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From Health Law Daily, April 27, 2015

CMS proposes IPF payment, quality, and reporting updates

By Bryant Storm, J.D.

HHS and CMS are proposing to update the prospective payment system (PPS) rates for covered psychiatric services provided under Medicare Part A through inpatient psychiatric facilities (IPFs) for the fiscal year (FY) beginning October, 1, 2015. The agencies are also proposing a new IPF-specific market basket as well as new quality measures and reporting requirements for the IPF Quality Reporting (IPFQR) Program. The Proposed rule, which is scheduled to be published in the Federal Register on May 1, 2015, is also intended to remind IPFs of the October 1, 2015, compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10).

IPF PPS. As mandated by 42 C.F.R. Sec. 412.428, CMS is proposing to update the IPF PPS rates with a market basket update of 1.9 percent. The update took the FY 2012-based IPF market basket update of 2.7 percent and reduced it by 0.6 percentage point for economy-wide productivity and 0.2 percentage point as required by Section 1886(s)(2)(A)(ii) of the Social Security Act (SSA). Section 3401(f) of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) mandates the productivity adjustment. The Proposed rule would also update the IPF per diem rate from $728.31 to $745.19. However, for IPFs that failed to report quality data for FY 2016, the FY 2016 per diem rate would be reduced to $730.56.

Under the Proposed rule, CMS and HHS also plan to adopt Office of Management and Budget (OMB) Core-Based Statistical Area (CBSA) delineations. CBSA changes would be implemented through a one-year transition period using a 50 percent blend of the current and new delineations. The CBSA changes would also lead to the phasing out of rural designations for 37 IPFs, which would be then designated as urban under the new CBSA standards.

IPQFR. Sections 3401(f) and 10322(a) of the ACA, which added and amended the IPQFR, require that HHS reduce the annual update of IPFs or psychiatric units that do not comply with quality data submission requirements. The Proposed rule, if finalized, would add five new measures for FY 2018 payment determinations. The added reporting measures relate to patient alcohol use, tobacco use, facility transfers, and screenings for metabolic disorders. HHS and CMS also propose to add several changes to the way data is reported for the IPQFR program. As of FY 2017, the Proposed rule would require that measures be reported as a single yearly count rather than by quarter.

Impact. HHS and CMS estimate the economic impact of the Proposed rule would be an estimated $80 million in increased IPF payments during FY 2016. The proposed costs to IPFs from the additional reporting requirements are estimated to reach $6.31 million. The agencies will accept comments on the proposal for through June 23, 2015.

MainStory: TopStory AgencyNews IPFNews HealthCareReformNews ReimbursementNews IPPSNews CMSNews BillingNews HealthReformNews PartANews QualityNews PaymentNews

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