On July 30, the Centers for Medicare & Medicaid Services (CMS) published two federal fiscal year 2020 final rules: (i) inpatient psychiatric facilities (IPFs) prospective payment system (PPS) and quality reporting updates; and (ii) skilled nursing facilities (SNFs) PPS and consolidated billing, including updates to the quality reporting program and value-based purchasing program.
IPF Final Rule
The IPF final rule updates the IPFs PPS payment rates, the outlier threshold, and the wage index for Medicare inpatient hospital services furnished by IPFs, resulting in a net payment increase of 1.5 percent ($65 million). The final rule also revises and rebases the IPF market basket to reflect a 2016 base year and removes the IPF PPS one-year lag of the wage index data. The rule also implements updates to the IPFs’ Quality Reporting Program, including adopting one new claims-based measure (Medication Continuation Following Inpatient Psychiatric Discharge) beginning with the FY 2021 payment determination. These changes will be effective for IPF discharges October 1, 2019 through September 30, 2020 (the Quality Reporting Program new claims-based measure will be effective FY 2021). The IPFs final rule is scheduled to be published in the Federal Register on August 6 but is available now at this link. A CMS fact sheet summarizing the rule is available here.
SNF Final Rule
The SNF final rule updates the payment rates under the SNF PPS for FY 2020 and includes a net payment increase of 2.4 percent ($851 million). The rule also adopts the same definition of group therapy for purposes of the SNF PPS as under the Inpatient Rehabilitation Facility PPS: Group therapy consists of two to six patients dong the same or similar activities. In addition, as part of the SNF Quality Reporting Program CMS is adopting two new quality measures to assess whether certain health information is provided by the SNF at the time of discharge. The two new measures are: (i) Transfer of Health Information to the Provider-Post-Acute Care; and (ii) Transfer of Health Information to the Patient-Post-Acute Care. The final rule is scheduled to be published in the Federal Register on August 7 but is accessible now at this link. A CMS fact sheet describing the final rule is available here.