Centers for Medicare & Medicaid Services Updates Inpatient Psychiatric Facilities Prospective Payment System
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Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for Fiscal Year Beginning
A Rule by the
Publication Date:
Agencies:
Dates: These regulations are effective on
Effective Date:
Entry Type: Rule
Action: Final rule.
Document Citation: 79 FR 45937
Page: 45937 -46009 (73 pages)
CFR: 42 CFR 412
Agency/Docket Number: CMS-1606-F
RIN: 0938-AS08
Document Number: 2014-18329
Shorter URL: https://federalregister.gov/a/2014-18329
Action
Final Rule.
Summary
This final rule will update the prospective payment rates for
DATES:
These regulations are effective on
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION:
I. Executive Summary
A. Purpose
This final rule updates the prospective payment rates for
B. Summary of the Major Provisions
In this final rule, we update the IPF PPS, as specified in 42 CFR 412.428. The updates include the following:
The FY 2008-based Rehabilitation, Psychiatric, and
The FY 2015 per diem rate is updated from
The electroconvulsive therapy payment is updated from
The fixed dollar loss threshold amount is updated from
The national urban and rural cost-to-charge ratio (CCR) ceilings for FY 2015 is 1.6582 and 1.8590, respectively, and the national median CCR will be 0.6220 for rural IPFs and 0.4710 for urban IPFs. These amounts are used in the outlier calculation to determine if an IPF's CCR is statistically accurate and for new providers without an established CCR.
The cost of living adjustment factors for IPFs located in
In addition:
We identify the ICD-10-CM/PCS codes that will be eligible for the MS-DRG and comorbidity payment adjustments under the IPF PPS. The effective date of those changes is
We identify the ICD-9-CM/PCS codes that will be eligible for the MS-DRG and comorbidity payment adjustments under the IPF PPS.
We use the best available hospital wage index and establish the wage index budget-neutrality adjustment of 1.0002.
We retain the 17 percent payment adjustment for IPFs located in rural areas, the 1.31 payment adjustment factor for IPFs with a qualifying emergency department, the coefficient value of 0.5150 for the teaching adjustment, and the MS-DRG adjustment factors and comorbidity adjustment factors currently being paid to IPFs in FY 2014.
C. Summary of Impacts
Provision description .....
Total transfers .....
FY 2015 IPF PPS payment rate update .....The overall economic impact of this final rule is an estimated
Costs .....
New quality reporting program requirements .....The total costs in FY 2015 for IPFs as a result of the final new quality reporting requirements is estimated to be
II. Background
A. Annual Requirements for Updating the IPF PPS
In
In that final rule, we explained that we believe it is important to delay updating the adjustment factors derived from the regression analysis until we have IPF PPS data that include as much information as possible regarding the patient-level characteristics of the population that each IPF serves. Therefore, we indicated that we did not intend to update the regression analysis and the patient- and facility-level adjustments until we complete that analysis. Until that analysis is complete, we stated our intention to publish a notice in the
In the
Our most recent IPF PPS annual update occurred in an
B. Overview of the Legislative Requirements for the IPF PPS
Section 124 of the
Section 405(g)(2) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173) extended the IPF PPS to distinct part psychiatric units of critical access hospitals (CAHs).
Section 3401(f) of the Patient Protection and Affordable Care Act (Pub. L. 111-148) as amended by section 10319(e) of that Act and by section 1105(d) of the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152) (hereafter referred to as "the Affordable Care Act") added subsections to section 1886 of the Act.
Section 1886(s)(1) of the Act titled "Reference to Establishment and Implementation of System" refers to section 124 of the BBRA, which relates to the establishment of the IPF PPS.
Section 1886(s)(2)(A)(i) of the Act requires the application of the productivity adjustment described in section 1886(b)(3)(B)(xi)(II) of the Act to the IPF PPS for the RY beginning in 2012 (that is, a RY that coincides with a FY) and each subsequent RY. For the RY beginning in 2014 (that is, FY 2015), the current estimate of the productivity adjustment will be equal to 0.5 percentage point, which we are finalizing in this FY 2015 final rule.
Section 1886(s)(2)(A)(ii) of the Act requires the application of an "other adjustment" that reduces any update to an IPF PPS base rate by percentages specified in section 1886(s)(3) of the Act for the RY beginning in 2010 through the RY beginning in 2019. For the RY beginning in 2014 (that is, FY 2015), section 1886(s)(3)(C) of the Act requires the reduction to be 0.3 percentage point. We are finalizing that reduction in this FY 2015 IPF PPS final rule.
Section 1886(s)(4) of the Act requires the establishment of a quality data reporting program for the IPF PPS beginning in RY 2014. We proposed and finalized new requirements for quality reporting for IPFs in the "Hospital Inpatient Prospective Payment System for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2014 Rates" proposed rule published on
To implement and periodically update these provisions, we have published various proposed and final rules in the
C. General Overview of the IPF PPS
The
The IPF PPS established the Federal per diem base rate for each patient day in an IPF derived from the national average daily routine operating, ancillary, and capital costs in IPFs in FY 2002. The average per diem cost was updated to the midpoint of the first year under the IPF PPS, standardized to account for the overall positive effects of the IPF PPS payment adjustments, and adjusted for budget-neutrality.
The Federal per diem payment under the IPF PPS is comprised of the Federal per diem base rate described above and certain patient- and facility-level payment adjustments that were found in the regression analysis to be associated with statistically significant per diem cost differences.
The patient-level adjustments include age, DRG assignment, comorbidities, and variable per diem adjustments to reflect higher per diem costs in the early days of an IPF stay. Facility-level adjustments include adjustments for the IPF's wage index, rural location, teaching status, a cost-of-living adjustment for IPFs located in
The IPF PPS provides additional payment policies for: outlier cases; interrupted stays; and a per treatment adjustment for patients who undergo electroconvulsive therapy (ECT). During the IPF PPS mandatory 3-year transition period, stop-loss payments were also provided; however, since the transition ended in 2008, these payments are no longer available.
A complete discussion of the regression analysis that established the IPF PPS adjustment factors appears in the
Section 124 of the BBRA did not specify an annual rate update strategy for the IPF PPS and was broadly written to give the Secretary discretion in establishing an update methodology.
Therefore, in the
Calculate the final Federal per diem base rate to be budget-neutral for the 18-month period of
Use a
Allow the IPF PPS first update to be effective for discharges on or after
[*Federal RegisterVJ 2014-08-06]
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Centers for Medicare & Medicaid Services Updates Inpatient Rehabilitation Facility Prospective Payment System for 2015
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