Tag: IPF

CMS Releases FY 2026 Final Rule for Inpatient Psychiatric Facilities

Member News

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.
  • 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.

CMS Releases FY 2025 Final Rule for Inpatient Psychiatric Facilities

Member News

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.