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We interpret the commenters' concerns to be directed at the standardized patient assessment data elements and Transfer of Health items that will be collected on/after October 1, 2022. The Grouper software produces a five-character CMG number. It will give IRFs the opportunity to analyze their quality of care across and between patient populations so that opportunities to achieve equity in healthcare outcomes might be more easily recognized, promoting provider accountability. In addition, Table 10 divides IRFs into those that are separate rehabilitation hospitals (otherwise called freestanding hospitals in this section), those that are rehabilitation units of a hospital (otherwise called hospital units in this section), rural or urban facilities, ownership (otherwise called for-profit, non-profit, and government), by teaching status, and by disproportionate share patient percentage (DSH PP). This covers what most people pay, including Late Enrollment Penalties (LEP) and Income Related Monthly Adjustment Amount (IRMAA). We believe it is necessary to obtain admission and discharge assessment information on all patients admitted to IRFs in order to obtain full and complete data regarding the quality of care provided by the IRF to the Medicare patients receiving care in that facility. After consideration of the comments we received, we are finalizing our proposal to update the CMG relative weights and ALOS values for FY 2023, as shown in Table 2 of this final rule. 8. Core-Based Statistical Areas (CBSAs) for the FY 2023 IRF Wage Index, 4. It was not an estimate of burden associated with the transition from the IRF-PAI version 3.0 to the IRF-PAI version 4.0 (that is, the collection of new data elements) since this burden was accounted for in the FY 2020 IRF PPS proposed and final rules (84 FR 17333 and 84 FR 39166). Microsoft is quietly building a mobile Xbox store that will rely on Activision and King games. The benefits these programs pay out are often far higher than what recipients paid in. documents in the last year, by the Centers for Medicare & Medicaid Services Log in to your member accountto check your current My Health Paysrewards balance. There are 10 measures in total, and they reflect a number of quality-of-care areas, such as skin integrity, major falls, medication reconciliation, and Transfer of Health information. Section 3(f) of Executive Order 12866 defines a significant regulatory action as an action that is likely to result in a rule: (1) having an annual effect on the economy of $100 million or more in any 1 year, or adversely and materially affecting a sector of the economy, productivity, competition, jobs, the environment, public health or safety, or State, local or tribal governments or communities (also referred to as economically significant); (2) creating a serious inconsistency or otherwise interfering with an action taken or planned by another agency; (3) materially altering the budgetary impacts of entitlement grants, user fees, or loan programs or the rights and obligations of recipients thereof; or (4) raising novel legal or policy issues arising out of legal mandates, the President's priorities, or the principles set forth in Executive Order 12866. The analysis we believe the commenters are referring to was done in 2016, 4 years prior to the start of the COVID-19 pandemic. A full discussion of the calculation of the labor-related share is located in section VI.C. i.e., [41] First, rather than link the status of displaced residents for the purpose of the receiving IRF's request to increase their FTE cap to the resident's presence at the closing IRF or program on the day prior to or the day of the residency program or IRF closure, we proposed to link the status of the displaced residents to the day that the closure was publicly announced (for example, via a press release or a formal notice to the Accreditation Council on Graduate Medical Education). Instead, they suggest requiring only the items on the IRF-PAI that are required to generate a case mix group (CMG), length of stay, discharge destination, and GG change to be calculated. MAP Coordination Strategy for Post-Acute Care and Long-Term Care Performance Measurement. We have reviewed the increases and decreases in the CMG relative weights for this final rule and we believe that these changes accurately reflect our best estimates of the relative costs of caring for different types of patients in the IRF setting for FY 2023 and that it would not be appropriate to prevent decreases in these values until after the PHE has ended. For example, in FY 2010 (74 FR 39762) we implemented a 3-year moving average approach to updating the facility-level adjustment factors to promote more consistency in the adjustment factors over time. The analysis above, together with the remainder of this preamble, provides an RIA. ++ Ways that meaningful difference in disparity results should be considered. We specifically sought comment on the future inclusion of the NHSN Healthcare-Associated Arlington, Va. The American Institutes for Research (AIR) has been awarded a five-year contract to continue to provide support to a federal program that rewards clinicians that provide high-value, high-quality care for Medicare enrollees. The IRF market basket was last rebased in the FY 2020 IRF final rule using 2016 Medicare cost reports (84 FR 39072 through 39084), the most recent year of complete data available at the time of the rebasing. Response: If you have purchased an association plan, an association fee may also apply. A number of underlying chronic conditions,[21] We proposed that the portion of Capital-Related costs that are influenced by the local labor market is 46 percent. Collection of Information Requirements for Updates Related to the IRF QRP Beginning With the FY 2026 IRF QRP, 4. ; & Section on Hospice and Palliative Medicine, Council on Children with Disabilities. While we will not be responding to specific comments submitted in response to this RFI in this final rule, we intend to use this input to inform our future measure development efforts. One of these commenters opposes the collection of patient data from patients who have no connection to the Medicare program. The The beneficiaries that get QMB also get an automatic qualification for acceptance into the Part D Extra Help program. Performance period means the time period during which data are collected for the purpose of calculating hospital performance on measures with respect to a fiscal year. As discussed in further detail in section XIII.C.2. The IPPS makes up the largest share of Medicare spending, affecting payment for inpatient stays in approximately 3,000 hospitals across the country. Impact of the COVID-19 Pandemic on the Hospital and Outpatient Clinician Workforce Update to Payments for High-Cost Outliers Under the IRF PPS for FY 2023, A. Update to the Outlier Threshold Amount for FY 2023, B. Update to the IRF Cost-to-Charge Ratio Ceiling and Urban/Rural Averages for FY 2023, VIII. While we will not be responding to specific comments submitted in response to this RFI, the following is a summary of some comments received: Comment: For FY 2023, we proposed to change the IRF policy pertaining to displaced residents resulting from IRF closures and closures of IRF residency teaching programs. Additionally, MedPAC is tasked with reporting to Congress on the payment adequacy of Medicare's FFS payment system, the Medicare Advantage program, and the Medicare prescription drug program. In states, and for products where applicable, the premium may include a $1 administrative fee. After the displaced residents leave the accepting IRF's training program or complete their medical residency training program, the accepting IRF's cap will revert to its original level. L. 116-136, enacted on March 27, 2020). If the estimated cost of the case is higher than the adjusted outlier threshold, we make an outlier payment for the case equal to 80 percent of the difference between the estimated cost of the case and the outlier threshold. ++ The usefulness of a Health Equity Summary Score (HESS) for IRFs, both in terms of provider actionability to improve health equity, and in terms of whether this information would support Care Compare website users in making informed healthcare decisions. Hospital performance on quality and cost measures is linked to the IPPS. The QMB helps pay Medicare Part A premiums, Medicare Part B premiums, Medicare deductibles, coinsurance, and co-payments. of this section, another IRF(s) may receive a temporary adjustment to its FTE cap to reflect displaced residents added because of the closure of the residency training program if the criteria specified in paragraph (e)(4)(ii)(A)( As established in the FY 2012 IRF PPS final rule, this letter must identify the residents who have come from the closed IRF or closed residency program and caused the receiving IRF to exceed its cap, and must specify the length of time that the adjustment is needed. Medicare Part C (Medicare Advantage) patients within the previous 10 years, and all other patients within the previous 5 years either in a paper format in the patient's clinical record or in an electronic computer file format that the inpatient rehabilitation facility can easily obtain and produce upon request to CMS or its contractors. It is possible that not all commenters reviewed the FY 2023 IRF PPS proposed rule in detail, and it is also possible that some reviewers chose not to comment on the FY 2023 proposed rule. of the proposed rule as follows: We received 61 timely responses from the public, many of which contained multiple comments on the FY 2023 IRF PPS proposed rule (87 FR 20218). In addition, we constructed five special CMGs to account for very short stays and for patients who expire in the IRF. Regarding the suggestion that CMS consider section 1135 waiver authority to remove the productivity adjustment, we do not believe that section 1135 authority is available in this circumstance. Other items collected on the IRF-PAI version 4.0 include special services, treatments, and interventions performed in the IRF. Using the methodology described in that final rule, we proposed to update the national urban and rural CCRs for IRFs, as well as the national CCR ceiling for FY 2023, based on analysis of the most recent data available. 100(10), 609-617. We note that prior to 2020, each rule or notice issued under the IRF PPS has included a detailed reiteration of the various regulatory provisions that have affected the IRF PPS over the years. Specifically, we received comments regarding Medicare beneficiaries and vaccine status, the inclusion of recreational therapy, and general patient access issues in post-acute care settings. New IRFs that have not yet submitted their first MCR. This updated data includes a more complete set of claims for FY 2021. www.bls.gov These seven items (race, ethnicity, preferred language, interpreter services, health literacy, transportation, and social isolation) were finalized for collection under our authority under section 2(d)(2)(B) of the IMPACT Act, as well as section 1899B(b)(1)(B)(vi) of the Act. To compute the wage-adjusted prospective payment, we multiply the labor portion of the Federal payment by the appropriate wage index located in the applicable wage index table. The 2020 asset or allowed financial resource limit was $7,860 for an adult individual or $11,800 for a married couple. of this final rule. *Log into theSecure Portalto access the NOP form. For FY 2023, the Medicare Payment Advisory Commission (MedPAC) recommends that we reduce IRF PPS payment rates by 5 percent. These commenters stated that they appreciated us clarifying the definition of a displaced resident for the purpose of reallocating the FTE to a new IRF, mitigating prior delayed transfer issues. For each reviewer of the rule, the estimated cost is $345.66 (3 hours x $115.22). A practical guide to acute pain management in children. According to section 1886(j)(3)(C)(i) of the Act, the Secretary shall establish an increase factor based on an appropriate percentage increase in a market basket of goods and services. The need for the information collection and its usefulness in carrying out the proper functions of our agency. 7. There are 577 non-profit IRFs. Facility B, an urban teaching hospital, has a DSH percentage of 15 percent (which would result in a LIP adjustment of 1.0454 percent), a wage index of 0.8600, and a teaching status adjustment of 0.0784. 2022 Medicare Star Rating (PDF), last updated 10/16/2021. Based on an analysis of the preliminary data used for the proposed rule, we estimated that IRF outlier payments as a percentage of total estimated payments would be approximately 3.8 percent in FY 2022. Office of Disease Prevention and Health Promotion. The exact eligibility varies from state to state; the states set the rules and make the decisions. We will take this comment into consideration as we coordinate with Federal partners, including ONC, on interoperability initiatives, and to inform future rulemaking. This is a bad outcome because the state governments have freedom to adjust the income and assets that they consider. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps. Clostridioides difficile We thank the commenters for the various suggested revisions to the outlier threshold methodology. We calculate the adjusted outlier threshold by adding the IRF PPS payment for the case (that is, the CMG payment adjusted by all of the relevant facility-level adjustments) and the adjusted threshold amount (also adjusted by all of the relevant facility-level adjustments). The effects of applying the budget-neutral labor-related share and wage index adjustment, as required under section 1886(j)(6) of the Act. Table 7 illustrates the components of the adjusted payment calculation. The documents posted on this site are XML renditions of published Federal Therefore, we anticipate that the impact to the wage index budget neutrality factor in future years would continue to be minimal. 15-01 that was issued on July 15, 2015. These regulations are effective on October 1, 2022. Among these, there are 487 urban IRFs This means that, if an individual IRF's CCR were to exceed this ceiling of 1.40 for FY 2023, we will replace the IRF's CCR with the appropriate proposed national average CCR (either rural or urban, depending on the geographic location of the IRF). The significance of the information (including, but not limited to health literacy, transportation, race, ethnicity, social isolation, high-risk medications) will assist IRFs in supporting patients as they make health decisions. Comment: of the proposed rule. regulatory information on FederalRegister.gov with the objective of 13. 15-01, we refer readers to the FY 2018 IRF PPS final rule. In the FY 2023 IRF PPS proposed rule (the proposed rule), we proposed to update the IRF PPS for FY 2023 and the IRF QRP for FY 2025. An inpatient rehabilitation facility must use the CMS inpatient rehabilitation facility patient assessment instrument to assess Medicare Part A fee-for-service and Medicare Part C (Medicare Advantage) inpatients who are admitted on or after January 1, 2002, or were admitted before January 1, 2002, and are still inpatients as of January 1, 2002. There are 434 for-profit IRFs. Not sure if you're a Large or Small Business? Commenters suggested using data from FY 2019, adjusting the data to account for changes in IRF utilization associated with the pandemic, blending multiple years of data or averaging the current 2022 threshold with the proposed threshold, using a charge inflation factor from prior years, and adjusting the CCRs used in the outlier calculation. One commenter stated the increased cost would be easier to absorb once the pandemic is truly endemic. The American Psychologist, However, as mentioned above, the data and methods are unchanged. January 5, 2017. A few commenters opposed the proposal because they stated that CMS did not provide information in the proposal to address their concerns raised in previous years. In column 7 of Table 14, we present the effects of the budget-neutral update of the CMG relative weights and ALOS values. 33. In this final rule, we refer to the two statutes collectively as the Patient Protection and Affordable Care Act or PPACA. For costs and complete details of the coverage, refer to the plan document or call or write your Humana insurance agent or the company. IRFs will be required to report these data with respect to admission and discharge for all patients, regardless of payer, discharged between October 1, 2024 and December 31, 2024. Standards in the DEL can be referenced on the CMS website ( Calculate the total amount of estimated IRF PPS payments using the FY 2023 wage index values (based on updated hospital wage data and considering the permanent cap on wage index decreases policy) and the FY 2023 labor-related share of 72.9 percent. The updated OMB delineations more accurately reflect the contemporary urban and rural nature of areas across the country, and the use of such delineations allows us to determine more accurately the appropriate wage index and rate tables to apply under the IRF PPS. Start Printed Page 47089 In that final rule, we adopted the IPPS definition of closure of a hospital at 413.79(h)(1)(i) to also apply to IRF, and to mean that the IRF terminates its Medicare provider agreement as specified in 489.52. We have received public input for the past 10 years on the need to standardize measurement data collection across all payers in the PAC settings. In section XIII.C.2. We thank the commenters for their support. AIR will support clinicians participation in the Merit-based Incentive Payment System (MIPS) on behalf of the Centers for Medicare & Medicaid Services (CMS) for the next five years. The QMB helps low-income Medicare beneficiaries pay Medicare Part A premiums, Medicare Part B premiums, and a significant amount of Medicare out-of-pocket costs including copays, deductibles, and coinsurance. Therefore, we proposed to update the outlier threshold amount from $9,491 for FY 2022 to $13,038 for FY 2023 to maintain estimated outlier payments at approximately 3 percent of total estimated aggregate IRF payments for FY 2023. This is the easy way to apply. This final rule also implements section 1886(j)(3)(C) of the Act, which requires the Secretary to apply a productivity adjustment to the market basket increase factor for FY 2012 and subsequent years. of the proposed rule, a new item would replace Item 20 on the IRF-PAI V4.0. , senior vice president for the AIR Health Division. of this final rule as follows: (3) The Hospital Value-Based Purchasing (VBP) Program is part of our ongoing work to structure Medicares payment system to reward providers for the quality of care they provide. The LIP and rural facility-level adjustment factors have been utilized since the inception of the IRF PPS, while the teaching status adjustment factor was finalized in the FY 2006 IRF PPS final rule (70 FR 47880) when our regression analysis indicated that it had become statistically significant in predicting IRF costs. In particular, the commenter was concerned that the methods used to estimate inflation in IRF spending are not capturing the pandemic-initiated shocks to the health care market that are significantly driving up costs, especially labor, across the spectrum of hospital inputs. As price increases work through the private sector, they eventually cause Medicare prices to rise too. In the FY 2020 IRF PPS final rule (84 FR 39090 through 39091), we adopted the updates set forth in OMB Bulletin No. $75 for a postpartum doctor visit between 7-84 days after delivery. In this final rule, we use the methods described in the FY 2022 IRF PPS final rule (86 FR 42362) to update the prospective payment rates for FY 2023 using updated FY 2021 IRF claims and the most recent available IRF cost report data, which is FY 2020 IRF cost report data. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Gai, N., Naser, B., Hanley, J., Peliowski, A., Hayes, J., & Aoyama, K. (2020). Table 2 shows how we estimate that the application of the revisions for FY 2023 would affect particular CMG relative weight values, which would affect the overall distribution of payments within CMGs and tiers. AIR will support clinicians participation in the, Merit-based Incentive Payment System (MIPS). on or before August 1 before each FY, the classification and weighting factors for CMGs used under the IRF PPS for such FY and a description of the methodology and data used in computing the prospective payment rates under the IRF PPS for that FY. (ii) Starting on October 1, 2022, CMS applies a cap on decreases to the wage index such that the wage index applied to an IRF is not less than 95 percent of the wage index applied to that IRF in the prior FY. Among these, there are 134 IRF units of hospitals located in rural areas and 12 freestanding IRF hospitals located in rural areas. Although we acknowledged at the time that certain changes to wage index policy may significantly affect Medicare payments, we reiterated that our policy principles with regard to the wage index include generally using the most current data and information available and providing that data and information, as well as any approaches to addressing any significant effects on Medicare payments resulting from these potential scenarios, in notice and comment rulemaking. The RFA requires agencies to analyze options for regulatory relief of small entities, if a rule has a significant impact on a substantial number of small entities. Response: Medicare pays for virtually all hospital services for the first 60 days youre in the hospital. Even if patients were transferred before receiving the typical, full course of inpatient rehabilitation, the IRF could still be paid the full CMG payment rate in the absence of a transfer payment policy. 1) of this section are met. With these policy principles in mind, for the FY 2023 proposed rule, we considered how best to address the potential scenarios about which commenters raised concerns in the FY 2022 final rule around IRF payment volatility; that is, scenarios in which changes to wage index policy may significantly affect Medicare payments. IRFs whose overall CCR is in excess of the national CCR ceiling for FY 2023, as discussed below in this section. (2) Residents who would have been at the closing IRF or IRF residency program on the day prior to or day of closure, but were on approved leave at that time, and are unable to return to their training at the closing IRF or IRF residency training program. Tebb, K.P., Pica, G., Twietmeyer, L., Diaz, A., & Brindis, C.D. We note that the final FY 2023 IRF market basket growth rate of 4.2 percent would be the highest market basket update implemented in a final rule since the beginning of the IRF PPS. For Texas residents: Insured or offered by Humana Insurance Company, HumanaDental Insurance Company or DentiCare, Inc (d/b/a Compbenefits). While we will not be responding to specific comments submitted in response to this RFI in this final rule, we intend to use this input to inform our future measure development efforts. The teaching status payment adjustment is based on the ratio of the number of full-time equivalent (FTE) interns and residents training in the IRF divided by the IRF's average daily census. The program helped pay for Part A premiums which could be as high as $458 per month; Part B premiums that average $144.60 per month, and expenses. One commenter stated that the assumptions underpinning the productivity adjustment are fundamentally flawed and strongly disagrees with the continuation of this policyparticularly during the PHE. Innovative Approaches to Address Social Determinants of Health Among Adolescents and Young Adults. Payments per discharge to freestanding rehabilitation hospitals are estimated to increase 3.7 percent in urban areas and increase 3.7 percent in rural areas. We disagree that this policy, if finalized, would take time away from patient care. Additionally, we do not believe it would be appropriate to limit changes in the outlier threshold to changes in the market basket as constraining adjustments to the outlier threshold may result in a threshold that generates outlier payments above or below the 3 percent target. Should we consider a policy similar to the IPPS transfer payment policy (see 412.4(a), (b) and (c))such as including as part of the IRF transfer payment policy a discharge from an IRF to home health under a written plan for the provision of home health services from a home health agency and those services to begin within 48 hours of referral, or within 48 hours of the patient's return home (see 484.55(a)(1)), or on the provider's start of care date? We did not propose to modify the transition policy that was finalized in the FY 2021 IRF PPS final rule, and therefore did not extend the transition period for FY 2022. Under the IRF QRP, the Secretary must reduce by 2 percentage points the annual increase factor for discharges occurring during a fiscal year for any IRF that does not submit data in accordance with the IRF QRP requirements established by the Secretary. In response to the question of whether IRFs would support utilizing EHRs as the mechanism of data collection and submission for IRF QRP measures, we received several supportive comments, citing the increased accuracy by relying on both microbiologic evidence of C. diff in stool and evidence of antimicrobial treatment using data derived from the electronic health record (EHR) and decreased provider burden associated with a digital measure. Office of the Assistant Secretary for Planning and Evaluation (ASPE). offers a preview of documents scheduled to appear in the next day's https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6238651/. 11/03/2022, 192 One of these commenters noted that IRFs could use those incentive payments to offset implementation costs, such as additional staff, licensing fees and new software and systems. The rates and policies set forth in this final rule will not have a significant impact (not greater than 4 percent) on a substantial number of small entities. Accessed 6/3/2022. Response: SB 1382 by Senator Lena Gonzalez (D-Long Beach) Air pollution: Clean Cars 4 All Program: Sales and Use Tax Law: zero emissions vehicle exemption. Go365 rewards your employees for engaging with Go365s telephonic coaching service or virtual coaching resources. The IPPS to rise too the private sector, they eventually cause Medicare prices to rise too with telephonic. 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