High-Level Takeaways on Proposed Changes in the rule A. Automatically adopt applicable periods (i.e., performance periods for measures used in the Program) beginning with the FY 2023 program year and all subsequent program years, and update the definition of. Penalties for excess readmissions, which reflect an adjustment to a hospital’s performance relative to other hospitals with a similar proportion of patients who are dually eligible for Medicare and full-benefit Medicaid, Penalty (1 percent) for worst-performing quartile under the Hospital-Acquired Condition Reduction Program. CMS is making policy changes related to closing teaching hospitals and closing residency programs to address the needs of residents attempting to find alternative hospitals in which to complete their training and to foster seamless Medicare indirect medical education and direct graduate medical education funding. Building on the actions CMS has taken to date for payments for new medical technologies, CMS is proposing to create a new MS-DRG specifically for cases involving CAR T-cell therapies. In this rule, CMS will distribute roughly $8.3 billion in uncompensated care payments for FY 2021, a decrease of approximately $60 million from FY 2020. Before sharing sensitive information, make sure you’re on a federal government site. We are proposing to continue the Query of PDMP measure as an optional measure worth five bonus points in CY 2021. For the FY 2021 IPPS/LTCH PPS proposed rule, CMS is proposing to: Hospital Inpatient Quality Reporting (IQR) Program. Make changes to the Hospital IQR Program validation process including: For chart abstracted measure validation, requiring the use of electronic file submissions via a CMS-approved secure file transmission process and no longer allowing the submission of paper copies of medical records or copies on digital portable media such as CD, DVD, or flash drive. This proposal would expand the existing definition of who is considered a displaced resident (beyond residents who are physically present at the hospital training on the day prior to or the day of hospital or program closure). PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program. FY 2021 IPPS Final Rule Has Significant MS-DRG Changes. These policy changes expand the existing definition of who is considered a displaced resident (beyond residents who are physically present at the hospital training on the day prior to or the day of hospital or program closure). The Hospital IQR Program is a pay-for-reporting quality program that reduces payment to hospitals that fail to meet program requirements. This is known as the hospital “market basket.” The IPPS pays hospitals for services provided to Medicare beneficiaries using a national base payment rate, adjusted for a number of factors that affect hospitals’ costs, including the patient’s condition and the cost of hospital labor in the hospital’s geographic area. In this proposed rule, CMS presents 24 new applications for new technology add-on payment for FY 2021. We are finalizing a change to rename the Support Electronic Referral Loops by Receiving and Incorporating Health Information measure. In order to allow eligible antimicrobial products to begin receiving the new technology add-on payment sooner, we are adopting a policy to provide for conditional approval for antimicrobial products that otherwise meet the NTAP alternative pathway criteria but do not receive FDA approval in time for consideration in the final rule. Before sharing sensitive information, make sure you’re on a federal government site. September 21, 2020 at 4:33 pm 4. Publicly report eCQM performance data for the first time, beginning with data reported by eligible hospitals and CAHs for the CY 2021 reporting period, on. Sign up to get the latest information about your choice of CMS topics in your inbox. or median of the final scores for all MIPS eligible clinicians for a prior period, and the Quality and Cost performance categories must be equally weighted at 30% each. Jason Tross, Deputy Director. Under the final rule, hospitals must report to CMS the median rate negotiated with Medicare Advantage organizations for inpatient services. We are finalizing changes to establish an EHR reporting period of a minimum of any continuous 90-day period in CY 2022 for new and returning participants (eligible hospitals and CAHs) attesting to CMS for the Medicare Promoting Interoperability Program. To download the FY 2020 CC/MCC tables, click here. Accordingly, CMS removed the CY 2020 exclusion for this … Hospitals; Share. In the FY 2021 IPPS/LTCH PPS final rule, CMS is finalizing our proposals to: Hospital Inpatient Quality Reporting (IQR) Program. Brian Leshak, Deputy Director The final rule will update Medicare payment policies for hospitals under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year 2021. We are finalizing the proposal to continue the Query of Prescription Drug Monitoring Program (PDMP) measure as optional and worth five bonus points in CY 2021. LTCHs are paid under the LTCH PPS. We are proposing to expand the alternative new technology add-on payment pathway for antimicrobial products designated by FDA as QIDPs to include products approved under FDA’s Limited Population Pathway for Antibacterial and Antifungal Drugs (LPAD pathway). These policies will provide greater flexibility for the residents to transfer while the hospital operations or residency programs were winding down, and will allow funding to be transferred for certain residents who are not physically at the closing hospital/closing program. CMS estimates total Medicare spending on acute care inpatient hospital services will increase by about $3.5 billion in FY 2021, or 2.7 percent. Catherine Howden, Director Key Takeaways. We are proposing an EHR reporting period of a minimum of any continuous 90-day period in CY 2022 for new and returning participants (eligible hospitals and CAHs) in the Medicare Promoting Interoperability Program attesting to CMS. CMS estimates that provisions in the final rule will result in a $3.5 billion increase in FY 2021 payments to IPPS hospitals. The Hospital VBP Program adjusts payments to hospitals under the IPPS for inpatient services based on their performance. Federal government websites often end in .gov or .mil. CMS projects the rate increase, together with other proposed changes to IPPS payment policies, will increase IPPS operating payments by approximately 2.5 percent. Reducing the number of hospitals selected for validation from up to 800 to up to 400 hospitals. Formalizing the process for conducting educational reviews for eCQM validation in alignment with current processes for providing feedback for chart-abstracted validation results. This fact sheet discusses major provisions of the final rule (CMS-1735-F), which can be downloaded from the Federal Register at: https://www.federalregister.gov/documents/2020/09/18/2020-19637/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the. Adding EHR Submitter ID as the fifth key element for file identification beginning with the CY 2021 reporting period/FY 2023 payment determination. The IPPS pays hospitals for services provided to Medicare beneficiaries using a national base payment rate, adjusted for a number of factors that affect hospitals’ costs, including the patient’s condition and the cost of hospital labor in the hospital’s geographic area. Building on the actions CMS has taken to date for payments for new medical technologies, CMS created a new Medicare Severity-Diagnosis Related Group (MS-DRG) specifically for cases involving CAR T-cell therapies. According to the FY 2021 IPPS final rule, Medicare spending on acute care inpatient hospital services will increase by approximately $3.5 billion in FY 2021, representing a 2.7 percent increase compared to the previous fiscal year. CMS is proposing to collect a summary of certain data already required to be disclosed by CMS’ 2019 price transparency rule, specifically hospitals’ median payer-specific negotiated inpatient services charges for Medicare Advantage organizations and third party payers. The policies in the IPPS/LTCH PPS final rule further advance the agency’s priority of creating a patient-centered healthcare system by achieving greater price transparency, interoperability, and significant burden reduction so that hospitals can operate with better flexibility and patients have what they need to be active healthcare consumers. The Hospital VBP Program adjusts payments to hospitals under the IPPS for inpatient services based on their performance. The LPAD pathway encourages the development of safe and effective drug products that address unmet needs of patients with serious bacterial and fungal infections. This text would read as follows: (A) 1 for FY 2018; (B) ¾ for FY 2019; (C) ½ for FY 2020; and (D) ¼ for FY 2021. https://www.federalregister.gov/public-inspection, 2020 Estimated Improper Payment Rates for Centers for Medicare & Medicaid Services (CMS) Programs, Trump Administration Announces Medicare Fee-For-Service Estimated Improper Payments Decline by $15 Billion Since 2016, CMS Takes Steps to Ensure Medicare Beneficiaries Have Wide Access to COVID-19 Antibody Treatment, CMS Finalizes Calendar Year 2021 Payment and Policy Changes for Home Health Agencies and Calendar Year 2021 Home Infusion Therapy Benefit. Under these two payment systems, CMS sets base payment rates prospectively for inpatient stays based on the patient’s diagnosis and severity of illness. CMS is proposing to: We previously announced that we would include a proposed update to the Overall Hospital Quality Star Rating methodology in the FY 2021 IPPS proposed rule based on the feedback we’ve received to date from stakeholders, including through a public comment period, listening sessions, a technical expert panel, and national quality conferences. (FY) 2021 Medicare Hospital Inpatient Prospective Payment System (IPPS) Final Rule (CMS-1735-F). The list below centralizes any IPPS file(s) related to the final rule. Below is a high-level summary of key policy changes: Changes to Payment Rates under the IPPS -CMS is updating the operating payment rates by 2.9 percent for general acute care hospitals which The PCHQR Program collects and publishes data on an announced set of quality measures. To read Revenue Cycle Advisor’s coverage of the final rule, click here. Overall, for FY 2021, CMS expects LTCH-PPS payments to decrease by approximately 0.9 percent or $36 million, which reflects the continued statutory implementation of the revised LTCH PPS payment system. Hospitals may be subject to other payment adjustments under the IPPS, including: In sum, CMS projects total Medicare spending on inpatient hospital services, including capital, will increase by about $2.07 billion in FY 2021. The Medicare Promoting Interoperability Program is proposing to adopt the following in alignment with the Hospital IQR Program: Progressively increase the number of quarters hospitals are required to report eCQM data, 2023 and each subsequent year – 4 quarters of data, We are proposing to publicly report eCQM performance data for the first time, beginning with data reported for the CY 2021 reporting period, on. The proposed increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users is approximately 3.1 percent. Policies implemented in the final rule are effective October 1, 2020, unless otherwise noted. CMS is finalizing proposals to: Medicare and Medicaid Promoting Interoperability Programs. Combining the validation processes for chart-abstracted measures and eCQMs by aligning: (a) data submission quarters; (b) hospital selection; and (c) scoring processes by providing one combined validation score for the validation of chart-abstracted measures and eCQMs with the eCQM portion of the combined score weighted at zero, Removing the current exclusions for eCQM validation selection. PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program. For FY 2021, CMS will use a single year of data on uncompensated care costs from Worksheet S-10 of hospitals’ FY 2017 cost reports to distribute these funds, in part because we have conducted audits of this data. CMS’ fact sheet on the rule can be found here. Hospitals may be subject to other payment adjustments under the IPPS, including: Market-Based MS-DRG Relative Weight Data Collection and Change in Methodology for Calculating MS-DRG Relative Weights. CMS News and Media Group The 2021 inpatient prospective payment system (IPPS) final rule was made available on September 2, 2020. In this final rule, CMS approved 13 technologies that applied for new technology add-on payments for FY 2021. Fact Sheet | Payment Reimbursement and Managed Care. Review our webinar presented on Oct. 9 and 10 to learn about changes affecting hospital-acquired conditions (HACs), patient safety indicators (PSIs) … We thank the stakeholders who have provided feedback on potential changes to the Overall Hospital Quality Star Rating methodology, and look forward to returning to this in future rulemaking. CMS recently released its fiscal year 2017 IPPS Final Rule.And I am joined today by Scott Besler who is a Senior Manager on our Reimbursement Services team to help break that rule down and provide us some of the key takeaways that hospitals need to know. The Hospital IQR Program is a pay-for-reporting quality program that reduces payment to hospitals that fail to meet program requirements. Reducing the number of hospitals selected for validation from up to 800 to up to 400 hospitals. Additionally, CMS is continuing the new technology add-on payments for 10 of the 18 technologies currently receiving the add-on payment (the remaining 8 technologies will no longer be within their newness period in FY 2021, which includes the Chimeric Antigen Receptor (CAR) T-cell therapies approved for the new technology add-on payment in FY 2019). Formalizing the process for conducting educational reviews for eCQM validation in alignment with current processes for providing feedback for chart-abstracted validation results. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. The Two-Midnight Rule, as finalized in the FY 2014 IPPS Final Rule, clarified when an inpatient admission is to be considered reasonable and necessary for purposes of Medicare Part A payment. The list contains the proposed rule (display version or published Federal Register version) and a subsequent published correction notices (if applicable), all tables, additional data and analysis files and the impact file. Refine the validation procedures for healthcare-associated infection (HAI) data beginning with the FY 2024 program year to align with the Hospital Inpatient Quality Reporting (IQR) Program. Refine validation procedures used by the Program in order to align with the Hospital IQR Program’s validation procedures, which happen concurrently. This reflects the projected hospital market basket update of 2.4 percent and a 0.0 percentage point productivity adjustment. The program includes six claims-based outcomes measures. Fact sheet. CMS pays acute care hospitals (with a few exceptions specified in the law) for inpatient stays under the IPPS. Part 541. CMS distributes a prospectively determined amount of uncompensated care payments to “Medicare disproportionate share hospitals” based on their relative share of uncompensated care nationally. However, to provide additional predictability and transparency CMS is making proposals with respect to technologies that applied under the alternative pathway for certain transformative devices and certain antimicrobial products adopted in last year’s rulemaking. We expect the Worksheet S-10 data for an increasing number of hospitals will be audited in future cost reporting years. CMS estimates increases to the IPPS rates required by the statute, in conjunction with other payment changes in this final rule, result in an estimated $3.5 billion increase in FY21 payments (+2.7%) compared to the FY20 final rule. On September 2, 2020, CMS issued the fiscal year (FY) 2021 final rule for the hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) … Combining the validation processes for chart-abstracted measures and eCQMs by aligning: (a) data submission quarters; (b) hospital selection; and (c) scoring processes by providing one combined validation score for the validation of chart-abstracted measures and eCQMs with the eCQM portion of the combined score weighted at zero. Refine two existing National Healthcare Safety Network (NHSN) measures, Catheter-Associated Urinary Tract Infection (CAUTI) and Central Line-Associated Bloodstream Infection (CLABSI), to incorporate an updated methodology developed by the Centers for Disease Control and Prevention that uses updated HAI baseline data that is risk-adjusted to stratify results by patient location. The 21st Century Cures Act directs CMS to assess payment reductions based on a hospital’s performance relative to other hospitals with a similar proportion of patients dually eligible for Medicare and full-benefit Medicaid. Payment rates to LTCHs are typically updated annually according to a separate market basket based on LTCH-specific goods and services. This includes two technologies under the alternative pathway for new medical devices that are part of the FDA Breakthrough Devices Program and five technologies approved under the alternative pathway for products that received FDA Qualified Infectious Disease Product (QIDP) designation. An official website of the United States government. This is almost double the 324 proposed changes in the FY 2020 IPPS proposed rule. The Hospital VBP Program adjusts payments to hospitals under the IPPS for inpatient services based on their performance. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. This accounts for the LTCH site neutral payment rate cases that will no longer be paid a blended payment rate with the end of the statutory transition period, which represent approximately 25 percent of all LTCH cases and 10 percent of all LTCH PPS payments. Proposed changes in uncompensated care payments, new technology add-on payments, and capital payments will decrease IPPS payments by approximately 0.4 percent. To read the CMS Fact Sheet on the final rule, click here. New Technology Add-On Payment Traditional Pathway “A new medical service or technology may be … In this rule, CMS proposes distributing roughly $7.8 billion in uncompensated care payments in FY 2021, a decrease of approximately $0.5 billion from FY 2020. This presentation provides an overview of the FY 2021 IPPS final rule, published in the September 18, 2020, Federal Register. Beginning the public display of eCQM data on the. The Hospital Readmissions Reduction Program (HRRP) reduces payments to hospitals with excess readmissions. New Technology Add-On Payment Pathway for Certain Antimicrobial Products. Make changes to the hospital reporting of eCQMs, [in alignment with the PI Program] including: Progressively increasing the number of quarters of eCQM data reported, from one self-selected quarter of data to four quarters of data over a three-year period, by requiring hospitals to report two quarters of data for the CY 2021 reporting period/FY 2023 payment determination, three quarters of data for the CY 2022 reporting period/FY 2024 payment determination, and four quarters of data beginning with the CY 2023 reporting period/FY 2025 payment determination and for subsequent years. CMS also seeks public comment on the following proposals: Proposed Changes to Payment Rates under LTCH PPS. The IPPS and LTCH PPS proposed rule is one of five proposed Medicare payment rules released on a fiscal year cycle to define payment and policy for inpatient hospitals, long-term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, skilled nursing facilities, and hospices. In total, 24 technologies are eligible to receive add-on payments for FY 2021. We expanded the alternative new technology add-on payment pathway for antimicrobial products designated by FDA as QIDPs to include products approved under FDA’s Limited Population Pathway for Antibacterial and Antifungal Drugs (LPAD pathway). February 19, 2021 By Patty Bohney, CVA, MBA, Dave Hesselink, MBA, … In light of recent information that continues to highlight the significant concerns and impacts related to antimicrobial resistance and emphasizes the continued importance this issue represents both for Medicare beneficiaries and public health overall, we are proposing some changes regarding new technology add-on payments for certain antimicrobials for FY 2021. This estimate of total uncompensated care payments reflects CMS Office of the Actuary’s projections that incorporate the estimated impact of the COVID-19 pandemic. Additionally, the FY 2021 IPPS/LTCH PPS final rule finalizes the following proposals to: Overall, for FY 2021, CMS expects LTCH-PPS payments to decrease by approximately 1.1 percent or $40 million, which reflects the continued statutory implementation of the revised LTCH PPS payment system. This fact sheet discusses major payment and policy provisions of the final rule, including the changes to termination notices for certain providers and the extension of the Rural Community Hospital Demonstration.
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