The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service (FFS) prospective payment system (PPS) for inpatient psychiatric facilities (IPFs) for fiscal year (FY) 2026.
Key provisions of the include:
- Increasing the IPF PPS federal per diem base rate by a net 1.9% after all adjustments, from $876.53 to $892.87 for IPFs that comply with the CMS IPF quality reporting program (QRP) requirements. The rate for providers that failed to report quality data is $875.44.
- Increasing the Electroconvulsive Therapy payment per treatment by a net 1.9% from $661.52 to $673.85 for IPFs that comply with IPF QRP requirements and $660.70 for IPFs that fail to report data.
- Revising the labor-related share from the current 78.8% to 79%.
- Increasing the cost outlier threshold by 3.3% from the current $38,110 to $39,360 to achieve the 2% target for outlier payments as compared to aggregate IPF payments, decreasing the number of cases that qualify for outlier payments.
- Modifying the facility-level adjustment factors:
- Rural adjustment from 1.17 to 1.18
- Teaching adjustment from 0.5150 to 0.7957
- Maintaining the 1.54 adjustment factor for IPFs with qualifying emergency departments.
- Updating the IPFQR Program to:
- Remove four measures beginning with the calendar year 2024 reporting period/FY 2026 payment determination:
- Facility Commitment to Health Equity
- COVID-19 Vaccination Coverage among Health Care Personnel
- Screening for Social Drivers of Health
- Screen Positive Rate for Social Drivers of Health
- Modify the reporting period of the 30-day-Risk-Standardized All Cause Emergency Department Visit Following an Inpatient Psychiatric Facility Discharge measure (referred to as the IPF ED Visit measure) from a one year, calendar year to a two-year, fiscal year period.
- Remove four measures beginning with the calendar year 2024 reporting period/FY 2026 payment determination:
- Finalizing changes to the IPFQR program’s extraordinary circumstances exception (ECE) policy to include extensions as a type of relief that the agency may grant in response to an ECE request
The MHA will provide IPFs with an updated hospital-specific impact analysis and additional details on the final rule in the near future. Members with questions should contact Vickie Kunz at the MHA.