Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016; Corrections
Federal Register, Volume 81 Issue 105 (Wednesday, June 1, 2016)
Federal Register Volume 81, Number 105 (Wednesday, June 1, 2016)
Rules and Regulations
Pages 34909-34913
From the Federal Register Online via the Government Publishing Office www.gpo.gov
FR Doc No: 2016-12841
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 414
CMS-1631-F3
RIN 0938-AS40
Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016; Corrections
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule; correcting amendment.
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SUMMARY: This document corrects technical and typographical errors that appeared in the final rule with comment period published in the November 16, 2015 Federal Register (80 FR 70886 through 71386) entitled ``Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and
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Other Revisions to Part B for CY 2016.'' The effective date for the rule was January 1, 2016.
DATES: Effective Date: This correcting document is effective May 31, 2016.
Applicability Date: The corrections indicated in this document are applicable beginning January 1, 2016.
FOR FURTHER INFORMATION CONTACT: Michelle Peterman (410) 786-2591.
SUPPLEMENTARY INFORMATION:
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Background
In FR Doc. 2015-28005 (80 FR 70886 through 71386), the final rule entitled ``Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016'' (hereinafter referred to as the CY 2016 PFS final rule with comment period), there were a number of technical and typographical errors that are identified and corrected in section IV., the Correction of Errors. These corrections are applicable as of January 1, 2016.
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Summary of Errors
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Summary of Errors in the Preamble
On page 71138, due to typographical errors, the QualityNet Help Desk email address, the qualified clinical data registry (QCDR) data validation execution report delivery date, and the email subject are incorrect.
On page 71139, due to typographical errors, the QualityNet Help Desk email address, the qualified registry data validation execution report delivery date, and the email subject are incorrect.
On pages 71141 and 71145, we incorrectly stated the Measure Application Validation (MAV) process utilized to determine the reporting of Physician Quality Reporting System (PQRS) cross-cutting resources.
On page 71147, we inadvertently omitted language restating the Consumer Assessment of Healthcare Providers and Systems (CAHPS) requirements that apply to groups of 100 or more eligible professionals (EPs) that register to participate in the Group Practice Reporting Option (GPRO) regardless of reporting mechanism.
On pages 71148 through 71150, we inadvertently omitted language restating the CAHPS requirement for the QCDR reporting option in Table 28--Summary of Requirements for the 2018 PQRS Payment Adjustment: Group Practice Reporting Criteria for Satisfactory Reporting of Quality Measures Data via the GPRO.
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Summary of Errors in Regulation Text
On page 71380 of the CY 2016 PFS final rule with comment period, we inadvertently omitted language in Sec. 414.90(k)(5)(i). In this paragraph, we inadvertently omitted language restating the CAHPS requirements that apply to groups of 100 or more EPs that register to participate in the Group Practice Reporting Option (GPRO) regardless of reporting mechanism.
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Waiver of Proposed Rulemaking
Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA), the agency is required to publish a notice of the proposed rule in the Federal Register before the provisions of a rule take effect. Similarly, section 1871(b)(1) of the Act requires the Secretary to provide for notice of the proposed rule in the Federal Register and provide a period of not less than 60 days for public comment. In addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i) of the Act mandate a 30-day delay in effective date after issuance or publication of a rule. Sections 553(b)(B) and 553(d)(3) of the APA provide for exceptions from the APA notice and comment, and delay in effective date requirements; similarly, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide exceptions from the notice and comment, and delay in effective date requirements of the Act. Section 553(b)(B) of the APA and section 1871(b)(2)(C) of the Act authorize an agency to dispense with normal notice and comment rulemaking procedures for good cause if the agency makes a finding that the notice and comment process is impracticable, unnecessary, or contrary to the public interest; and includes a statement of the finding and the reasons for it in the notice. In addition, both section 553(d)(3) of the APA and section 1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay in effective date where such delay is contrary to the public interest and the agency includes in the rule a statement of the finding and the reasons for it.
In our view, this correcting document does not constitute a rulemaking that would be subject to these requirements. This document merely corrects typographical and technical errors in the CY 2016 PFS final rule with comment period. The corrections contained in this document are consistent with, and do not make substantive changes to, the policies and payment methodologies that were adopted subject to notice and comment procedures in the CY 2016 PFS final rule with comment period. As a result, the corrections made through this correcting document are intended to ensure that the CY 2016 PFS final rule with comment period accurately reflects the policies adopted in that rule.
Even if this were a rulemaking to which the notice and comment and delayed effective date requirements applied, we find that there is good cause to waive such requirements. Undertaking further notice and comment procedures to incorporate the corrections in this document into the CY 2016 PFS final rule with comment period or delaying the effective date of the corrections would be contrary to the public interest because it is in the public interest to ensure that the CY 2016 PFS final rule with comment period accurately reflects our final policies as soon as possible following the date they take effect. Further, such procedures would be unnecessary, because we are not altering the payment methodologies or policies, but rather, we are simply correcting the Federal Register document to reflect the policies that we previously proposed, received comment on, and subsequently finalized. This correcting document is intended solely to ensure that the CY 2016 PFS final rule with comment period accurately reflects these policies. For these reasons, we believe there is good cause to waive the requirements for notice and comment and delay in effective date.
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Correction of Errors
In FR Doc. 2015-28005 of November 16, 2015 (80 FR 70886), make the following corrections:
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Correction of Errors in the Preamble
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On page 71138, second column, second paragraph, lines 8 through 12, the phrase and sentence ``Desk at Qnetsupport@sdps.org by 5:00 p.m. e.s.t. on June 30, 2016. The email subject should be ``PY2015 Qualified Registry Data Validation Execution Report.'' '' are corrected to read ``Desk at Qnetsupport@hcqis.org by 5:00 p.m. e.s.t. on June 30, 2017. The email subject should be ``PY2016 Qualified Registry Data Validation Execution Report.'' ''.
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On page 71139, third column, fifth full paragraph, lines 8 through 14, the phrase and sentence ``Desk at Qnetsupport@sdps.org by 5:00 p.m. ET on June 30 of the year in which the reporting period occurs (that is, June 30, 2016 for reporting periods occurring in 2016). The email subject should be ``PY2015 Qualified Registry Data Validation Execution Report.'' '' are corrected to read ``Desk at Qnetsupport@
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hcqis.org by 5:00 p.m. ET on June 30 following the year in which the reporting period occurs (that is, June 30, 2017 for the reporting periods occurring in 2016). The email subject should be ``PY2016 Qualified Registry Data Validation Execution Report.'' ''.
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On page 71141, first column, first partial paragraph, lines 5 through 9, the sentence ``In addition, the MAV process will also allow us to determine whether an EP should have reported on any of the PQRS cross-cutting measures.'' is corrected to read ``Please note, the MAV process is not utilized to determine whether an EP should have reported on any of the PQRS cross-cutting measures. This analysis occurs prior to the EP being subject to MAV.''.
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On page 71145, third column, first partial paragraph, lines 4 through 8, the sentence ``However, please note that the MAV process for the 2018 PQRS payment adjustment will now allow us to determine whether a group practice should have reported on at least 1 cross-cutting measure.'' is corrected to read ``Please note, the MAV process is not utilized to determine whether an EP should have reported on any of the PQRS cross-cutting measures. This analysis occurs prior to the EP being subject to MAV.''.
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On page 71147, the third column is corrected by adding the following paragraph after the first partial paragraph:
``For group practices of 100 or more EPs registered to participate in the GPRO via QCDR for the 2018 PQRS payment adjustment: The administration of the CAHPS for PQRS survey is REQUIRED. Therefore, if reporting via QCDR, these group practices must meet the following criterion for satisfactory reporting for the 2018 PQRS payment adjustment: For the 12-month reporting period for the 2018 PQRS payment adjustment, report all CAHPS for PQRS survey measures via a certified survey vendor, and report at least 6 measures available for reporting under a QCDR covering at least 2 of the NQS domains, AND report each measure for at least 50 percent of the group practice's patients. Of the non-CAHPS for PQRS measures, the group practice would report on at least 2 outcome measures, OR, if 2 outcomes measures are not available, report on at least 1 outcome measures and at least 1 of the following types of measures--
resource use, patient experience of care, efficiency/appropriate use, or patient safety.''
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On page 71148 through 71150, Table 28--Summary of Requirements for the 2018 PQRS Payment Adjustment: Group Practice Reporting Criteria for Satisfactory Reporting of Quality Measures Data via the GPRO is corrected to read as follows:
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Group practice Reporting Satisfactory reporting
Reporting period size Measure type mechanism criteria
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12-month (Jan 1-Dec 31, 2016).. 25-99 EPs; Individual GPRO Web Interface.... Report on all measures
100+ EPs (if Measures in the included in the web
CAHPS for PQRS Web Interface. interface; AND
does not apply). populate data fields
for the first 248
consecutively ranked
and assigned
beneficiaries in the
order in which they
appear in the group's
sample for each
module or preventive
care measure. If the
pool of eligible
assigned
beneficiaries is less
than 248, then the
group practice must
report on 100 percent
of assigned
beneficiaries. In
other words, we
understand that, in
some instances, the
sampling methodology
we provide will not
be able to assign at
least 248 patients on
which a group
practice may report,
particularly those
group practices on
the smaller end of
the range of 25-99
EPs. If the group
practice is assigned
less than 248
Medicare
beneficiaries, then
the group practice
must report on 100
percent of its
assigned
beneficiaries. A
group practice must
report on at least 1
measure for which
there is Medicare
patient data.
12-month (Jan 1-Dec 31, 2016).. 25-99 EPs that Individual GPRO Web Interface + The group practice
elect CAHPS for Measures in the CMS-Certified must have all CAHPS
PQRS;. Web Interface + Survey Vendor. for PQRS survey
100+ EPs (if CAHPS for PQRS. measures reported on
CAHPS for PQRS its behalf via a CMS-
applies). certified survey
vendor. In addition,
the group practice
must report on all
measures included in
the Web Interface;
AND populate data
fields for the first
248 consecutively
ranked and assigned
beneficiaries in the
order in which they
appear in the group's
sample for each
module or preventive
care measure. If the
pool of eligible
assigned
beneficiaries is less
than 248, then the
group practice must
report on 100 percent
of assigned
beneficiaries. A
group practice will
be required to report
on at least 1 measure
for which there is
Medicare patient
data.
Please note that, if
the CAHPS for PQRS
survey is applicable
to a group practice
who reports quality
measures via the Web
Interface, the group
practice must
administer the CAHPS
for PQRS survey in
addition to reporting
the Web Interface
measures.
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12-month (Jan 1-Dec 31, 2016).. 2-99 EPs; Individual Qualified Report at least 9
100+ EPs (if Measures. Registry. measures, covering at
CAHPS for PQRS least 3 of the NQS
does not apply). domains. Of these
measures, if a group
practice sees at
least 1 Medicare
patient in a face-to-
face encounter, the
group practice would
report on at least 1
measure in the PQRS
cross-cutting measure
set. If less than 9
measures covering at
least 3 NQS domains
apply to the group
practice, the group
practice would report
on each measure that
is applicable to the
group practice, AND
report each measure
for at least 50
percent of the
group's Medicare Part
B FFS patients seen
during the reporting
period to which the
measure applies.
Measures with a 0
percent performance
rate would not be
counted.
12-month (Jan 1-Dec 31, 2016).. 2-99 EPs that Individual Qualified The group practice
elect CAHPS for Measures + CAHPS Registry + CMS- must have all CAHPS
PQRS; for PQRS. Certified Survey for PQRS survey
100+ EPs (if Vendor. measures reported on
CAHPS for PQRS its behalf via a CMS-
applies). certified survey
vendor, and report at
least 6 additional
measures, outside of
the CAHPS for PQRS
survey, covering at
least 2 of the NQS
domains using the
qualified registry.
If less than 6
measures apply to the
group practice, the
group practice must
report on each
measure that is
applicable to the
group practice. Of
the additional
measures that must be
reported in
conjunction with
reporting the CAHPS
for PQRS survey
measures, if any EP
in the group practice
sees at least 1
Medicare patient in a
face-to-face
encounter, the group
practice must report
on at least 1 measure
in the PQRS cross-
cutting measure set.
12-month (Jan 1-Dec 31, 2016).. 2-99 EPs; Individual Direct EHR Report 9 measures
100+ EPs (if Measures. Product or EHR covering at least 3
CAHPS for PQRS Data Submission domains. If the group
does not apply). Vendor Product. practice's direct EHR
product or EHR data
submission vendor
product does not
contain patient data
for at least 9
measures covering at
least 3 domains, then
the group practice
must report all of
the measures for
which there is
Medicare patient
data. A group
practice must report
on at least 1 measure
for which there is
Medicare patient
data.
12-month (Jan 1-Dec 31, 2016).. 2-99 EPs that Individual Direct EHR The group practice
elect CAHPS for Measures + CAHPS Product or EHR must have all CAHPS
PQRS; for PQRS. Data Submission for PQRS survey
100+ EPs (if Vendor Product + measures reported on
CAHPS for PQRS CMS-Certified its behalf via a CMS-
applies). Survey Vendor. certified survey
vendor, and report at
least 6 additional
measures, outside of
CAHPS for PQRS,
covering at least 2
of the NQS domains
using the direct EHR
product or EHR data
submission vendor
product. If less than
6 measures apply to
the group practice,
the group practice
must report all of
the measures for
which there is
Medicare patient
data. Of the
additional 6 measures
that must be reported
in conjunction with
reporting the CAHPS
for PQRS survey
measures, a group
practice would be
required to report on
at least 1 measure
for which there is
Medicare patient
data.
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12-month (Jan 1-Dec 31, 2016).. 2-99 EPs; Individual PQRS Qualified Report at least 9
100+ EPs (if measures and/or Clinical Data measures available
CAHPS for PQRS non-PQRS Registry (QCDR). for reporting under a
does not apply). measures QCDR covering at
reportable via a least 3 of the NQS
QCDR. domains, AND report
each measure for at
least 50 percent of
the group practice's
patients. Of these
measures, the group
practice would report
on at least 2 outcome
measures, OR, if 2
outcomes measures are
not available, report
on at least 1 outcome
measures and at least
1 of the following
types of measures--
resource use, patient
experience of care,
efficiency/
appropriate use, or
patient safety.
12-month (Jan 1-Dec 31, 2016).. 2-99 EPs that Individual PQRS Qualified The group practice
elect CAHPS for measures and/or Clinical Data must have all CAHPS
PQRS; non-PQRS Registry (QCDR) for PQRS survey
100+ EPs (if measures + CMS-Certified measures reported on
CAHPS for PQRS reportable via a Survey Vendor. its behalf via a CMS-
applies). QCDR + CAHPS for certified survey
PQRS. vendor, and report at
least 6 additional
measures, outside of
the CAHPS for PQRS
survey, covering at
least 2 of the NQS
domains using the
QCDR AND report each
measure for at least
50 percent of the
group practice's
patients. Of these
non-CAHPS measures,
the group practice
would report on at
least 2 outcome
measures, OR, if 2
outcomes measures are
not available, report
on at least 1 outcome
measures and at least
1 of the following
types of measures--
resource use, patient
experience of care,
efficiency/
appropriate use, or
patient safety.
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List of Subjects in 42 CFR Part 414
Administrative practices and procedure, Health facilities, Health professions, Kidney diseases, Medicare, Reporting and recordkeeping requirements.
Accordingly, 42 CFR chapter IV is corrected by making the following correcting amendments to part 414:
PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES
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The authority citation for part 414 continues to read as follows:
Authority: Secs. 1102, 1871, and 1881(b)(l) of the Social Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(l)).
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Section 414.90 is amended by revising paragraph (k)(5)(i) to read as follows:
Sec. 414.90 Physician Quality Reporting System (PQRS).
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(k) * * *
(5) * * *
(i) If a group practice does not report the CAHPS for PQRS survey measures, report at least 9 measures available for reporting under a QCDR covering at least 3 of the NQS domains, and report each measure for at least 50 percent of the eligible professional's patients. Of these measures, report on at least 3 outcome measures, or, if 3 outcomes measures are not available, report on at least 2 outcome measures and at least 1 of the following types of measures--resource use, patient experience of care, efficiency/appropriate use, or patient safety. If a group practice reports the CAHPS for PQRS survey measures, apply reduced criteria as follows: 6 QCDR measures covering 2 NQS domains; and, of the non-CAHPS for PQRS measures, 2 outcome measures or 1 outcome and 1 other specified type of measure, as applicable.
* * * * *CMS-1631-F3
Dated: May 25, 2016.
Madhura Valverde,
Executive Secretary to the Department.
FR Doc. 2016-12841 Filed 5-31-16; 8:45 am
BILLING CODE 4120-01-P
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