The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule to update the Medicare fee-for-service prospective payment system (PPS) for inpatient psychiatric facilities (IPFs) for fiscal year (FY) 2026.
Key provisions of the proposed rule include:
- Increasing the IPF PPS federal per diem base rate by a net 1.8% after all adjustments, from $876.53 to $891.99. IPFs that fail to comply with the CMS IPF Quality Reporting Program (QRP) requirements would be paid using a base rate of $874.57.
- Increasing the Electroconvulsive Therapy payment per treatment by a net 1.8% from $661.52 to $673.19 for IPFs that comply with IPF QRP requirements and $660.04 for IPFs that fail to report data.
- Increasing the labor-related share from the current 78.8% to 78.9%.
- 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.
- Revising facility-level adjustment factors:
- Rural adjustment from 1.17 to 1.18
- Teaching adjustment from 0.5150 to 0.7981
- Updating the IPF QRP to:
- Remove four measures beginning with the calendar year 2024 reporting period and or 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 and or FY 2026 payment determination:
- Seeking feedback on three topics through requests for information for:
- A potential future star ratings system for IPFs.
- Future measures for the IPF QRP.
- Using the Fast Healthcare Interoperability Resources standard for electronic exchange of healthcare information for patient assessment reporting.
The CMS is seeking comments on opportunities to streamline regulations and reduce administrative burdens on providers, suppliers, beneficiaries and other interested parties participating in the Medicare program.
The MHA will provide IPFs with a facility-specific impact analysis and additional details on the proposed rule in the near future. The MHA also encourages members to submit comments to the CMS by June 10 and to contact Vickie Kunz at the MHA with questions and issues identified by May 27.