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CMS issues FFY 2019 inpatient rehabilitation facility PPS final rule

The Centers for Medicare & Medicaid Services (CMS) on July 31 released the federal fiscal year (FFY) 2019 final payment rule for the inpatient rehabilitation facility (IRF) prospective payment system (PPS). A SDAHO brief of the final rule outlines the program changes finalized by CMS which are effective for discharges on or after Oct. 1 unless otherwise noted.

Highlights

CMS finalized a 1.35 percent increase factor for payment rates. After factoring in an additional approximate 0.1 percent decrease to aggregate payments due to updating the outlier threshold, the overall estimated update for FFY 2019 is approximately 1.3 percent, or $105 million, relative to payments in FFY 2018.

Notably, CMS finalized a number of its proposals to remove the functional independence measure instrument and associated modifiers from the inpatient rehabilitation facility patient assessment instrument (IRF-PAI) and revised the case-mix classification system.

CMS also finalized its proposal to incorporate certain data items located in the quality indicators section of the IRF-PAI into the IRF case-mix classification system, as well as the use of these data items to assign patients into a case-mix group for payment purposes under the IRF PPS for discharges on or after Oct. 1, 2019.

In response to stakeholder comments, CMS will base its analysis for revising the case mix group definitions on two full years of data (FFYs 2017 and 2018), rather than one; these definitions will become effective in FFY 2020.

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15jun12:00 pm2:00 pmEMTALA 2 Part Series2-Part Series12:00 pm - 2:00 pm Event Type :Education Events,Webinar

15jun3:00 pm4:00 pmCovid's Impact on Trust in Health CareWebinar3:00 pm - 4:00 pm Event Type :Webinar

16jun10:00 am12:00 pmSDAHO District II Summer MeetingWebster, SD10:00 am - 12:00 pm Event Type :District Meeting

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June 15 at Noon - 2pm CST

This program will cover the following (Part 1 of 2):

  • OIG changes that every hospital should be aware of
  • Two-day visit with immediate jeopardy
  • Common deficiency report by CMS
  • Basic concept of EMTALA
  • Revised manual
  • New survey memos
  • How to locate copy of the EMTALA regulations
  • OCR memo and EMTALA investigations
  • OIG advisory opinions on EMTALA
  • Compliance program
  • CMS Survey memos regarding EMTALA
  • Impact of COVID-19 on EMTALA
  • EMTALA definitions and requirements
  • The Joint Commission standards
  • EMTALA sign requirements
  • To whom EMTALA applies
  • Reasonable registration process
  • Financial questions from patients
  • Patients who sign out AMA
  • Specialized capability
  • Policies and procedures required
  • Hospital recommendations

 

July 20 at Noon to 2pm CST

This program will cover the following (Part 2 of 2):

  • On-call physician issues
  • Dedicated emergency department
  • Central log
  • Special responsibilities
  • Meaning of “comes to the ED”
  • Definition of hospital property
  • EMTALA and outpatients
  • Capacity
  • Dedicated emergency department
  • Inpatients and observation patients
  • Medical screening exam
  • Certification of false labor
  • Born alive law and EMTALA
  • Minor child request for treatment
  • Telemetry
  • When diversion is allowed
  • Parking of patients
  • Helipad
  • State plans and EMTALA
  • Who can be a QMP
  • Waiver of sanctions
  • Requests for medications
  • Blood alcohol tests
  • Emergency medical condition
  • Stabilization
  • OB patients
  • Born-Alive Infant Protection Act and MLN clarification
  • Transfer and transfer forms
  • Behavioral health patients
  • QIO role with EMTALA