The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service prospective payment system (PPS) for inpatient psychiatric facilities (IPFs) for federal fiscal year (FY) 2025. Key provisions of the rule include:
- Increasing the Electroconvulsive Therapy (ECT) payment per treatment by 71.5% from $385.58 to $661.52 for IPFs that comply with IPF quality reporting program (QRP) requirements and $648.65 for IPFs that fail to report data. The CMS believes this will improve access to ECT services.
- Decreasing the IPF PPS federal per diem base rate by a net 2.1% after all adjustments, from $895.63 to $876.53. IPFs that fail to comply with the CMS IPF QRP requirements would be paid using a base rate of $859.48.
- Updating the wage index using the most recent Office of Management and Budget statistical area delineations based on the 2020 Decennial Census.
- Increasing the labor-related share from the current 78.7% to 78.8%.
- Increasing the cost outlier threshold by 14% from the current $33,470 to $38,110 to achieve the 2% target for outlier payments, as compared to aggregate IPF payments, decreasing the number of cases that qualify for outlier payments.
- Finalizing changes to the patient-level adjustments.
- Maintaining the existing facility-level adjustment factors for rural location, teaching status and emergency department.
- Changes to the IPFQR Program:
- Finalizing the proposed adoption of the 30-Day Risk-Standardized All-Cause Emergency Department Visit following an IPF discharge measure beginning with the FY 2027 payment determination.
- Not finalizing the proposal to require IPFs to submit patient-level data on a quarterly basis based on comments received and determining that some IPFs may be unable to meet this requirement in the proposed timeframe.
- Summarizing comments received about the IPF PPS Patient Assessment Instrument (IPF-PAI), as required by the Consolidated Appropriations Act, 2023 and considering the comments for development of the IPF-PAI and in future rulemaking.
The MHA will provide IPFs with an updated facility-specific impact analysis and additional details on the final rule, effective Oct. 1, in the near future. Members with questions should contact Vickie Kunz at the MHA.