CMS Publishes FY 2020 Final Rules for IRF PPS and Hospice Payments

On July 31, the Centers for Medicare & Medicaid Services (CMS) published two federal fiscal year (FY) 2020 final rules – inpatient rehabilitation facility (IRF) prospective payment system (PPS) and hospice payments.

IRF PPS Final Rule

The IRF PPS final rule updates the Medicare PPS payment rate for IRFs resulting in a net payment increase of 2.5 percent ($210 million). The rule rebases and revises the IRF market basket to reflect a 2016 base year rather than the current 2012 base year. The final rule also revises the case-mix groups (CMGs) and updates the CMG relative weights and average length of stay values. The rule updates the IRF wage index to use the concurrent fiscal year inpatient prospective payment system wage index. The rule amends the regulations to provide that the determination whether a physician qualifies as a rehabilitation physician (a licensed physician with specialized training and experience in inpatient rehabilitation) is to be determined by the IRF.  The provisions of the final rule are effective October 1. The IRF PPS final rule is scheduled to be published in the Federal Register on August 8 but is available now at this link. A CMS fact sheet summarizing the final rule is available here.

Hospice Final Rule

The hospice final rule updates the payment rates for hospices by 2.6 percent (net payment increase of $520 million), including updates to hospice payment rates, wage index, and cap amount. The rule rebases the continuous home care, general inpatient care, and inpatient respite care per diem payment rates. The final rule also includes modifications to the election statement requiring hospices, upon request, to furnish an election statement addendum effective beginning in FY 2021. The addendum will list those items, services, and drugs the hospice has determined to be unrelated to the beneficiary’s terminal illness and related conditions. The provisions of the final rule are effective October 1. The hospice final rule is scheduled to be published in the August 6 Federal Register but is available now at this link. A CMS fact sheet describing the final rule is available here.