Justia Department Of Health And Human Services Centers For Medicare & Medicaid Services Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; Medicaid Promoting Interoperability Program; Quality Payment Program-Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year; Provisions From the Medicare Shared Savings Program-Accountable Care Organizations Pathways to Success; and Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder Under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act; Correction, 539-571 [2018-28354]

Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; Medicaid Promoting Interoperability Program; Quality Payment Program-Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year; Provisions From the Medicare Shared Savings Program-Accountable Care Organizations Pathways to Success; and Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder Under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act; Correction, 539-571 [2018-28354]

Download as PDF Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations For the reasons stated in the preamble, the Commission amends chapter III of title 39 of the Code of Federal Regulations as follows: 1. The authority citation for part 3015 continues to read as follows: Authority: 39 U.S.C. 503; 3633. 2. Amend § 3015.7 by revising paragraph (c) to read as follows: ■ Standard for Compliance. * * * * * (c)(1) Annually, on a fiscal year basis, the appropriate share of institutional costs to be recovered from competitive products collectively, at a minimum, will be calculated using the following formula: ASt ∂ 1 = ASt * (1+%DCCMt¥1 + CGDt¥1) Where, AS = Appropriate Share, expressed as a percentage and rounded to one decimal place CCM = Competitive Contribution Margin CGD = Competitive Growth Differential t = Fiscal Year If t = 0 = FY 2007, AS = 5.5 percent (2) The Commission shall, as part of each Annual Compliance Determination, calculate and report competitive products’ appropriate share for the upcoming fiscal year using the formula set forth in paragraph (c)(1) of this section. By the Commission. Stacy L. Ruble, Secretary. [FR Doc. 2019–00399 Filed 1–30–19; 8:45 am] khammond on DSKBBV9HB2PROD with RULES BILLING CODE 7710–FW–P VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 RIN 0938–AT31 II. Summary of Errors Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; Medicaid Promoting Interoperability Program; Quality Payment Program—Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year; Provisions From the Medicare Shared Savings Program— Accountable Care Organizations Pathways to Success; and Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder Under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act; Correction A. Summary of Errors in the Regulation Text On page 60090, in regulation text regarding § 414.1415, we made a typographical error in identifying the year in the effective date. Centers for Medicare & Medicaid Services ■ § 3015.7 [CMS–1693–CN] I. Background In FR Doc. 2018–24170 of November 23, 2018 (83 FR 59452 through 60303), there were a number of technical errors that are identified and corrected in the Correction of Errors section below. These corrections are effective January 1, 2019. DEPARTMENT OF HEALTH AND HUMAN SERVICES PART 3015—REGULATION OF RATES FOR COMPETITIVE PRODUCTS 539 42 CFR Part 414 Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Correction of final rule. AGENCY: This document corrects technical errors that appeared in the final rule published in the Federal Register on November 23, 2018 entitled ‘‘Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; Medicaid Promoting Interoperability Program; Quality Payment Program—Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year; provisions from the Medicare Shared Savings Program—Accountable Care Organizations Pathways to Success; and Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder under the Substance UseDisorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act.’’ DATES: This correcting document is effective January 31, 2019, and is applicable beginning January 1, 2019. FOR FURTHER INFORMATION CONTACT: Benjamin Chin, (410) 786–0679, Alesia Hovatter (410) 786–6861 or Molly MacHarris, (410) 786–4461. SUPPLEMENTARY INFORMATION: SUMMARY: PO 00000 Frm 00029 Fmt 4700 Sfmt 4700 B. Summary of Errors in the Appendix On page 60151, we inadvertently omitted Table B.6. Internal Medicine (Removal Table), Table B.7. Emergency Medicine, Table B.8. Obstetrics/ Gynecology, Table B.9. Ophthalmology, Table B.10. Orthopedic Surgery, Table B.11. Otolaryngology, Table B.12. Pathology, and Table B.13 Pediatrics. III. Waiver of Proposed Rulemaking Under 5 U.S.C. 553(b) of the Administrative Procedure Act (the 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 Social Security Act (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 30day 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; in cases in which these exceptions apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide exceptions from the notice and 60-day comment period and delay in effective date requirements of the Act as well. 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 rule. In addition, section 553(d)(3) of the APA and section 1871(e)(1)(B)(ii) allow the agency to avoid the 30-day delay in effective date where such delay is contrary to the public interest and the E:\FR\FM\31JAR1.SGM 31JAR1 540 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations khammond on DSKBBV9HB2PROD with RULES 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 technical errors in the CY 2019 PFS final rule. The corrections contained in this document are consistent with, and do not make substantive changes to, the policies and payment methodologies that were proposed, subject to notice and comment procedures, and adopted in the CY 2019 PFS final rule. As a result, the corrections made through this correcting document are intended to resolve inadvertent errors so that the rule accurately reflects the policies adopted in the final 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 VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 requirements. Undertaking further notice and comment procedures to incorporate the corrections in this document into the CY 2019 PFS final rule 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 rule accurately reflects our policies as of the date they take effect. Further, such procedures would be unnecessary because we are not making any substantive revisions to the final rule, but rather, we are simply correcting the Federal Register document to reflect the policies that we previously proposed, received public comment on, and subsequently finalized in the final rule. For these reasons, we believe there is good cause to waive the requirements for notice and comment and delay in effective date. PO 00000 Frm 00030 Fmt 4700 Sfmt 4700 IV. Correction of Errors In FR Doc. 2018–24170 of November 23, 2018 (83 FR 59452 through 60303), make the following corrections: § 414.1415 [Corrected] 1. On page 60090, in the second column; in amendatory instruction 41, in line 2, the parenthetical ‘‘(effective January 1, 2010)’’ is corrected to read ‘‘(effective January 1, 2020)’’. ■ 2. On page 60151, Table B.6. Internal Medicine (Removal Table), Table B.7. Emergency Medicine, Table B.8. Obstetrics/Gynecology, Table B.9. Ophthalmology, Table B.10. Orthopedic Surgery, Table B.11. Otolaryngology, Table B.12. Pathology, and Table B.13 Pediatrics should be added in their entirety. ■ BILLING CODE 4120–01–P E:\FR\FM\31JAR1.SGM 31JAR1 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations 541 MEASURES FINALIZED FOR REMOVAL Note: In this fi nal rule, we removed the fo llowing meas ure(s) below from thi s specific spec ialty measure set based upon rev iew of updates made to existing quality measure specifications, the addition of new measures for inclus ion in MIPS , and the feed back provided by specialty societies. Quality NQF C MS Collection Measure Nati onal Measure Title a nd Measure R a tionale for Removal eCQMID T ype T ype Quality Description # # Stewa rd Str a tegy Domain 0056 163 CMS 123v eCQM Process Effective Comprehensive Dia betes Care: Foot National Thi s measure is being Specifications removed from the 2019 7 Clinical Exa m: Comm ittee for Quality program based on the Care The percentage of patients 18-75 years of age with diabetes (type I and type Assurance detai led rationale 2) who received a foot exam (visual described below for this inspection and sensory exam with measure in 'Table C: mono fi lament and a pulse exam) Quality Measures during the measurement year. Finalized fo r Removal in the 202 1 MIPS Payment Year and Future Years. " National This meas ure is being Medicare Part Process Effective Ischemic Vascula r Disease (IVD): 0068 204 CMS 164v B Claims Clinical Use of Aspirin or Another Committee removed from the 2019 7 program based on the Measure Care Antipla telet: for Quality Assurance detai led rationale Specifications, Percentage of patients 18 years of age eCQM and older who were diagnosed with described below for this Specifications, acute myocardial infarction (AMI), measure in "Table C: coronary artery bypass graft (CABG) CMS Web Quality Measures Interface or percutaneous coronary Finalized for Removal interventions (PC!) in the 12 months in the 202 1 MIPS Measure Payment Year and Specifications, prior to the measurement period, or Future Years. " MIPS CQMs who had an active diagnosis of Specifications ischemi c vascular disease (IV D) during the measurement period, and who had documentation of use of aspirin or another antipl atelet during the measurement period. MIPS CQMs N/A 276 N/A Process Effective American This measure is being Sleep Apnea : Assessment of Sleep Academy removed from the 20 19 Specifications Clinical Symptoms: of Sleep program based on the Care Percentage of visits for patients aged 18 years and older with a diagnos is of Med icine detai led rationale described below for this obstructive sleep apnea that incl udes measure in "Table C: documentation of an assessment of sleep symptoms, including presence or Quality Measures Finalized for Removal absence of snoring and daytime sleepiness. in the 202 1 MIPS Payment Year and Future Years. " American Th is meas ure is being N/A 278 N/A MIPS CQMs Process Effective Sleep Apnea : Positive Airway Specifications Clinical Academy removed from the 20 19 Pressure T hera py Prescribed: Care Percentage of patients aged 18 years of Sleep program based on the and older with a diagnosis of moderate Medicine detailed rationale described below for this or severe obstructive sleep apnea who were prescribed positive airway measure in "Table C: pressure therapy Quality Measures Finalized for Removal in the 202 1 MIPS Payment Year and Future Years. " Efficiency Efficiency Adult Sinu sitis: More tha n One American This measure is being 334 N/A MIPS CQMs N/A Specifications and Cost Computerized Tomography (CT) Academy removed from the 20 19 of program based on the Reduction Sca n W ithin 90 Days for C hronic Otolaryngol detailed rationale Sinusiti s (Overu se): Percentage of patients aged 18 years ogydescri bed below for this and older with a diagnos is of chron ic Otolaryngol measure in "Table C: sinusitis who had more than one CT ogy- Head Quality Measures scan of the paranasal sinuses ordered and Neck Finalized for Removal Surgery inthe202 1 MIPS or received with in 90 days after the date of diagnos is Payment Year and Future Years. " Intermedi Effective Hypertension: Impr ovement in Centers for Th is measure is being N/A 373 CMS65v8 eCQM VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00031 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.030</GPH> khammond on DSKBBV9HB2PROD with RULES B .6 . Inte rn a l Medi cin e 542 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.6. Internal Medicine Outcome Specifications Care y/ Populatio n Health Blood Pressure: Percentage of patients aged 18-85 years of age with a diagnosis of hypertension whose blood pressure improved during the measurement period. Medicaid Services and Follow Up: The percentage of female adolescents 16 years of age who had a chlamydia screening test with proper follow-up during the measurement period Committee for Quality Assurance program based on the detailed rationale described below for this measure in "Table C: Quality Measures Finalized for Removal in the 2021 MIPS Payment Year and Future Years." program based on the detailed rationale described below for this measure in "Table C: Quality Measures Finalized for Removal in the 2021 MIPS Payment Year and Future Years." We did not receive specific comments regarding the proposed removal of measures from this specialty measure set. VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00032 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.031</GPH> khammond on DSKBBV9HB2PROD with RULES FINAL ACTION: We are finalizing the removal of measures from the Internal Medicine Specialty Measure Set as proposed for the 2019 Performance Period and future years. However, as noted in our responses to public comments in Table C, we are not finalizing the following measures for removal from this measure set: and 18. 543 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations 8.7. Emergency Medicine In addition to the considerations discussed in the introductory language of Table B in thi s final rule, the Emergency Medicine specialty set takes into consideration the following criteria, which includes, but is not limited to: the measure reflects current clinical gu idelines and the coding of the measure includes the spec ialists. We may reassess the appropriateness of individual measures, on a case-by-case basis, to ensure appropriate inclusion in the specialty set. This measure set does not have any measures removed from prior years. 8.7. Emergency Medicine NQF # 1,., Indicator Quality CMS # . eCQM ID !i'i > Measure Steward Appropriate Testing for Children with Pharyngitis: Percentage of ch ildren 3-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode. Acute Otitis Externa (AOE): Topical Therapy: Percentage of patients aged 2 years and o lder with a diagnosis of AOE who were prescribed topical preparations. National Committee for Quality Assurance :· N/A 066 CMS I46 v7 eCQM Specifications, MIPSCQMs Specifications Process Efficiency and Cost Reduction ! (Appropriate Use) 0653 091 N/A Process Effective Clinical Care ! (Appropriate Use) 0654 093 N/A Pan B Claims Measure Specifications, MIPSCQMs Specifications Pan B Claims Measure Specifications, MIPS CQMs Specifications Process Efficiency and Cost Reduction eCQM Specifications Process § ! (Appropriate Use) 107 CMS I61 v7 Effective Clinical Care 0058 116 N/A MIPSCQMs Specifications Process Efficiency and Cost Reduction N/A 187 N/A MIPSCQMs Specifications Process Effective Cl inical Care N/A 254 N/A Pan B Claims Measure Specifications, M1PSCQMs Specitications Process Effective Clinical Care N/A 255 N/A Part B Claims Measure Specifications, MIPSCQMs Specifications Process Effective Clinical Care Part B Claims Measure Specifications, Process N/A 317 16:41 Jan 30, 2019 CMS22v 7 Jkt 247001 PO 00000 Frm 00033 Fmt 4700 Community /Population Health Sfmt 4725 Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy- Avoidance of Inappropriate Use: Percentage of patients aged 2 years and older wi th a diagnos is of AOE who were not prescribed systemic antimicrobial therapy. Adult Major Depressive Disorder (Ml>D): Suicide Risk Assessment: Percentage of patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) with a suicide risk assessment completed during the visit in which a new diagnosis or recurrent episode was identified. Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis: Percentage of ad ults 18-64 years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription. Stroke and Stroke Rehabilitatio n: Thrombolytic Therapy: Percentage of patients aged 18 years and older with a diagnosis of acute ischemic stroke who arrive at the hospital within 2 hours of time last known well and for whom IV t-PA was initiated within 3 hours of time last known well. Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain: Percentage of pregnant female patients aged 14 to 50 who present to the emergency depanment (ED) with a chief complaint of abdominal pain or vaginal bleeding who receive a trans-abdominal or trans-vaginal ultrasound to determine pregnancy location. Rh Immunoglobulin (Rhogam) for Rh-Negative Pregnant Women at Risk of Fetal Blood Exposure: Percentage of Rh-negative pregnant women aged 14-50 years at risk of fetal blood exposure who receive Rh-lmmunoglobulin (Rhogam) in the emergency depanment (ED). Preventive Care a nd Screening: Screening for High Blood Pressure and Follow-Up Documented: E:\FR\FM\31JAR1.SGM 31JAR1 American Acade my of Otolaryngolog y-Head and Neck Surgery American Academy of Otolaryngolog y-Head and Neck Surgery Physician Consortium tor Performance Improvement Foundation (PCP I®) National Committee for Quality Assurance American Heart Association American College of Emergency Physicians American College of Emergency Physicians Centers for Medicare & Medicaid ER31JA19.032</GPH> ! (Efficiency) VerDate Sep<11>2014 ;>, Measure Title and l>escriptipn Domain 0104 khammond on DSKBBV9HB2PROD with RULES MEASliRES FINALIZED FOR INCLUSION Measure National Type Quality Strategy " Collec.tion " Type 544 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.7. Emergency Medicine ! N/A 331 N/A (Appropriate Use) ! N/A 332 N/A (Appropriate Use) ! (Appropriate Use) MIPSCQMs Specifications Process MIPSCQMs Specifications Process Efficiency and Cost Reduction Efficiency and Cost Reduction N/A 333 N/A MIPSCQMs Specifications Efficiency Efficiency and Cost Reduction N/A 415 N/A Part B Claims Measure Specifications, MIPSCQMs Specifications Efficiency Efficiency and Cost Reduction N/A 416 N/A Part B Claims Measure Specifications, MIPSCQMs Specifications Efficiency Efficiency and Cost Reduction ! (Efficiency) ! (Efficiency) Sinusitis (Overuse): Percentage of patients, aged 18 years and older, with a diagnosis of acute sinusitis who were prescribed an antibiotic within 10 days after onset Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use): Percentage of patients aged 18 years and older with a diagnosis of acute bacterial sinusitis that were prescribed amoxicillin, with or without clavulanate, as a first line antibiotic at the time of Head and Neck Surgery Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse): Percentage of patients aged 18 years and older with a diagnosis of acute sinusitis who had a computerized tomography (CT) scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 after date of Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 18 Years and Older: Percentage of emergency department visits for patients aged 18 years and older who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care provider who have an indication for a head CT. Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 2 through 17 Years: Percentage of emergency department visits for patients aged 2 through 17 years who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care provider who are classified as low risk according to the Pediatric Emergency Care Applied Research Network (PECARN) prediction rules for traumatic brain· · Comment: One commenter noted that measure Q066: Appropriate Testing for Children with Pharyngitis measure promotes neither efficiency nor cost reduction in the emergency setting. The commenter noted that when a strep test is ordered in the emergency setting, it must be run through a lab system, rather than at the point of care, as a result of Clinical Laboratory Improvement Amendments (CLIA) requirements. As a result, a reflex culture is also ordered and results sent back to the ED, which is then responsible for calling back patients who are often not part of the larger system. Because this measure promotes inefficient practices and actually drives costs up, the commenter recommended not including it in this measure set. Response: We disagree as we worked extensively with stakeholders to solicit their feedback and ensure the measures under this measure set were relevant for this specialty. We believe measure Q066 is relevant to the emergency setting and is currently standard to perform Group A Strep testing prior to treatment with an antibiotic and that testing could be at the point of care or in a lab. Both approaches are used routinely in acute care settings across the country. We acknowledge the inconvenience of the need to contact patients regarding results that occur well after the patient visit (for ED, Urgent Care, Non-Primary Care Physicians, etc.), but we would still consider that process the standard of care. Further, point of care testing is common in ambulatory care settings including Emergency Departments. Therefore, we believe this measure does promote cost reduction to avoid unnecessary antibiotic treatment to reduce antibiotic resistance which can contribute to increased health costs. We believe this outweighs the cost of appropriate testing and does not promote the overuse of antibiotics to save time. VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00034 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.033</GPH> khammond on DSKBBV9HB2PROD with RULES Comment: One commenter expressed concern the denominator used for measure Q107: Adult Major Depressive Disorder: Suicide Risk Assessment relies on a that is not used in and noted that in the future the measure should be broadened to include other initial such as Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations 545 B.7. Emergency Medicine Depression, Not Otherwise Specified, that are much more commonly used in the ED. Response: We disagree as we worked extensively with stakeholders to solicit their feedback and ensure the measures under this measure set were relevant for this specialty. This measure was originally developed as part of a suite of measures to improve care for adults with major depressive disorder and was specified and tested for that population. We consulted with the measure steward and they will give consideration to your suggestion for future updates and retesting. We believe this measure is very important to assess for suicide risk in the ED. While adding more general depression diagnosis codes may be appropriate, this revision would need to be vetted through the measure steward and stakeholders for future implementation. Comment: One commenter supported measure Ql87: Stroke and Stroke Rehabilitation: Thrombolytic Therapy in this measure set. The commenter encouraged CMS to continue to consider measurement and payment of high quality, cost effective stroke care in all settings, including in the hospital inpatient setting. Response: We thank the commenter for their support of measure Ql87: Stroke and Stroke Rehabilitation: Thrombolytic Therapy. VerDate Sep<11>2014 16:41 Jan 30, 2019 Medicine Jkt 247001 PO 00000 Frm 00035 for the 2019 Performance Period and future Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.034</GPH> khammond on DSKBBV9HB2PROD with RULES FINAL ACTION: We are 546 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.S. Obstetrics/Gynecology In addition to the considerations discussed in the introductory language of Table B in this final rule, the Obstetrics/Gynecology specialty set takes into consideration the following criteria, which includes, but is not limited to: the measure reflects current clinical guidelines and the coding of the measure includes the specialists. We may reassess the appropriateness of individual measures, on a case-by-case basis, to ensure appropriate inclusion in the specialty set. In addition, as outlined at the end of this table, we removed the following quality measures from the specialty set: Quality IDs: 369, and 447. B.S. Obstetrics/Gynecology ! (Care Coordinatio n) Conununicat ion and Care Coordination Measure Specifications, MIPSCQMs Specifications N/A 048 N/A Medicare Part 8 Claims Measure Specifications, MIPSCQMs Process Advance Care Plan: Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or an advance care Conunittee for Quality Assurance National Conunittee for Quality Assurance Effective Clinical Care 0041 110 Process v8 * NIA 111 8 Claims Measure Specifications, eCQM Specifications, CMSWeb Interface Measure Specifications, MIPSCQMs CMS127 v7 Population Health khammond on DSKBBV9HB2PROD with RULES VerDate Sep<11>2014 2372 112 16:41 Jan 30, 2019 CMS125 v7 Medicare Part 8 Claims Measure Specifications, eCQM Specifications, CMSWeb Interface Measure Specifications, MIPSCQMs Jkt 247001 PO 00000 Consortium for Performance Improvement Foundation (PC PI®) Process Conununity/ Population Health Pneumococcal Vaccination Status for Older Adults: Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine National Conunittee for Quality Assurance Process Effective Clinical Care Breast Cancer Screening: Percentage of women 51-74 years of age who had a manunogram to screen for breast cancer. National Conunittee for Quality Assurance Measure Specifications, eCQM Specifications, MIPSCQMs § Preventive Care and Screening: Influenza Immunization: Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza inununization OR who reported previous receipt of an influenza immunization. Frm 00036 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.035</GPH> Experience and Outcomes 547 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.S. Obstetrics/Gynecology Percentage 18 years with a BMI documented during the current encounter or during the previous 12 months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous 12 months of the current encounter. Normal Parameters: Age 18 years and older BMI => 18.5 and< 25 Measure Specifications, eCQM Specifications, MIPSCQMs Specifications ! (Patient Safety) 0419 130 § § ! (Outcome) 0018 236 CMS68v 8 Medicare Part B Claims Measure Specifications, eCQM Specifications, MIPSCQMs Specifications v7 B Claims Measure Specifications, eCQM Specifications, CMSWeb Interface Measure Specifications, MIPSCQMs Specifications CMS165 v7 Medicare Part B Claims Measure Specifications, eCQM Specifications, CMSWeb Interface Measure Specifications, MTPSCQMs ! (Care Coordinatio Intermedi ate Outcome Specifications 0032 309 CMS124 v7 eCQM Specifications Patient Safety Effective Clinical Care Documentation of Current Medications in the Medical Record: Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-thecounters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration. Tobacco Use: Screening and Cessation Intervention: a. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months. b. Percentage of patients aged 18 years and older who were screened for tobacco use and identified as a tobacco user who received tobacco cessation intervention. c .Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user. Controlling High Blood Pressure: Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period. Centers for Medicare & Medicaid Services Consortium for Performance Improvement Foundation (PCPI®) National Committee for Quality Assurance ion and Care Coordination Process Effective Clinical Care Cervical Cancer Screening: Percentage of women 21--{)4 years of age who were screened for cervical cancer using either of the following criteria: • Women age 21--{)4 who had cervical cytology performed every 3 years • Women age 30--{)4 who had cervical cytology/human papillomavirus (HPV) co-testing Committee for Quality Assurance for VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00037 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.036</GPH> khammond on DSKBBV9HB2PROD with RULES § Process Services 548 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.S. Obstetrics/Gynecology 317 CMS22v 7 Medicare Part B Claims Measure Specifications, eCQM Specifications, MIPSCQMs 7 Specifications, MIPSCQMs Specifications N/A MIPSCQMs Specifications Process Community/ Population Health Process ! (Care Coordinatio n) N/A 402 ion and Care Coordioation Process B Claims Measure Specifications, MIPSCQMs Specifications ! (Patient Safety) ! (Patient Safety) 2063 N/A 422 429 N/A N/A Medicare Part B Claims Measure Specifications, MIPSCQMs Medicare Part B Claims Measure Specifications, MIPSCQMs Effective Clinical Care Process Process Specifications khammond on DSKBBV9HB2PROD with RULES ! (Outcome) VerDate Sep<11>2014 N/A 432 16:41 Jan 30, 2019 N/A Jkt 247001 MTPSCQMs Specifications PO 00000 Community/ Population Health Patient Safety Patient Safety Population Health Outcome Frm 00038 Patient Safety Fmt 4700 Sfmt 4725 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented: Percentage of patients aged 18 years and older seen duriog the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) readiog as indicated. Closing the Referral Loop: Receipt of Specialist Report: Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred. Tobacco Use and Help with Quitting Among Adolescents: The percentage of adolescents 12 to 20 years of age with a primary care visit during the measurement year for whom tobacco use status was documented and received help with quitting if identified as a tobacco user. Women Who Had a Fracture: The percentage of women age 50-85 who suffered a fracture io the 6 months prior to the performance period through June 30 of the performance period and who either had a bone mineral density test or received a prescription for a drug to treat in the 6 months after the fracture. Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse to Detect Lower Urinary Tract Injury: Percentage of patients who undergo cystoscopy to evaluate for lower urinary tract injury at the time Centers for Medicare & Medicaid Services Medicare & Medicaid Services National Committee for Quality Assurance Committee for Quality Assurance American Urogynecolog ic Society Percentage of patients undergoiog appropriate preoperative evaluation of stress urinary incontinence prior to pelvic organ prolapse surgery ACOG/AUGS/AUA Pelvic Organ Prolapse: Preoperative Screening for Uterine Malignancy: Percentage of patients who are screened for uterine malignancy prior to vaginal closure or obliterative surgery for pelvic organ prolapse. Alcohol Use: Screening & Brief Counseling: Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user. Proportion of Patients Sustaining a Bladder Injury at the Time of any Pelvic Organ Prolapse Repair: to E:\FR\FM\31JAR1.SGM 31JAR1 Consortium for Performance Improvement Foundation (PCPI®) Society ER31JA19.037</GPH> N/A 549 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.S. Obstetrics/Gynecology ! (Outcome) ! (Outcome) N/A N/A 433 434 N/A N/A § ! (Patient § ! (Care Coordinatio n) ! N/A 448 472 (Appropriat e Use) 475 N/A CMS249 vi CMS349 vi MTPSCQMs Specifications Outcome MIPSCQMs Specifications Outcome MIPSCQMs Specifications Process MIPSCQMs Specifications Process eCQM Specifications Process eCQM Specifications Patient Safety Proportion of Patients Sustaining a Bowel Injury at the Time of any Pelvic Organ Prolapse Repair: Percentage of patients undergoing surgical repair of pelvic organ prolapse that is complicated by a bowel injury at the time of index surgery that is recognized intraoperatively or within 30 days after Patient Safety Committee for Quality Assurance Centers for Medicare & Medicaid Services Patient Safety Communicat ion and Care Coordination and Cost Reduction Process Society Community/ Population Health Factor Profile for Osteoporotic Fracture: Percentage of female patients aged 50 to 64 without select risk factors for osteoporotic fracture who received an order for a dual-energy x-ray absorptiometry (DXA) scan during the measurement HIV Screening: Percentage of patients 15-65 years of age who have ever been tested for human virus Centers Medicare & Medicaid Services Centers Disease and Prevention We did not receive specific comments regarding the measures included in this specialty measure set. VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00039 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.038</GPH> khammond on DSKBBV9HB2PROD with RULES FINAL ACTION: We are finalizing the Obstetrics/Gynecology Specialty Measure Set as proposed for the 2019 Performance Period and future years. Note: As noted in our responses to public comments in Table C, measure Q048 is not finalized for removal from this measure set as proposed; therefore, it is retained in this measure set for the 2019 Performance Period and future 550 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.8. Obstetrics/Gynecology 7 A 447 Specifications MIPS CQMs Specifications Clinical Care Process Commu nity/ Populati on Health Pregnant women that bad HBsAg testing: This measure identifies pregnant women who had an HBsAg (hepatitis B) test during their pregnancy. Chlamydia Screening and Follow Up: The percentage of female adolescents 16 years of age who had a chlamydia screening test with proper follow-up during the measurement period. measure removed from the 2019 program based on the detailed rationale described below for this Committee for Quality Assurance program based on the detailed rationale described below for this measure in "Table C: Quality Measures Finalized for Removal in the 2021 MIPS Payment Year and Future Years." We did not receive specific comments regarding the proposed removal of measures from this specialty measure set. VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00040 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.039</GPH> khammond on DSKBBV9HB2PROD with RULES FINAL ACTION: We are finalizing the removal of measures from the Obstetrics/Gynecology Specialty Measure Set as proposed for the 2019 Performance Period and future years. However, as noted in our responses to public comments in Table C, we are not finalizing Q048 for removal from this measure set. 551 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.9. Ophthalmology In addition to the considerations discussed in the introductory language of Table Bin this final rule, the Ophthalmology specialty set takes into consideration the following criteria, which includes, but is not limited to: the measure reflects current clinical guidelines and the coding of the measure includes the specialists. CMS may reassess the appropriateness of individual measures, on a case-by-case basis, to ensure appropriate inclusion in the specialty set. In addition, as outlined at the end of this table, we removed the following quality measures from the specialty set: Quality IDs: 018, and 140. B.9. Ophthalmology 014 N/A Medicare Part Process Effective Clinical Care Process Communi cat ion and Care Coordination Process Clinical Care Process Effective Clinical Care 8 Claims Measure Specifications, MTPSCQMs Specifications ! (Care Coordinatio n) 0089 * 0055 019 CMS142v 7 Medicare Part 8 Claims Measure Specifications, eCQM Specifications, MIPSCQMs Specifications 117 § CMS13lv 7 Medicare Part 8 Claims Measure Specifications, eCQM Specifications, MIPSCQMs 0086 012 CMS143v 7 Medicare Part 8 Claims Measure Specifications, eCQM Specifications, MIPSCQMs khammond on DSKBBV9HB2PROD with RULES (Patient Safety) 8 Claims Measure Specifications, eCQM Specifications, MIPSCQMs Specifications 0563 141 N/A Medicare Part Outcome 8 Claims VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00041 Fmt 4700 Sfmt 4725 Age-Related Macular Degeneration (AMD): Dilated Macular Examination: Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage AND the level of macular degeneration severity during one or more office visits within 12 months. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care: Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care ofthe patient with diabetes mellitus regarding the fmdings of the macular or fundus exam at least once within 12 months. Diabetes: Eye Exam: Percentage of patients 18- 75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period. American Academy of Ophthalmology Physician Consortium for Performance Improvement Foundation (PCPI®) National Committee for Quality Assurance Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation: Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months. Physician Consortium for Performance Improvement Foundation (PCPI®) the Medical Record: Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-thecounters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration. Primary Open-Angle Glaucoma Reduction of Intraocular Medicare& Medicaid Services E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.040</GPH> 0087 552 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.9. Ophthalmology ! (Outcome) 0565 191 CMS133v 7 7 (Outcome) 0028 226 § eCQM Specifications, MIPSCQMs Specifications Coordination Outcome Clinical Care Specifications, MIPSCQMs Specifications CMS138v Medicare Part 7 8 Claims Process khammond on DSKBBV9HB2PROD with RULES Measure Specifications, eCQM Specifications, CMSWeb Interface Measure Specifications, MIPSCQMs Specifications (Outcome) Specifications ! (Care Coordinatio n) Specifications, MIPSCQMs Specifications VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Reported Outcome Frm 00042 Fmt 4700 15% OR Documentation of a Plan of Care: Ophthalmology Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) whose glaucoma treatment has not failed (the most recent lOP was reduced by at least 15 percent from the preintervention level) OR if the most recent lOP was not reduced by at least 15 percent from pre- intervention level, a plan of care was documented within 12 months. Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery: Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and no significant ocular conditions impacting the visual of surgery and had best-corrected visual acuity of20/40 or better (distance or near) achieved within90 the cataract Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Consortium for Additional Surgical Procedures: Performance Improvement Percentage of patients aged 18 years and Foundation older with a diagnosis of uncomplicated (PCPI®) cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any ofthe following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power I0 L, retinal Community/ Population Health Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention: a. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months. b. Percentage of patients aged 18 years and older who were screened for tobacco use and identified as a tobacco user who received tobacco cessation intervention. c. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user. Cataracts: Improvement in Patient's Person CaregiverVisual Function within 90 Days Following Centered Cataract Surgery: Percentage of patients aged 18 years and Experience and Outcomes older who had cataract surgery and had improvement in visual function achieved within 90 days following the cataract surgery, based on completing a pre-operative and visual function Loop: nand Care Coordination Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 Physician Consortium for Performance Improvement Foundation (PCPI®) Academy of Ophthalmology Medicaid Services ER31JA19.041</GPH> Measure Specifications, MIPSCQMs Specifications Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations 553 B.9. Ophthalmology (Outcome) Specifications Clinical Care Specifications Clinical Care Detachment Surgery: No Return to the Operating Room Within 90 Days of Surgery: Patients aged 18 years and older who had surgery for primary rhegmatogenous retinal detachment who did not require a return to the room within 90 Adult Primary Rhegmatogenous Retinal Detachment Surgery: Visual Acuity Improvement Within 90 Days of Surgery: Patients aged 18 years and older who had surgery for primary rhegmatogenous retinal detachment and achieved an improvement in their visual acuity, from their preoperative level, within 90 days of surgery in the Academy of Ophthalmology Academy of Ophthalmology ! (Outcome) N/A 388 N/A MIPS CQMs Specifications Outcome Patient Safety Cataract Surgery with Intra-Operative Complications (Unplanned Rupture of Posterior Capsule Requiring Unplanned Vitrectomy: Percentage of patients aged 18 years and older who had cataract surgery performed and had an unplanned rupture of the posterior American Academy of Ophthalmology ! (Outcome) N/A 389 N/A MIPS CQMs Specifications Outcome Effective Clinical Care Cataract Surgery: Difference Between Planned and Final Refraction: Percentage of patients aged 18 years and older who had cataract surgery performed and who achieved a fmal refraction within +/- 0.5 diopters of their planned (target) refraction. American Academy of Ophthalmology We did not receive specific comments regarding the measures included in this specialty measure set. FINAL ACTION: We are the for the 2019 Performance Period and future B.9. Ophthalmology khammond on DSKBBV9HB2PROD with RULES Care 0566 VerDate Sep<11>2014 140 N/A 16:41 Jan 30, 2019 Medicare Part B Claims Jkt 247001 Process PO 00000 Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy: Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months. Improvement Foundation (PCPI®) Effective Clinical Frm 00043 Fmt 4700 of Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 This measure is being removed from the 2019 ER31JA19.042</GPH> v7 554 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.9. Ophthalmology Measure Specifications, MIPSCQMs Specifications Care on Antioxidant Supplement: Ophthalmolo program based on the Percentage of patients aged 50 years gy detailed rationale and older with a diagnosis of agedescribed below for this measure in "Table C: related macular degeneration (AMD) or their caregiver( s) who were Quality Measures counseled within the 12-month Finalized for Removal in performance period on the benefits the 2021 MIPS Payment Year and Future Years." and/or risks ofthe Age-Related Eye Disease Study (AREDS) 2 formulation for preventing progression of AMD. Comment: One commenter disagreed with CMS' suggestion that measure Ql8: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy is duplicative of measure Q019: Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care. These two measures were developed by the measure steward not as duplicative, but rather as complementary measures to ensure the assessment of the level of retinopathy which comprises that which is communicated to the primary physician, thus promoting coordination of care of clinically meaningful information. The commenter recommended that CMS retain these two measures for the 2019 performance year. Response: We appreciate the commenter's feedback on measure Q018: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy. It is our goal to provide meaningful measures for eligible clinicians. We believe measure Q019: Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care fulfills a high priority area by promoting care coordination among eligible clinicians. Whereas measure QO 18 does not address a high priority or produce clinical outcomes. It may be advantageous to combine these two measures to create a more robust testing and communication measure in the future. Measures QO 18 and QO 19 assess whether the level of severity of retinopathy was captured, but QO 18 does not require the results to be communicated to the clinician managing the diabetes. The numerator of Measure 018 is considered the standard of care as it captures an assessment with no additional clinical action. We encourage the commenter to collaborate with measure developers to submit an alternative measure to the Call for Measures process. Comment: One commenter opposed the removal of both measure Q012: Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation and measure Q191: Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery because they noted that the removal will limit the quality measure options applicable to ophthalmologists. Other commenters opposed the proposal to remove measures QO 18 - Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy; and Ql40: Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement. The commenters noted that this is a significant number of measures to remove related to eye care, and represents a disproportionately large percentage of measures for which physicians are eligible to submit. The commenter further noted that while measure stewards are working to develop homegrown Qualified Clinical Data Registry (QCDR) measures, some Doctors of Optometry are not yet fully connected to the Measures and Outcomes Registry for Eyecare and others are still struggling to implement electronic health records. The commenter stated that these factors may limit certain clinicians' ability to perform in MIPS and therefore requested that CMS move slowly in the removal of these measures and to allow for additional time before these measures are phased out. Other commenters were concerned about the Ophthalmology measures that are being retired, as specialty specific measures are already generally very sparse and because clinicians who report via claims will not have six ophthalmology-related measures available in the measure set. Response: To clarify, measure Ql91 is not proposed for removal; therefore, the measure will remain in the program and will be included in the Ophthalmology Specialty Measure Set. With regard to other measures proposed for removal in this specialty set, we are committed to our goal to remove measures that are duplicative in clinical concept to other measures and to be consistent with ensuring measures are more meaningful. In addition, there are 14 measures proposed for inclusion in the Ophthalmology Specialty Measure Set that are suggested for this specialty which is more than the six measures currently required for meeting the quality performance category requirements. We are attempting to reduce reporting burden where measures are duplicative in concept or do not drive quality action by eligible clinician. We encourage the commenter to collaborate with measure developers to submit to the Call for Measures process so that the Ophthalmology specialty has additional quality measures. Comment: One commenter opposed removal of measure Q012 because measure Q141, which is cited as duplicative to Q012 can only be reported via claims and registry/QCDR submission and not as an eCQM. Response: We agree with the commenter's concern about Ql41 not being reportable as an eCQM and, therefore, will not finalize measure Q012 for removal as previously proposed. VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00044 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.043</GPH> khammond on DSKBBV9HB2PROD with RULES FINAL ACTION: We are finalizing the removal of measures from the Ophthalmology Specialty Measure Set as proposed for the 2019 Performance Period and future years. However, as noted in our responses to public comments in Table C, we are not finalizing the removal of measure QO 12 from this measure set. 555 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.IO. Orthopedic Surgery In addition to the considerations discussed in the introductory language of Table B in this fmal rule, the Orthopedic Surgery specialty set takes into consideration the following criteria, which includes, but is not limited to: the measure reflects current clinical guidelines and the coding of the measure includes the specialists. CMS may reassess the appropriateness of individual measures, on a case-by-case basis, to ensure appropriate inclusion in the specialty set. B.IO. Orthopedic Surgery 0268 021 NIA Medicare Part B Claims Measure Specifications, MIPSCQMs Specifications Process khammond on DSKBBV9HB2PROD with RULES Process (Patient Safety) Measure Specifications, MIPSCQMs Specifications (Care Coordination) Measure Specifications, MIPSCQMs Specifications ! (Care Coordination) Measure Specifications, MIPSCQMs Specifications VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00045 Fmt 4700 Patient Safety Perioperative Care: Selection of Prophylactic Antibiotic- First OR Second Generation Cephalosporin: Percentage of surgical patients aged 18 years and older undergoing procedures with the indications for a first OR second generation cephalosporin prophylactic antibiotic, who had an order for a first OR second generation for antimicrobial Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis Safety (When Indicated in ALL Patients): Percentage of surgical patients aged 18 years and older undergoing procedures for which venous thromboembolism (VTE) prophylaxis is indicated in all patients, who had an order for Low Molecular Weight Heparin (LMWH), Low-Dose Unfractionated Heparin (LDUH), adjusted-dose warfarin, fondaparinux or mechanical prophylaxis to be given within 24 hours prior to incision time or within 24 hours after end time. or tion and Other Clinician Managing On-going Care Care Post-Fracture for Men and Women Aged 50 Coordinatio Years and Older: n Percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient's on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing. This measure is reported by the physician who treats the fracture and who therefore is held accountable for the cation and Care Coordinat ion Sfmt 4725 The percentage of discharges from any inpatient facility (for example hospital, skilled nursing facility, or rehabilitation facility) for patients 18 years of age and older seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record. This measure is submitted as three rates stratified by age group: • Submission Criteria 1: 18-64 years of age. • Submission Criteria 2: 65 years and older. • Total Rate: All patients 18 years of age and E:\FR\FM\31JAR1.SGM 31JAR1 American Society of Plastic Surgeons Society of Plastic Surgeons Committee for Quality Assurance Committee for Quality Assurance ER31JA19.044</GPH> ! (Patient Safety) 556 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.IO. Orthopedic Surgery MIPSCQMs Specifications Coordination) N/A 109 N/A Medicare Part B Claims Measure Specifications, MTPSCQMs Specifications Process 0421 128 CMS69 v7 Medicare Part B Claims Measure Specifications, eCQM Specifications, MIPSCQMs Specifications Process 0419 130 CMS68 v8 Medicare Part B Claims Measure Specifications, eCQM Specifications, MIPSCQMs Specifications Process Patient Safety 0420 131 N/A Medicare Part B Claims Measure Specifications, MIPSCQMs Specifications Process Communi cation and Care Coordinat ion 0418 134 CMS2v 8 Medicare Part B Claims Measure Specifications, eCQM Specifications, CMS Web Interface Measure Specifications, MIPSCQMs Specifications Process Communi ty/ Populatio n Health 0101 154 N/A Medicare Part B Claims Measure Specifications, MIPSCQMs Specifications Process Patient Safety 0101 155 (Patient Experience) ! (Patient Safety) (Care Coordination) ! (Patient Safety) ! khammond on DSKBBV9HB2PROD with RULES Measure Specifications, MIPSCQMs 16:41 Jan 30, 2019 for Quality Assurance American Academy of Orthopedic Surgeons Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan: Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous 12 months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous 12 months of the current encounter. Normal Parameters: Age 18 years and older BMI => 18.5 and< 25 Documentation of Current Medications in the Medical Record: Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration. Pain Assessment and Follow-Up: Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up when Preventive Care and Screening: Screening for Depression and Follow-Up Plan: Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on screen. the date of the Falls: Risk Assessment: Percentage of patients aged 65 years and older with a history of falls who had a risk assessment for falls completed within 12 Centers for Medicare& Medicaid Services National Committee for Quality Assurance Percentage of patients aged 65 years and older with a history of falls who had a plan of care for falls documented within 12 months. Committee for Quality Assurance Centers for Medicare& Medicaid Services Centers for Medicare& Medicaid Services Centers for Medicare& Medicaid Services Process (Care Coordination) VerDate Sep<11>2014 Person and Caregiver -Centered Experienc e and Outcomes Communi ty/Populat ion Health years who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care Osteoarthritis (OA): Function and Pain Assessment: Percentage of patient visits for patients aged 21 years and older with a diagnosis of osteoarthritis (OA) with assessment for function and pain. Jkt 247001 PO 00000 Frm 00046 Fmt 4700 cation and Care Coordinat Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.045</GPH> ! Care Coordinat ion Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations 557 B.IO. Orthopedic Surgery Specifications 0028 ! N/A 226 350 Clinical Care CMS13 8v7 Medicare Part B Claims Measure Specifications, eCQM Specifications, CMS Web Interface Measure Specifications, MlPSCQMs Specifications v7 Measure Specifications, eCQM Specifications, MTPSCQMs Specifications N/A (Care Coordination) MTPSCQMs Specifications Management Percentage of patients aged 18 years and older with a diagnosis of rheumatoid arthritis (RA) who have been assessed for glucocorticoid use and, for those on prolonged doses of prednisone 2: 10 mg daily (or equivalent) with improvement or no change in disease activity, documentation of glucocorticoid management within 12 months. Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention: a. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months. b. Percentage of patients aged 18 years and older who were screened for tobacco use and identified as a tobacco user who received tobacco cessation intervention. c. Percentage of patients aged 18 years and who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if Process Communi ty/ Populatio n Health Process Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented: Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) as indicated. Total Knee Replacement: Shared Decisiontion and Making: Trial of Conservative (NonCare surgical) Therapy: Coordinatio Percentage of patients regardless of age n undergoing a total knee replacement with documented shared decision-making with discussion of conservative (non-surgical) therapy (for example nonsteroidal antiinflammatory drugs (NSAIDs), analgesics, weight loss, exercise, injections) prior to the ty/ Populatio n Health Process College of Rheumatol ogy Physician Consortium for Performanc e lmproveme nt Foundation (PCPT®) Medicare& Medicaid Services American Association ofHipand Knee Surgeons Process (Patient Safety) Specifications Safety VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00047 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.046</GPH> khammond on DSKBBV9HB2PROD with RULES Evaluation: Percentage of patients regardless of age a total knee who are 558 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.IO. Orthopedic Surgery N/A 352 N/A MIPSCQMs Specifications Process Patient Safety N/A 353 N/A MIPSCQMs Specifications Process Patient Safety Total Knee Replacement: Identification of Implanted Prosthesis in Operative Report: Percentage of patients regardless of age undergoing a total knee replacement whose operative report identifies the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic and the size of each American Association ofHipand Knee Surgeons and Caregiver -Centered Experienc e and Outcomes and Communication: Percentage of patients who underwent a nonemergency surgery who had their personalized risks of postoperative complications assessed by their surgical team prior to surgery using a clinical data-based, patient-specific risk calculator and who received personal College of Surgeons (Patient Safety) ! (Patient Safety) (Patient Experience) Specifications 374 ! CMS50 v7 (Care Coordination) eCQM MIPSCQMs Specifications Process cation and Care Coordinat ion N/A 375 CMS66 v7 eCQM Specifications Process Person and Caregiver -Centered Experienc e and Outcomes N/A 376 CMS56 v7 eCQM Specifications Process Person and Caregiver -Centered Experienc e and Outcomes N/A 402 N/A MIPSCQMs Specifications Process Communi ty/ Populatio n Health ! khammond on DSKBBV9HB2PROD with RULES (Patient Experience) VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00048 Fmt 4700 Sfmt 4725 Closing the Referral Loop: Receipt of Specialist Report: Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred. Functional Status Assessment for Total Knee Replacement: Changes to the measure description: Percentage of patients 18 years of age and older who received an elective primary total knee arthroplasty (TKA) who completed baseline and follow-up patient-reported and completed a fimctional status assessment within 90 days prior to the surgery and in the 270-365 after the Functional Status Assessment for Total Hip Replacement: Percentage of patients 18 years of age and older with who received an elective primary total hip arthroplasty (THA) who completed baseline and follow-up patient-reported and completed a fimctional status assessment within 90 days prior to the surgery and in the 270-365 after the Tobacco Use and Help with Quitting Among Adolescents: The percentage of adolescents 12 to 20 years of age with a primary care visit during the measurement year for whom tobacco use status was documented and received help with if identified as a tobacco user. E:\FR\FM\31JAR1.SGM 31JAR1 American Association ofHipand Knee Surgeons Medicaid Services Centers for Medicare& Medicaid Services Centers for Medicare& Medicaid Services National Committee for Quality Assurance ER31JA19.047</GPH> ! evaluated for the presence or absence of venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (for example history of Deep Vein Thrombosis (DVT), Puhnonary Embolism (PE), Myocardial Infarction (MI), Arrhythmia and Total Knee Replacement: Preoperative Antibiotic Infusion with Proximal Tourniquet: Percentage of patients regardless of age undergoing a total knee replacement who had the prophylactic antibiotic completely infused Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations 559 B.IO. Orthopedic Surgery 408 NIA MIPSCQMs Specifications Process Effective Clinical Care ! NIA 412 NIA MIPSCQMs Specifications Process Effective Clinical Care NIA 414 NIA MIPSCQMs Specifications Process Effective Clinical Care (Opioid) (Opioid) Measure Specifications, MIPSCQMs Specifications khammond on DSKBBV9HB2PROD with RULES (Outcome) VerDate Sep<11>2014 Specifications 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00049 Reported Outcome Fmt 4700 Opioid Therapy Follow-up Evaluation: All patients 18 and older prescribed opiates for longer than 6 weeks duration who had a follow-up evaluation conducted at least every 3 months during Opioid Therapy documented in the medical record. Documentation of Signed Opioid Treatment Agreement: All patients 18 and older prescribed opiates for longer than 6 weeks duration who signed an opioid treatment agreement at least once during Opioid Therapy documented in the medical record. Evaluation or Interview for Risk of Opioid Misuse: All patients 18 and older prescribed opiates for longer than 6 weeks duration evaluated for risk of opioid misuse using a brief validated instrument (for example Opioid Risk Tool, SOAPP-R) or patient interview documented at least once during Opioid Therapy in the medical record. American Academy of Neurology Clinical Care Had a Fracture: The percentage of women age 50-85 who suffered a fracture in the 6 months prior to the performance period through June 30 of the performance period and who either had a bone mineral density test or received a prescription for a drug to treat osteoporosis in the 6 months Committee for Quality Assurance Person and Caregiver -Centered Experienc e and Outcomes Person and Caregiver -Centered Experienc e and Outcomes Person and Caregiver -Centered Average Change in Back Pain Following Lumbar Discectomy I Laminotomy: The average change (preoperative to 3 months postoperative) in back pain for patients 18 years of age or older who had lumbar discectomy /laminotomy procedure. MN Community Measureme nt Average Change in Back Pain Following Lumbar Fusion: The average change (preoperative to I year postoperative) in back pain for patients 18 years of age or older who had lumbar spine fusion surgery. MN Community Measureme nt Average Change in Leg Pain Following Lumbar Discectomy I Laminotomy: The average change (preoperative to 3 months postoperative) in leg pain for patients 18 years of age or older who had lumbar discectomy I laminotomy procedure. MN Community Measureme nt Caregiver -Centered Experienc e and Sfmt 4725 American Academy of Neurology American Academy of Neurology Average Change in Functional Status Following Lumbar Spine Fusion Surgery: For patients age 18 and older undergoing spine fusion surgery, the average change from pre-operative functional status to 1 year (9 to 15 months) post-operative functional status using Oswestry Disability Index (ODI version 2.la) outcome tool. E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.048</GPH> NIA (Opioid) 560 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.lO. Orthopedic Surgery Experience and Outcomes ! N/A 473 N/A (Patient Experience) MIPSCQMs Specifications Patient Reported Outcome CaregiverCentered Experience and Outcomes knee replacement surgery, the average change from pre-operative functional status to 1 year (9 to 15 months) post-operative functional status using the Oxford Knee Score (OKS) patient outcome tool. Average Change in Functional Status Following Lumbar Discectomy Laminotomy Surgery: For patients age 18 and older undergoing discectomy laminotomy surgery, the average change from pre-operative functional status to 3 months (6 to 20 weeks) post-operative status using the Oswestry Disability Average Change in Leg Pain Following Lumbar Spine Fusion Surgery: For patients age 18 and older undergoing lumbar spine fusion surgery, the average change from pre-operative leg pain to 1 year (9 to 15 months) post-operative leg pain using the Visual Analog Scale (VAS) patient reported outcome tool. Community Measureme nt measure set. VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00050 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.049</GPH> khammond on DSKBBV9HB2PROD with RULES FINAL ACTION: We are finalizing the Orthopedic Surgery Specialty Measure Set as proposed for the 2019 Performance Period and future years with the exception of the newly proposed composite measure: Falls: Screening, Risk-Assessment, and Plan of Care to Prevent Future Falls. We are no longer finalizing the inclusion of the composite falls measure because it must be fully vetted to utilize standardized tools that would appropriately identify the at-risk patient population. In addition, as noted in our responses to public comments in Table C, measures Q154, Q155, and Q375 are not finalized for removal from this measure set as proposed; therefore, they will be retained in this measure set for the 2019 Performance Period and future 561 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.ll. Otolaryngology In addition to the considerations discussed in the introductory language of Table B in this final rule, the Otolaryngology specialty set takes into consideration the following criteria, which includes, but is not limited to: the measure reflects current clinical guidelines and the coding of the measure includes the specialists. CMS may reassess the appropriateness of individual measures, on a case-by-case basis, to ensure appropriate inclusion in the specialty set. In addition, as outlined at the end of this table, we removed the following quality measures from the specialty set: Quality IDs: 276, 278, and 334. B.ll. Otolaryngology (Patient Safety) B Claims Measure Specifications, MIPSCQMs Specifications Safety Antibiotic- First OR Second Generation Cephalosporin: Percentage of surgical patients aged 18 years and older undergoing procedures with the indications for a first OR second generation cephalosporin prophylactic antibiotic, who had an order for a first OR second generation cephalosporin for antimicrobial Society of Plastic Surgeons (Patient Safety) B Claims Measure Specifications, MIPSCQMs Specifications Safety (VTE) Prophylaxis (When Indicated in ALL Patients): Percentage of surgical patients aged 18 years and older undergoing procedures for which venous thromboembolism (VTE) prophylaxis is indicated in all patients, who had an order for Low Molecular Weight Heparin (LMWH), Low-Dose Unfractionated Heparin (LDUH), adjusted-dose warfarin, fondaparinux or mechanical prophylaxis to be given within 24 hours prior to incision time or within 24 hours after end time. Advance Care Plan: Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker an advance care Appropriate Treatment for Children with Upper Respiratory Infection (URI): Percentage of children 3 months through 18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic onor3 after the Acute Otitis Externa (AOE): Topical Therapy: Percentage of patients aged 2 years and older with a diagnosis of AOE who were prescribed topical preparations. Society of Plastic Surgeons 0326 047 N/A Medicare Part B Claims Measure Specifications, MIPSCQMs Specifications Process Communica tion and Care Coordinatio n ! (Appropriate Use) 0069 065 CMS15 4v7 eCQM Specifications, MIPSCQMs Specifications Process Efficiency and Cost Reduction ! (Appropriate Use) 0653 091 N/A Medicare Part B Claims Measure Specifications, MIPSCQMs Process Effective Clinical Care and Cost Reduction khammond on DSKBBV9HB2PROD with RULES 7v8 VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 I Population Health B Claims Measure Specifications, eCQM Specifications, CMSWeb Interface PO 00000 Frm 00051 Fmt 4700 Sfmt 4725 National Committee for Quality Assurance National Committee for Quality Assurance American Academy of Otolaryngolo gy-Head and Neck Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy- Avoidance of Inappropriate Use: Percentage of patients aged 2 years and older with a diagnosis of AOE who were not prescribed systemic antimicrobial Immunization: Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization. E:\FR\FM\31JAR1.SGM 31JAR1 Performance Improvement Foundation (PCP!®) ER31JA19.050</GPH> ! (Care Coordination) 562 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.ll. Otolaryngology Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine. 0421 128 (Patient Safety) Process v7 B Claims Measure Specifications, eCQM Specifications, MIPSCQMs Specifications /Population Health v8 B Claims Measure Specifications, eCQM Specifications, MIPSCQMs Specifications Safety Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan: Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous 12 months AND with a BMT outside of normal parameters, a follow-up plan is documented during the encounter or during the previous 12 months of the current encounter. Normal Parameters: Age 18 years and older BMI => 18.5 and< 25 Centers Medicare& Medicaid Services Medical Record: Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, and route of administration. Medicare& Medicaid Services Percentage of patients aged 65 years and older with a history of falls who had a risk assessment for falls completed within 12 months. 0101 155 N/A Process Comrnunica tion and Care Coordinatio n Measure Specifications, eCQM Specifications, CMSWeb Interface Measure Specifications, MIPSCQMs Specifications ! N/A 265 N/A khammond on DSKBBV9HB2PROD with RULES (Care VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 MIPSCQMs Specifications PO 00000 Process Frm 00052 Fmt 4700 Comrnunica tion and Care Sfmt 4725 Falls: Plan of Care: Percentage of patients aged 65 years and older with a history of falls who had a plan of care for falls documented within 12 months. Screening and Cessation Intervention: a. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months. b. Percentage of patients aged 18 years and older who were screened for tobacco use and identified as a tobacco user who received tobacco cessation intervention. c. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user. Biopsy Follow Up: Percentage of new patients whose biopsy results have been reviewed and communicated to the E:\FR\FM\31JAR1.SGM 31JAR1 National Committee Quality Assurance Performance Improvement Foundation (PCP!®) American Academy of ER31JA19.051</GPH> ! (Care Coordination) 563 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.ll. Otolaryngology N/A 277 N/A MIPSCQMs Specifications Process Care N/A 279 N/A MIPSCQMs Specifications v7 B Claims Measure Specifications, eCQM Specifications, Process Effective Clinical Care /Population Health MTPSCQMs ! (Appropriate Use) N/A 331 9v7 Specifications, CMSWeb Interface Measure N/A MTPSCQMs Specifications (Appropriate Use) ! (Efficiency) Safety Process Specifications N/A 333 N/A MTPSCQMs Specifications Efficiency and Cost Reduction and Cost Reduction Efficiency Efficiency and Cost Reduction Sleep Apnea: Severity Assessment at Initial Diagnosis: Percentage of patients aged 18 years and older with a diagoosis of obstructive sleep apnea who had an apnea hypopnea index (AHT) or a respiratory disturbance index (RDT) measured at the time of initial Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy: Percentage of visits for patients aged 18 years and older with a diagoosis of obstructive sleep apnea who were prescribed positive airway pressure therapy who had documentation that adherence to positive airway pressure therapy was objectively measured. American Academy of Sleep Medicine High Blood Pressure and Follow-Up Documented: Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated. Medicare &Medicaid Services Future Fall Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period. Adult Sinusitis: Antibiotic Prescribed for Acute Sinusitis (Overuse): Percentage of patients, aged 18 years and older, with a diagoosis of acute sinusitis who were prescribed an antibiotic within 10 days after onset of Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use): Percentage of patients aged 18 years and older with a diagoosis of acute bacterial sinusitis that were prescribed amoxicillin, with or without Clavulanate, as a first line antibiotic at the time of Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse): Percentage of patients aged 18 years and older with a diagoosis of acute sinusitis who had a computerized tomography (CT) scan of the paranasal sinuses ordered at the time of diagoosis or after date of · received within 28 American Academy of Sleep Medicine Committee Quality Assurance American Academy of Surgery American Academy of VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00053 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.052</GPH> khammond on DSKBBV9HB2PROD with RULES Experience and Outcomes 564 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.ll. Otolaryngology Centers Medicare& Medicaid Services N/A 402 N/A MIPSCQMs Specifications Process Specifications 0657 464 N/A MIPSCQMs Specifications (Patient Safety) Community /Population Health /Population Health Process Patient Safety, Efficiency, and Cost Reduction Composite measure of the percentage of pediatric and adult patients whose asthma is well-controlled as demonstrated by one of three age appropriate patient outcome tools. Tobacco Use and Help with Quitting Among Adolescents: The percentage of adolescents 12 to 20 years of age with a primary care visit during the measurement year for whom tobacco use status was documented and received help with quitting if identified as a tobacco Unhealthy and Alcohol Use: Screening & Brief Counseling: Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an alcohol user. Otitis Media with Effusion (OME): Systemic Antimicrobials- Avoidance of Inappropriate Use: Percentage of patients aged 2 months through 12 years with a diagnosis of OME who were not prescribed systemic antimicrobials. Community Measurement National Committee Quality Assurance American Academy of Otolaryngolo gy-Head and Neck Surgery Foundation Comment: One commenter supported measure Q277: Sleep Apnea: Severity Assessment at Initial Diagnosis and measure Q279: Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy in this measure set. Response: We thank the commenter for their support. VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00054 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.053</GPH> khammond on DSKBBV9HB2PROD with RULES FINAL ACTION: We are finalizing the Otolaryngology Specialty Measure Set as proposed for the 2019 Performance Period and future years with the exception of the newly proposed composite measure: Falls: Screening, Risk-Assessment, and Plan of Care to Prevent Future Falls. We are no longer fmalizing the inclusion of the composite falls measure because it must be fully vetted to utilize standardized tools that would appropriately identify the at-risk patient population. In addition, as noted in our responses to public comments in Table C, measures Q154, QISS, and Q318 are not finalized for removal from this measure set as proposed; therefore, they will be retained in this measure set for the 2019 Performance Period and future Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations 565 B.ll. Otolaryngology N/A 276 N/A MIPSCQMs Specifications Process Effective Clinical Care Sleep Apnea: Assessment of Sleep Symptoms: Percentage of visits for patients aged 18 years and older witb a diagnosis of obstructive sleep apnea tbat includes documentation of an assessment of sleep symptoms, including presence or absence of snoring and daytime American Academy of Sleep Medicine This measure is being removed from tbe 2019 program based on tbe detailed rationale described below for tbis measure in "Table C: Quality Measures Finalized for Removal in tbe 2021 MIPS Payment Year and Future Years." N/A 278 N/A MIPSCQMs Specifications Process Effective Clinical Care Sleep Apnea: Positive Airway Pressure Therapy Prescribed: Percentage of patients aged 18 years and older witb a diagnosis of moderate or severe obstructive sleep apnea who were prescribed positive airway pressure therapy. American Academy of Sleep Medicine This measure is being removed from tbe 2019 program based on tbe detailed rationale described below for this measure in "Table C: Quality Measures Finalized for Removal in tbe 2021 MIPS Payment Year and Future Years." N/A 334 N/A MIPSCQMs Specifications Efficiency Efficiency and Cost Reduction Adult Sinusitis: More than One Computerized Tomography (CT) Scan Within 90 Days for Chronic Sinusitis (Overuse): Percentage of patients aged 18 years and older witb a diagnosis of chronic sinusitis who had more tban one CT scan oftbe paranasal sinuses ordered or received within after the date of 90 We did not receive specific comments regarding tbe proposed removal of measures from tbis specialty measure set. American Academy of Otolaryngol ogyOtolaryngol ogy- Head and Neck Surgery below for this "Table C: Quality Finalized for in the 2021 MIPS Year and Future VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00055 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.054</GPH> khammond on DSKBBV9HB2PROD with RULES FINAL ACTION: We are finalizing tbe removal of measures from tbe Otolaryngology Specialty Measure Set as proposed for tbe 2019 Performance Period and future years. However, as noted in our responses to public comments in Table C, we are not finalizing tbe following measures proposed for removal from tbis measure set: Ql54, 55 and 8. 566 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.12. Pathology In addition to the considerations discussed in the introductory language of Table B in this final rule, the Pathology specialty set takes into consideration the following criteria, which includes, but is not limited to: the measure reflects current clinical guidelines and the coding of the measure includes the specialists. CMS may reassess the appropriateness of individual measures, on a case-by-case basis, to ensure appropriate inclusion in the specialty set. In addition, as outlined at the end of this table, we removed the following quality measures from the specialty set: Quality IDs: 099, 100, and 251. B.12. Pathology I 1853 250 N/A N/A 395 N/A N/A 396 N/A (Care Coordination (Care Coordination B Claims Measure Specifications, MIPS CQMs Specifications Medicare Part Process B Claims Measure Specifications, MIPS CQMs Specifications Medicare Part Process B Claims Measure Specifications, MIPS CQMs Specifications Medicare Part Process 13 Claims Clinical Care Effective Clinical Care Barrett's Esophagus: Percentage of esophageal biopsy reports that document the presence of Barrett's mucosa that also include a statement about dysplasia. Radical Prostatectomy Pathology Reporting: Percentage of radical prostatectomy pathology reports that include the pT category, the pN category, the Gleason score and a statement about margin status. Communication Lung Cancer Reporting (Biopsy/ Cytology Specimens): and Care Pathology reports based on biopsy and/or cytology Coordination specimens with a diagnosis of primary non-small cell lung cancer classified into specific histologic type or classified as NSCLC-NOS with an explanation included in the pathology report. Communication Lung Cancer Reporting (Resection Specimens): Pathology reports based on resection specimens and Care with a diagnosis of primary lung carcinoma that Coordination include the pT category, pN category and for nonsmall cell lung cancer, histologic type. American Pathologists College of American Pathologists College of American Pathologists College of American Pathologists Measure Specifications, MIPS CQMs S eci±ications College of N/A N/A Medicare Part Process Communication Melanoma Reporting: 397 Pathology reports for primary malignant cutaneous American B Claims and Care ! Pathologists melanoma that include the pT category and a Measure (Care Coordination Specifications, statement on thickness, ulceration and mitotic rate. Coordination ) MIPS CQMs Specifications Comment: One commenter noted that the following measures were previously designated as outcome measures: Q395- Lung cancer reporting (biopsy/cytology specimens) Q396 -Lung cancer reporting (resection specimens) and Q397 -Melanoma reporting. The commenter stated that CMS summarily changed the designation of the above measures ±rom outcome to high priority without appropriate notice and explanation. The commenter asked that CMS once again designate these measures as outcomes measures to allow pathologists the opportunity to score bonus points by reporting additional outcomes measures and be able to maximize their score in the Quality category. ) Response: We maintain that these measures do not meet the criteria for outcome measures. Outcome measures assesses the results ofhealthcare that are experienced by patients: clinical events, recovery and health status, experiences in the health system, and efficiency/cost. In these measures, it does not assess an outcome but rather assesses the process of capturing the documentation of appropriate elements within a pathology report. During the 2018 measures finalization review process, we had discussions with the measure steward to confirm the definition of an outcome measure and concluded that these measures should be classified as process measures. As such, measures Q395, Q396 and Q397 were finalized as process measures in the CY 2018 Quality Payment Program final rule (82 FR 53976 through 54146) VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00056 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.055</GPH> khammond on DSKBBV9HB2PROD with RULES FINAL ACTION: We are finalizing the Pathology Specialty Measure Set as proposed for the 2019 Performance Period and future years. Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations 567 8.12. Pathology Breast Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grade: Percentage of breast cancer resection pathology reports that include the pT category (primary tumor), the pN category (regional lymph nodes), and the histologic grade. Effective N/A 100 N/A Colorectal Cancer Resection Medicare Part Process Clinical B Claims Pathology Reporting: pT Category Care (Primary Tumor) and pN Measure Specifications, Category (Regional Lymph Nodes) MIPS CQMs with Histologic Grade: Specifications Percentage of colon and rectum cancer resection pathology reports that include the p T category (primary tumor), the pN category (regional lymph nodes) and the histologic grade. Medicare Part N/A 251 N/A Quantitative Structure Effective I3 Claims Immunohistochemical (IHC) Clinical Measure Care Evaluation of Human Epidermal Specifications, Growth Factor Receptor 2 Testing MIPS CQMs (HER2) for Breast Cancer Specifications Patients: This is a measure based on whether quantitative evaluation of Human Epidermal Growth Factor Receptor 2 Testing (HER2) by immunohistochemistry (IHC) uses the system recommended in the current ASCO/CAP Guidelines for Human Epidermal Growth Factor Receptor 2 Testing in breast cancer. We did not receive specific comments regarding the proposed removal of measures from this specialty measure set. B Claims Measure Specifications, MIPS CQMs Specifications Clinical Care College of American Pathologists College of American Pathologists This measure is being removed from the 2019 program based on the detailed rationale described below for this measure in "Table C: Quality Measures Finalized for Removal in the 2021 MIPS Payment Year and Future Years." This measure is being removed tram the 2019 progran1 based on the detailed rationale described below for this measure in "Table C: Quality Measures Finalized for Removal in the 2021 MIPS Payment Year and Future Years." This measure is being removed from the 2019 program based on the detailed rationale described below for this measure in "Table C: Quality Measures Finalized for Removal in the 2021 MIPS Payment Year and Future Years." VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00057 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.056</GPH> khammond on DSKBBV9HB2PROD with RULES FINAL ACTION: We are finalizing the removal of measures from the Pathology Specialty Measure Set as proposed for the 2019 Performance Period and future years. 568 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.13. Pediatrics In addition to the considerations discussed in the introductory language of Table Bin this final rule, the Pediatrics specialty set takes into consideration the following criteria, which includes, but is not limited to: the measure reflects current clinical guidelines and the coding of the measure includes the specialists. CMS may reassess the appropriateness of individual measures, on a case-by-case basis, to ensure appropriate inclusion in the specialty set. In addition, as outlined at the end of this table, we removed the following quality measure from the specialty set: Quality ID: 447. B.13. Pediatrics Assurance ! (Appropriate Use) 0653 091 NIA ! (Appropriate Use) 0654 093 NIA 0041 110 Medicare Part B Claims Measure Specifications, MIPSCQMs CMS14 7v8 Process Effective Clinical Care Acute Otitis External (AOE): Topical Therapy: Percentage of patients aged 2 years and older with a diagnosis of AOE who were prescribed topical preparations. Process Efficiency and Cost Reduction Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy- Avoidance of Inappropriate Use: Percentage of patients aged 2 years and older with a diagnosis of AOE who were not prescribed systemic antimicrobial therapy. 134 CMS2v 8 Community Preventive Care and Screening: Influenza /Population Immunization: Percentage of patients aged 6 months and older seen for Health a visit between October I and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization. Physician Consortium for Performance Improvement Foundation (PCPI®) Process Community Preventive Care and Screening: Screening for /Population Depression and Follow-Up Plan: Health Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen. Centers for Medicare& Medicaid Services Measure Specifications, eCQM Specifications, CMSWeb Interface Measure Specifications, MIPSCQMs § 0405 160 Process v7 Effective Clinical Care HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis: Percentage of patients aged 6 weeks and older with a diagnosis of HIVI AIDS who were prescribed · Jiroveci Pneumonia National Committee for Quality Assurance for VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00058 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.057</GPH> khammond on DSKBBV9HB2PROD with RULES Surgery Process Measure Specifications, eCQM Specifications, CMSWeb Interface Measure Specifications, MIPSCQMs 0418 American Academy of Otolaryngology -Head and Surgery 569 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.13. Pediatrics 0024 ! (Opioid) 239 CMS15 5v7 eCQM Specifications 7v7 Specifications Process diagnosis ofHIVIAIDS for whom chlamydia, gonorrhea and syphilis screenings were performed at least once since the of HIV infection. Community Weight Assessment and Counseling for N ntrition and I Physical Activity for Children and Adolescents: Population Percentage of patients 3-17 years of age who had an Health outpatient visit with a Primary Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of the following during the measurement period. Three rates are reported. • Percentage of patients with height, weight, and body mass index (BMI) percentile documentation. • Percentage of patients with counseling for nutrition. • Percentage of patients with counseling for physical /Population Health 0004 305 CMS13 7v7 eCQM Specifications Process 0033 310 CMS15 3v7 eCQM Specifications Process 0108 366 CMSI3 6v8 eCQM Specifications Process Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second Effective Initiation and Engagement of Alcohol and Other Clinical Drug Dependence Treatment: Care Percentage of patients 13 years of age and older with a new episode of alcohol and other drug (AOD) dependence who received the following. Two rates are reported. • Percentage of patients who initiated treatment within 14 days of the diagnosis. • Percentage of patients who initiated treatment and who had two or more additional services with an of the initiation visit. AOD within 30 Community Chlamydia Screening for Women: Percentage of women 16-24 years of age who were I Population identified as sexually active and who had at least one test Health the measurement ADHD: Follow-Up Care for Children Prescribed ADHD Effective Clinical Medication (ADD): Percentage of children 6-12 years of age and newly Care dispensed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported. a) Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase. b) Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 after the Initiation Phase ended. Assurance National Committee for Quality Assurance Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance Medicaid Services VerDate Sep<11>2014 1365 382 16:41 Jan 30, 2019 CMS17 7v7 Jkt 247001 eCQM Specifications PO 00000 Process Frm 00059 Fmt 4700 Patient Safety Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment: Percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk. Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 Physician Consortium for Performance ER31JA19.058</GPH> khammond on DSKBBV9HB2PROD with RULES ! (Patient Safety) 570 Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations B.13. Pediatrics ! 0576 391 NIA (Care Coordination) 1407 394 NIA ! (Outcome) MIPSCQMs Specifications Process MIPSCQMs Specifications Process MIPSCQMs Specifications Outcome Follow-up After Hospitalization for Mental Dlness (FUH): The percentage of discharges for patients 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who had a followup visit with a mental health practitioner. Two rates are submitted: The percentage of discharges for which the patient received follow-up within 30 days of discharge. The percentage of discharges for which the patient received within 7 Community Immunizations for Adolescents: /Population The percentage of adolescents 13 years of age who had Health the recommended immunizations by their 13th birthday. Communic ation/Care Coordinatio n Optimal Asthma Control: Composite measure of the percentage of pediatric and adult patients whose asthma is well-controlled as demonstrated by one of three age appropriate patient outcome tools. NIA 402 NA MIPSCQMs Specifications Process § ! (Efficiency) NIA 444 NIA MIPSCQMs Specifications Process Efficiency and Cost Reduction ! 0657 464 NIA MIPSCQMs Specifications Process Patient Safety, Efficiency, and Cost Reduction NIA 467 NIA MIPSCQMs Specifications Process (Patient Safety) Committee for Quality Assurance National Committee for Quality Assurance Community Measurement National Committee for Quality Assurance Medication Management for People with Asthma (MMA): The percentage of patients 5-64 years of age during the measurement year who were identified as having persistent asthma and were dispensed appropriate medications that they remained on for at least 75 percent of their treatment Otitis Media with Effusion (OME): Systemic Antimicrobials- Avoidance of Inappropriate Use: Percentage of patients aged 2 months through 12 years with a diagnosis of OME who were not prescribed systemic antimicrobials. National Committee for Quality Assurance American Academy of Otolaryngolog y-Headand Neck Surgery Foundation Community Developmental Screening in the First Three Years of /Population Life: Health The percentage of children screened for risk of University developmental, behavioral and social delays using a standardized screening tool in the first 3 years of life. This is a measure of screening in the first 3 years oflife that includes 3, age-specific indicators assessing whether children are screened by 12 months of age, by 24 months and 36 months of commenter measures require different services than adults. The commenter noted that CMS plays an important role in aligning measures across programs and payers. While many of the MIPS measures have been used for health plan accreditation and other system-level measurement, there is little information on how the validity of these measures were examined within the context of the Quality Payment Program or the application to those who care for the very few Medicare-enrolled children. Thus, the commenter recommended that any process CMS uses to examine the application of the Quality Payment Program model to the Medicaid program and commercial payers specifically assess the appropriateness, usefulness and validity of pediatric measures in its application. VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00060 Fmt 4700 Sfmt 4725 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.059</GPH> khammond on DSKBBV9HB2PROD with RULES Response: We agree that it is important to align measures across programs. Many of these measures have been included in legacy quality programs that evaluated the validity of the measure to be included in quality programs including the Quality Payment Program. We have expanded to include all payer patient data for the quality measures for many of the data collection types, which allows evaluation of children that are not only Medicare-enrolled but those that are covered under other health plans. As MIPS evolves, we will assess appropriateness, usefulness and validity of pediatric measures in relation to the Medicaid program and commercial payers. Federal Register / Vol. 84, No. 21 / Thursday, January 31, 2019 / Rules and Regulations 571 Dated: December 20, 2018. Ann C. Agnew, Executive Secretary to the Department, Department of Health and Human Services. [FR Doc. 2018–28354 Filed 1–30–19; 8:45 am] VerDate Sep<11>2014 16:41 Jan 30, 2019 Jkt 247001 PO 00000 Frm 00061 Fmt 4700 Sfmt 9990 E:\FR\FM\31JAR1.SGM 31JAR1 ER31JA19.060</GPH> khammond on DSKBBV9HB2PROD with RULES BILLING CODE 4120–01–C

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[Federal Register Volume 84, Number 21 (Thursday, January 31, 2019)]
[Rules and Regulations]
[Pages 539-571]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-28354]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 414

[CMS-1693-CN]
RIN 0938-AT31


Medicare Program; Revisions to Payment Policies Under the 
Physician Fee Schedule and Other Revisions to Part B for CY 2019; 
Medicare Shared Savings Program Requirements; Quality Payment Program; 
Medicaid Promoting Interoperability Program; Quality Payment Program--
Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS 
Payment Year; Provisions From the Medicare Shared Savings Program--
Accountable Care Organizations Pathways to Success; and Expanding the 
Use of Telehealth Services for the Treatment of Opioid Use Disorder 
Under the Substance Use-Disorder Prevention That Promotes Opioid 
Recovery and Treatment (SUPPORT) for Patients and Communities Act; 
Correction

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

ACTION: Correction of final rule.

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SUMMARY: This document corrects technical errors that appeared in the 
final rule published in the Federal Register on November 23, 2018 
entitled ``Medicare Program; Revisions to Payment Policies under the 
Physician Fee Schedule and Other Revisions to Part B for CY 2019; 
Medicare Shared Savings Program Requirements; Quality Payment Program; 
Medicaid Promoting Interoperability Program; Quality Payment Program--
Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS 
Payment Year; provisions from the Medicare Shared Savings Program--
Accountable Care Organizations Pathways to Success; and Expanding the 
Use of Telehealth Services for the Treatment of Opioid Use Disorder 
under the Substance Use-Disorder Prevention that Promotes Opioid 
Recovery and Treatment (SUPPORT) for Patients and Communities Act.''

DATES: This correcting document is effective January 31, 2019, and is 
applicable beginning January 1, 2019.

FOR FURTHER INFORMATION CONTACT: Benjamin Chin, (410) 786-0679, Alesia 
Hovatter (410) 786-6861 or Molly MacHarris, (410) 786-4461.

SUPPLEMENTARY INFORMATION: 

I. Background

    In FR Doc. 2018-24170 of November 23, 2018 (83 FR 59452 through 
60303), there were a number of technical errors that are identified and 
corrected in the Correction of Errors section below. These corrections 
are effective January 1, 2019.

II. Summary of Errors

A. Summary of Errors in the Regulation Text

    On page 60090, in regulation text regarding Sec.  414.1415, we made 
a typographical error in identifying the year in the effective date.

B. Summary of Errors in the Appendix

    On page 60151, we inadvertently omitted Table B.6. Internal 
Medicine (Removal Table), Table B.7. Emergency Medicine, Table B.8. 
Obstetrics/Gynecology, Table B.9. Ophthalmology, Table B.10. Orthopedic 
Surgery, Table B.11. Otolaryngology, Table B.12. Pathology, and Table 
B.13 Pediatrics.

III. Waiver of Proposed Rulemaking

    Under 5 U.S.C. 553(b) of the Administrative Procedure Act (the 
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 Social Security Act (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; in cases in which 
these exceptions apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of 
the Act provide exceptions from the notice and 60-day comment period 
and delay in effective date requirements of the Act as well. 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 rule. In addition, section 553(d)(3) of the APA 
and section 1871(e)(1)(B)(ii) allow the agency to avoid the 30-day 
delay in effective date where such delay is contrary to the public 
interest and the

[[Page 540]]

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 technical errors in the CY 2019 PFS 
final rule. The corrections contained in this document are consistent 
with, and do not make substantive changes to, the policies and payment 
methodologies that were proposed, subject to notice and comment 
procedures, and adopted in the CY 2019 PFS final rule. As a result, the 
corrections made through this correcting document are intended to 
resolve inadvertent errors so that the rule accurately reflects the 
policies adopted in the final 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 2019 PFS final rule 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 
rule accurately reflects our policies as of the date they take effect. 
Further, such procedures would be unnecessary because we are not making 
any substantive revisions to the final rule, but rather, we are simply 
correcting the Federal Register document to reflect the policies that 
we previously proposed, received public comment on, and subsequently 
finalized in the final rule. For these reasons, we believe there is 
good cause to waive the requirements for notice and comment and delay 
in effective date.

IV. Correction of Errors

    In FR Doc. 2018-24170 of November 23, 2018 (83 FR 59452 through 
60303), make the following corrections:


Sec.  414.1415   [Corrected]

0
1. On page 60090, in the second column; in amendatory instruction 41, 
in line 2, the parenthetical ``(effective January 1, 2010)'' is 
corrected to read ``(effective January 1, 2020)''.

0
2. On page 60151, Table B.6. Internal Medicine (Removal Table), Table 
B.7. Emergency Medicine, Table B.8. Obstetrics/Gynecology, Table B.9. 
Ophthalmology, Table B.10. Orthopedic Surgery, Table B.11. 
Otolaryngology, Table B.12. Pathology, and Table B.13 Pediatrics should 
be added in their entirety.
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    Dated: December 20, 2018.
Ann C. Agnew,
Executive Secretary to the Department, Department of Health and Human 
Services.
 [FR Doc. 2018-28354 Filed 1-30-19; 8:45 am]
 BILLING CODE 4120-01-C

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