Tag: The Centers for Medicare and Medicaid Services

Sept 1 Deadline for Wage and Occupational Mix Survey Data Revisions

Member News

The Centers for Medicare & Medicaid Services (CMS) released a corrected public use file (PUF) Aug. 14 containing wage and occupational mix survey data being used to develop the fiscal year (FY) 2025 Medicare wage index, which will take effect Oct. 1, 2024. The MHA urged the CMS to release the corrected PUF for hospital review following an error in the July PUF that resulted in reflecting 0 for nursing aide salary and hours for many hospitals. The MHA also recently provided hospitals with updated reports that included the corrected PUF data.

Hospitals can submit requests for any changes to their wage and 2022 occupational mix survey data until Sept. 1. The MHA encourages hospitals to review their data and submit requests for any changes, along with supporting documentation, to the Medicare Administrative Contractor by Sept. 1.

Members with questions should contact Vickie Kunz at the MHA.

FY 2024 LTCH Prospective Payment System Final Rule Released

Member News

The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service (FFS) long term care hospital (LTCH) prospective payment system for fiscal year (FY) 2024.

Specifics of the rule include the following:

  • Provides a net 3.6% increase from $46,433 to $48,116 for LTCHs that meet the CMS quality program reporting (QPR) requirements. LTCHs that fail to meet these requirements are subject to a two percentage point reduction to the annual update.
  • Increases the high-cost outlier (HCO) threshold for standard LTCH cases by 55% from the current $38,518 to $59,873 (instead of the proposed $94,378) to achieve the target of paying roughly 8% of aggregate LTCH payments as HCO payments. This increase will result in a decrease in the number of cases qualifying for an outlier payment.
  • Pays all site-neutral cases at the site neutral rate following the May 11, 2023, expiration of the public health emergency, which ended the requirement that all LTCH cases be paid based on the standard LTCH rate regardless of whether they met LTCH criteria.
  • Updates the cost outlier threshold for site-neutral cases to the inpatient PPS finalized threshold of $42,750, up 10% from the current $38,859 threshold.
  • Updates the LTCH quality reporting program (QRP) by adopting two new measures, modifying the COVID-19 Vaccination Coverage among Healthcare Personnel measure and removing two measures.
  • Increases the data completion threshold beginning with the FY 2026 LTCH QRP. The CMS will require LTCHs to report 100% of the required quality measure data and standardized assessment data collected using the LTCH CARE Data Set tool on at least 85%, up from the current 80%, of assessments submitted to the CMS. LTCHs that fail to meet this requirement will be subject to a two percentage point reduction to their applicable annual update.

The MHA continues to review the final rule and will provide hospitals with an estimated impact analysis in the near future.

Members with questions should contact Vickie Kunz at the MHA.

CMS Releases FY 2024 Skilled Nursing Facility Final Rule

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 skilled nursing facilities (SNF) for fiscal year (FY) 2024, which begins Oct. 1, 2023. The rule includes:

  • Continuation of the negative 2.3% parity adjustment to the Patient Driven Payment Model (PDPM) case mix indices following implementation of the PDPM to maintain budget neutrality with the prior RUG-IV case-mix system. The CMS finalized a two-year phase-in of the proposed 4.6% negative adjustment for FYs 2023 and 2024, despite opposition from the MHA, the American Hospital Association and others.
  • A 6.4% net increase to the SNF federal per diem base rate for providers that comply with the CMS IPF quality reporting program requirements. Facilities should note that the 6.4% net increase will be offset by the negative 2.3% parity adjustment described above.
  • A slight increase in the labor-related share from the current 70.8% to 71.1%.
  • Updating the SNF QRP to adopt two new measures, modify the COVID-19 Vaccination Coverage Among Health Care Personnel measure and remove two measures. The CMS did not finalize the CoreQ:Short Stay Discharge Measure, with the agency noting they intend to propose a resident satisfaction or experience measure in the future.
  • Updating the SNF Value-based Purchasing program for future years by
    • Adding the following new measures:
      • Nursing Staff Turnover Measure.
      • Falls with Major Injury (Long-term) Measure.
      • Discharge Function Measure.
      • Long Stay Hospitalization Measure.
    • Replacing the 30-Day All Cause Readmission Measure with the Within Stay Potentially Preventable Readmissions Measure.
    • Adopting a Health Equity Adjustment.
  • Increasing the data completion thresholds to require SNFs to report 100% of the required quality measure data and standardized assessment data collected using the Minimum Data Set tool to at least 90% (instead of 80%) of assessment submitted to the CMS. SNFs that do not meet this requirement will be subject to a two percentage point reduction to their applicable annual payment update.

The MHA will provide SNFs with a facility-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 2024 Inpatient Psychiatric Facility Final Rule

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 (IPF) for fiscal year (FY) 2024, which begins Oct. 1, 2023.

Key provisions of the final rule include:

  • A 3.5% net increase to the IPF federal per diem base rate for providers that comply with the CMS IPF quality reporting (QR) program requirements, resulting in a final rate of $895.63, an increase from the current rate of $865.63.
  • A 3.5% increase to the electroconvulsive therapy per diem payment rate from the current $372.67 to $385.58 for providers that comply with the CMS IPF QR program requirements.
  • A rebased IPF PPS market basket to use FY 2021 data instead of FY 2016.
  • An increase in the labor-related share from the current 77.4% to 78.7%.
  • A 36% increase in the outlier threshold amount from the current $24,630 to $33,470 to maintain estimated outlier payments at 2% of total estimated aggregate IPF PPS payments. This will result in fewer cases qualifying for an outlier payment.
  • Modifying the excluded unit regulation to allow a hospital to open a new IPF unit and begin being paid under the IPF PPS at any time during the cost reporting period if the hospital meets certain requirements. Currently facilities cannot attain excluded unit status in the middle of a cost reporting period.
  • Changes to the IPF QRP including:
    • Adopting new quality measures, including one on patient experience.
    • Modifying the COVID-19 Vaccination Coverage Among Health Care Personnel measure
    • Removing two measures:
      • Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification (HBIPS-5).
      • Tobacco Use Brief Intervention Provided or Offered and Tobacco Use Brief Intervention Provided (TOB-2/2a).
    • Adopting a data validation pilot program starting with data submitted in 2025.

The MHA will provide IPFs with a facility-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 2024 Final Rule for Inpatient Rehabilitation 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 rehabilitation facilities (IRFs) for federal fiscal year (FY) 2024.

Key provisions of the final rule include:

  • Rebasing the IRF market basket using data using FY 2021, instead of FY 2016 data.
  • Increasing the IRF PPS payment rate by 3.7% from $17,878 to $18,541 for IRFs that comply with the CMS IRF Quality Reporting Program (QRP) requirements. IRFs that fail to comply are subject to a two percentage point reduction.
  • Increasing the labor-related share from the current 72.9% to 74.1%.
  • Using the FY 2024 pre-floor, pre-reclassification inpatient PPS hospital wage index, with a 5% cap on any decrease to a provider’s wage index from its prior year wage index.
  • Decreasing the cost outlier threshold by 17% from the current $12,526 to $10,423, to achieve the 3% target for outlier payments as compared to aggregate IRF payments, which will increase the number of cases that qualify for outlier payments.
  • Updating the IRF QRP by:
    • Modifying the COVID-19 Vaccination Coverage among Healthcare Personnel measure.
    • Adopting one new measure: The Discharge Function Score measure.
    • Adopting the COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date measure beginning with the FY 2026 IRF QRP.
    • Removing three existing measures:
      • The Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function measure (NQF #2631).
      • The IRF Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients measure (NQF #2633).
      • The IRF Functional Outcome Measure: Change in Mobility Score for Medical Rehabilitation Patients measure (NQF #2634).
    • Modifying the excluded unit regulation to allow a hospital to open a new IRF unit and begin being paid under the IRF PPS at any time during the cost reporting period if the hospital meets certain requirements rather than the current limit that only allows for payment under the IRF PPS at the beginning of a cost reporting period.

The MHA will provide IRFs with a facility-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 Proposed Rule to Update Home Health PPS

Member News

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule to update the home health (HH) prospective payment system (PPS) for calendar year (CY) 2024. The proposed rule includes updates to the Medicare fee-for-service (FFS) HH PPS payment rates based on changes by the CMS and those previously adopted by Congress.

The proposed updates include:

  • A negative 5.653% behavioral offset to achieve budget neutrality due to the transition to the Patient-Driven Groupings Model (PDGM).
  • A 30-day standard payment rate of $1,974.38, which is a 1.81% decrease from the current rate after the 3% marketbasket update is reduced for the negative behavioral adjustment and budget neutrality.
  • Recalibration of the PDGM case-mix weights, low utilization payment adjustment thresholds, functional levels and comorbidity adjustment subgroups.
  • Updates to the expanded HH value-based purchasing program previously expanded to all 50 states. All HH agencies certified before Jan. 1, 2022, will have a reduction or an increase to their Medicare payments by up to 5% based on their performance on specified quality measures beginning in CY 2025.
  • The addition of two new measures to the HH quality reporting program.
  • Payment rates for the administration of Home Intravenous Immune Globulin items and services.
  • Creation of the Hospice Informal Dispute Resolution and special focus programs.
  • Changes to durable medical equipment, prosthetics, orthotics and supplies outlined by the Consolidated Appropriations Act of 2023.
  • A decrease in the labor-related share of the HH 30-day period standard rate from 76.1% in 2023 to 74.9%.
  • A request for information on the use of home health aides.

Comments on the proposed rule are due to the CMS Aug. 29 and can be submitted electronically by using the website’s search feature to search for file code “1780-P.” The MHA will provide an estimated impact analysis of the proposed rule within the next few weeks.

Members with questions should contact Vickie Kunz at the MHA.

CMS Releases Final Rule to Update OPPS

Member News

The Centers for Medicare and Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service (FFS) outpatient prospective payment system (OPPS) effective Jan. 1, 2023.

The rule restores 340B drug payments to the default rate, generally average sales price (ASP) plus 6%, up from the previous ASP minus 22.5%, in response to the recent federal Supreme Court (SC) ruling.  The CMS notes that the agency is still evaluating how to apply the SC’s decision in the American Hospital Association (AHA) v Becerra case which ordered the CMS to restore payments. The CMS will address this in future rulemaking prior to the 2024 OPPS proposed rule.  

The MHA, along with the AHA and others, continue to urge the Court to order the CMS to promptly repay hospitals harmed by the unlawful cuts implemented in 2018 and ensure that no hospitals are not penalized.  Other provisions of the final rule include:

  • Increasing the conversion factor by a net 1.7% after budget neutrality adjustments from $84.18 to $85.59 for hospitals that comply with the CMS outpatient quality reporting (OQR) program requirements.
  • Establishing the new rural emergency hospital provider type to allow critical access hospitals and rural hospitals with less than 50 beds to continue providing essential outpatient services while eliminating inpatient services.
  • Exempting rural sole community hospitals from the site neutral clinic visit cuts and instead paying the full OPPS rate for visits provided at grandfathered off-campus hospital outpatient departments.
  • Increasing the cost outlier threshold by 40% from $6,175 to $8,625, to maintain outlier payments at the targeted 1% of total OPPS payments, resulting in fewer cases qualifying for an outlier payment.
  • Removing 11 services from the inpatient only list and adding 8 services that were newly created by the American Medical Association Common Procedural Terminology Editorial Panel.
  • Implementing a permanent 5% cap on wage index decreases.
  • Adding four procedures to the Ambulatory Surgical Center covered procedures list.
  • Requiring prior authorization for an additional service category,­ facet joint interventions, beginning dates of service on or after July 1, 2023.
  • Continuing payment for virtual behavioral health services with an in-person service required within six months prior to the initiation of the virtual service and then annually thereafter, with exceptions made based on beneficiary circumstances. The CMS clarified that the requirement for an in-person visit within six months prior to the initial services is not required for patients who began receiving services during the public health emergency (PHE) or during the 151-day period following the end of the PHE.
  • Maintaining the current policy of providing separate payment for non-opioid pain management drugs and biologicals that function as supplies in the ASC setting.
  • Implementing a payment adjustment for costs incurred for domestically manufactured National Institute for Occupational Safety and Health (NIOSH)-approved surgical N95 respirators with payments provided biweekly as interim lump-sum payments and reconciled at cost report settlement for cost reporting periods beginning on or after Jan. 1, 2023.
  • Creating a new G-code for dental rehabilitation services that require monitored anesthesia and the use of an operating room and assigning it to APC 5871 (Dental Procedures), effectively increasing the payment from roughly $200 to approximately $2,000.
  • Changes to the hospital OQR program including:
  • Making the Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery (OP-31) measure voluntary rather than mandatory beginning with the 2025 reporting period and 2027 payment determination.
  • Aligning the patient encounter quarters for chart-abstracted measures to the calendar year for annual payment update determinations.
  • Adding a targeting criterion for measure data validation.

The MHA will provide hospitals with an updated impact analysis and additional details of the rule in the coming weeks.

Members with questions should contact Vickie Kunz at the MHA.

News to Know – Week of Sept. 12

Member News
  • The Centers for Medicare and Medicaid Services recently released a final rule to update the Medicare fee-for-service inpatient prospective payment system for fiscal year 2023, which begins Oct. 1, 2022. Hospitals are invited to participate in a national webinar hosted by DataGen at 3 p.m. Sept. 14 to review key provisions of the rule and estimated impact analysis provided by the MHA. The webinar is free of charge, but registration is required.
  • The deadline to provide contact information in preparation for the state’s anticipated grant program to implement an Emergency Department Medication for Opioid Use Disorder program has been extended to Sept. 23.

MHA Drafts Comments on 340B Provisions and REH Payment Policies

Member News

The MHA has drafted comments in response to the Centers for Medicare and Medicaid Services (CMS) proposed rule to update the Medicare fee-for-service (FFS) outpatient prospective payment system (OPPS) for calendar year 2023. The MHA submitted comments regarding the 340B provisions in mid-August urging the CMS to:

  • Restore payment rates for 340B drugs to average sales price (ASP) plus 6%.
  • Hold all hospitals harmless for 2018-2022 claims.
  • Find new funds to restore 340B payments to ASP plus 6% with no reduction to the outpatient conversion factor.

The MHA also prepared comments in response to the proposed payment policies for rural emergency hospitals (REHs), a new hospital designation established by the Consolidated Appropriations Act, for critical access hospitals and rural prospective payment system hospitals with fewer than 50 beds.

The MHA recently posted hospital-specific estimated impact reports of the OPPS proposed rule on the hospital association reporting portal (HARP) for members to access and encourages hospitals to review the impact of the proposed rule on their operations and submit comments to the CMS by 5 p.m. Sept. 13. The CMS is expected to release a final rule to update the OPPS, including finalization of REH payment policies around Nov. 1 for the Jan. 1, 2023 effective date.

The MHA will provide an updated impact analysis following release of the final rule. Members with questions should contact Vickie Kunz at the MHA.

CMS Releases FY 2023 Final Rule to Update Hospital IPPS

Member News

The Centers for Medicare and Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service (FFS) hospital inpatient prospective payment system (IPPS) for fiscal year (FY) 2023. The rule will:

  • Reduce disproportionate share hospital and uncompensated care pool (UCC) payments by $360 million, rather than $800 million as proposed. The CMS projects a UCC pool of roughly $6.87 billion to be allocated to hospitals based on audited Worksheet S-10 data from FY 2018 and FY 2019 cost reports. The CMS finalized its proposal to use a 3-year average to calculate UCC payments starting in FY 2024.
  • Eliminate payment enhancements for Medicare dependent hospitals (MDHs) and low-volume hospitals absent Congressional action to extend those payments which expire Sept. 30, 2022. The MHA, along with the American Hospital Association and others, continue to advocate for making the enhanced low volume hospital adjustment and MDH program permanent.
  • Provide a net 4.15% increase in the federal operating rate for hospitals that successfully participate in the inpatient quality reporting program and are meaningful electronic health record users. This is up from the proposed 3.17% net increase in response to comments received regarding the inflationary increase hospitals are facing and is the highest increase in more than two decades.
  • Increase the standard federal capital rate by 2.4% from $472.60 to $483.76, also higher than the proposed 1.6% increase.
  • Establish a cost outlier threshold of $38,859, up 25% (compared to 39% in the proposed rule) from the current $30,988 threshold, resulting in fewer cases qualifying for an outlier payment. The CMS adjusts the threshold annually to ensure that outlier payments do not exceed the established target of 5.1% of aggregate IPPS payments.
  • Establish a permanent 5% annual cap on wage index decreases.
  • Modify graduate medical education policy related to full time equivalent caps and increased flexibility for hospitals that participate in a rural track program.
  • Suppress measures in the hospital VBP and HAC reduction programs, resulting in neutral payment adjustment for FY 2023.
  • Add 10 new measures to the inpatient quality reporting (IQR) program, including two health equity measures.
  • Adopt a new “birthing friendly” designation for hospitals that attest positively to both questions in the IQR’s previously adopted Maternal Morbidity Structural Measure.

The MHA is continuing to review the final rule and will provide hospitals with an updated impact analysis in the near future. Members with questions should contact Vickie Kunz at the MHA.