Busy week for CMS rule releases

As referenced in the April 27 Unified Voice, the Centers for Medicare & Medicaid Services (CMS) has released a series of rules aimed at empowering patients through better access to hospital price information and greater price transparency and interoperability. Provided below is a quick summary of each rule release.

Hospital Inpatient PPS Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) issued on April 24 its hospital inpatient prospective payment system (PPS) and long term care hospital (LTCH) PPS proposed rule for FY 2019.

CMS proposes:

  • A 2.8 percent market-basket update;
  • A productivity adjustment offset of 0.8 percent;
  • An Affordable Care Act-mandated cut of 0.75 percent; and
  • A decrease of 0.27 percent due to updating the high-cost outlier threshold.

CMS proposes an increase of 0.5 percentage points to partially restore cuts made as a result of the American Taxpayer Relief Act (ATRA) of 2012. In addition, in support of its Meaningful Measure Initiative, CMS proposes to remove eight measures from the IPF Quality Reporting Program for FY 2020.

In these proposed rules CMS included a Request For Information (RFI) on promoting interoperability and electronic health information exchange.

CMS is moving forward with its “Measures that Matter” effort and there are several facets of the Hospital Quality Reporting and Value Programs included in the proposal:

  • Eliminate (18) and decrease duplication (21) for a total of 39 measures.  Acute care hospitals will continue to be required to report the five hospital quality and value-based purchasing programs which maintains meaningful measures of hospital quality and patient safety.
  • Continue to report clinical quality measures (CQMs) electronically for eligible hospitals and critical access hospitals (CAHs), make the Promoting Interoperability (PI) Program reporting period one, self-selected calendar quarter of the calendar year (CY) 2019 and report on four self-selected CQMs from the set of 16. The submission period would be January 1 through February 29, 2020.
  • Make the PI electronic health record (EHR) reporting period in 2019 and 2020 for new and returning participants attesting to CMS or their state Medicaid agency be a minimum of any continuous 90-day period within each of the calendar years 2019 and 2020.
  • Remove eight of the 16 CQMs consistent with CMS’ commitment to producing a smaller set of more meaningful measures and in alignment with the Hospital IQR Program beginning with the 2020 reporting period.
  • Overhaul the PI Programs to focus on interoperability, improve flexibility, relieve burden, and incentivize providers to make it easier for patients to obtain their medical records electronically.
  • Remove certain measures that do not emphasize interoperability and the electronic exchange of health information.
  • Add new measures, such as Query of the PDMP and Verify Opioid Treatment Agreement, related to e-prescribing of Schedule II controlled substances/opioids, which aligns with the overall CMS initiative on the treatment of opioid and substance use disorders.
  • Create a new scoring methodology.

CMS will accept comments until June 25. See the CMS Fact Sheet for more information.

Skilled Nursing Facility (SNF) Proposed Rules

CMS issued a proposed rule outlining proposed FY 2019 Medicare payment updates and proposed quality program changes for Skilled Nursing Facilities (SNFs).

The proposed rule includes a payment increase of 2.4 percent over FY 2018 levels, as mandated by the Bipartisan Budget Act of 2018, an $850 million increase. No forecast error correction would apply since the difference between the estimated and actual FY 2017 market-basket index does not exceed the 0.5 percent threshold.

CMS will accept comments until June 26. See the CMS Fact Sheet for more information.

Inpatient Rehabilitation Facility (IRF)

CMS proposed changes on how Medicare pays Inpatient Rehabilitation Facilities (IRFs) to make it easier for providers to spend more time with their patients and improve the use of electronic health records.

Proposed updates to IRF payment rates include an increase in net payments of 0.9 percent ($75 million) relative to FY 2018, including a 2.9 percent market-basket update offset by statutorily mandated cuts of 0.8 percentage points for productivity and an additional cut of 0.75 percent, as well as a 0.4 percent decrease in outlier payments.

CMS will accept comments until June 26. See the CMS Fact Sheet for more information.

Inpatient psychiatric facility (IPF) PPS Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the federal fiscal year (FY) 2019 inpatient psychiatric facility (IPF) prospective payment system (PPS).

CMS will accept comments until June 26. See the CMS Fact Sheet for more information.

Long Term Care Hospital (LTCH) PPS Proposed Rule

In FY 2019 Medicare payments to LTCHs will continue to be implemented under the statutorily mandated, two-tiered payment system, which includes a standard LTCH PPS component for higher acuity cases and a neutral payment component for lower acuity cases. Refer to the American Hospital Association’s Special Bulletin to see the provisions for the standard rate and site-neutral rate and to learn more about the proposed elimination of the 25 percent rule which expires September 2018.

CMS proposes only a few changes to the LTCH Quality Reporting Program (QRP) for three measures, and if finalized, providers would no longer be required to collect data on all three measures beginning with admissions and discharges on October 1, 2018. Comments on the proposed rule are due June 25. SDAHO will provide members with a summary brief and impact analysis of the proposed rule in the coming weeks.

The final rule will be published approximately August 1 and the policies and payment rates would take effect October 1.

CMS will accept comments until June 25. See the CMS Fact Sheet for more information.

Hospice Wage Index and Payment Rates Proposed Rule

This proposed rule would update the hospice wage index, payment rates, and cap amount for FY 2019. The rule also proposes to make text changes to recognize physician assistants as designated hospice attending physicians effective January 1, 2019. Finally, the rule proposes changes to the Hospice Quality Reporting Program. The overall economic impact of this proposed rule is estimated to be $340 million in increased payments to hospices during FY 2019.

CMS will accept comments until June 26. See the CMS Fact Sheet for more information.