitation services, medical and nursing care, interdisciplinary 
team goal setting and care planning, family training, and discharge 
planning. We are also soliciting information on publicly available 
instruments and measures that can be used to capture patients' or 
family members' experiences with LTCH care in a variety of formats (for 
example, standardized, computer readable format) that can be collected 
by providers or CAHPS[supreg] survey vendors. We are interested in 
suggested topic areas and the identification of publicly available 
instruments that can measure the quality of care from the patients' or 
family member's perspective in LTCH settings; instruments that can be 
used to track changes over time; and items that are developed for or 
can be modified to address low case volume. Existing instruments are 
preferred if they have been tested, have been found to have a high 
degree of reliability and validity, or are in wide use already in the 
industry/hospital settings, including those in rural and frontier 
communities. Instruments capable of risk adjustment, and/or instruments 
that minimize duplication of efforts and/or that utilize common quality 
measures, where available, are preferred. Whenever possible, preference 
will be given to quality measures identified by the Secretary under 
section 1139A or 1139B of the Act, or endorsed under section 1890 of 
the Act.
    The following information would be especially helpful in any 
comments responding to this request for information:
     A brief cover letter summarizing the information requested 
for submitted instruments and topic areas, respectively, and how the 
submitted materials could be used to fulfill the intent of the survey.
     (Optional) Information about the person submitting the 
materials for the purpose of allowing for follow-up questions about the 
submission, including the following:
    ++ Name.
    ++ Title.
    ++ Organization.
    ++ Mailing address.
    ++ Telephone number.
    ++ Email address.
     When submitting topic areas, we encourage including, to 
the extent available, the following information:
    ++ Detailed descriptions of the suggested topic area(s) and 
specific purpose(s).
    ++ Relevant peer-reviewed journal articles or full citations.
     When submitting publicly available instruments or survey 
questions, we encourage including to the extent available the following 
information:
    ++ Name of the instrument.
    ++ Indication that the instrument is publicly available.
    ++ Copies of the full instrument in all available languages.
    ++ Topic areas included in the instrument.
    ++ Measures that can be derived from data collected using the 
instrument.
    ++ Information regarding instrument reliability (internal 
consistency, test-retest, etc.) and validity (content, construct, 
criterion related).
    ++ Results of cognitive testing (one-on-one testing with a small 
number of respondents to ensure that they understand the 
questionnaire.)
    ++ Results of field testing.
    ++ Current use of the instrument (who is using it, for what it is 
being used, with what population it is being used, how instrument 
findings are reported, and by whom the findings are used).
    ++ Relevant peer-reviewed journal articles or full citations.

[[Page 72725]]

    ++ CAHPS[supreg] trademark status.
    ++ NQF endorsement status.
    ++ Survey administration instructions.
    ++ Data analysis instructions.
    ++ Guidelines for reporting survey data.
    If you wish to provide comment on this information collection, 
please submit your comments as specified in the ADDRESSES section of 
this request for information.
    Comments must be received on/by January 19, 2016.

III. Collection of Information Requirements

    This RFI does not impose any information collection requirements. 
We believe it is a solicitation of comments from the general public. As 
stated in the implementing regulations of the Paperwork Reduction Act 
of 1995 (PRA) at 5 CFR 1320.3(h)(4), it is exempt from the requirements 
of the PRA (44 U.S.C. 3501 et seq.) .
    The data collected via this RFI will be used to develop the LTCH 
PEC Survey. While surveys are generally subject to the requirements of 
the PRA, we believe the LTCH PEC Survey is exempt. Section I of this 
RFI explains that we plan to collect this information in support of the 
NQS and, under sections 1886(m)(5) and 1890A(e) of the the Act and 
develop the LTCH PEC Survey into a quality measure that we may consider 
proposing for adoption in the LTCH Quality Reporting Program (QRP). In 
accordance with section 102 of the Medicare Access and CHIP 
Reauthorization Act of 2015 (MACRA) (Pub. L. 114-110), the PRA shall 
not apply to the collection of information for the development of 
quality measures.
    Also, as stated earlier in section I. of this RFI, we will develop 
the CMS LTCH PEC Survey in accordance with CAHPS[supreg] Survey Design 
Principles and are developing this survey and plans to submit the 
resulting instrument to AHRQ for recognition as a CAHPS[supreg] survey. 
Upon receiving recognition as a CAHPS[supreg] survey and prior to 
implementation, CMS will submit the CAHPS recognized LTCH PEC Survey 
through the OMB approval process. At that time, the public will have 
the opportunity to review, comment, or review and comment on the 
proposed information collection request prior to its submission to OMB 
for review and approval.

IV. Response to Comments

    Because of the large number of public comments we normally receive 
on Federal Register documents, we are not able to acknowledge or 
respond to them individually. We will consider all comments we receive 
by the date and time specified in the DATES section of this preamble, 
and, when we proceed with a subsequent document, we will respond to the 
comments in the preamble to that document.

    Dated: November 6, 2015.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2015-29622 Filed 11-19-15; 8:45 am]
BILLING CODE 4120-01-P