Since the implementation of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) and the development of the statutorily required quality measures, we have also received public input suggesting that the quality measures used in the IRF QRP should be calculated using data collected from all IRF patients, regardless of the patients' payer. The process to calculate the CMG relative weights for this final rule is as follows: Step 1. This adjustment is made on a claim basis as an interim payment and the final payment in full for the claim is made during the final settlement of the cost report. This rule establishes a permanent cap policy to smooth the impact of year-to-year changes in IRF payments related to decreases in the IRF wage index. The FVR provides detailed information about the status of submission files, including warnings and fatal errors encountered. https://www.healthit.gov/isa/sites/isa/files/inline-files/2022-ISA-Reference-Edition.pdf. After consideration of the comments we received, we are finalizing our proposal to continue to use the updated pre-reclassification and pre-floor IPPS wage index data develop the FY 2023 IRF PPS wage index. We do not anticipate a financial impact associated with the codification of the IRF teaching status adjustment policies. For example, as part of their recommendations on Coordination Strategy for Post-Acute Care and Long-term Care Performance Measurement,[14] However, we determined that the changes in OMB Bulletin No. 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. 15-01 effective October 1, 2017, beginning with the FY 2018 IRF wage index. Closure of an IRF or IRF residency training program. We apply the national urban and rural CCRs in the following situations: Specifically, for FY 2023, we proposed to estimate a national average CCR of 0.463 for rural IRFs, which we calculated by taking an average of the CCRs for all rural IRFs using their most recently submitted cost report data. The commenter also requested that CMS release data that would allow IRFs to crosswalk the IPPS wage index values after the application of the low wage index hospital policy to the IRF PPS wage indices. For some states, they use policies that favor inclusion and will decide close issues in the applicants favor. We also adopted the IPPS definition of closure of a hospital residency training program as it is currently defined at 413.79(h)(1)(ii) to also apply to IRF residency training program closures, and to mean that the IRF ceases to offer training for residents in a particular approved medical residency training program. We also proposed that if more recent data became available after the publication of the proposed rule and before the publication of this final rule, we would use such data to determine the FY 2023 national average rural and urban CCRs and the national CCR ceiling in the final rule. Additionally, we welcomed ideas and suggestions as to what could be driving the changes observed in these adjustment factors from year-to-year. https://www.bls.gov/oes/current/oes_nat.htm). We believe the IRF-PAI items are completed by Registered Nurses (RN), Licensed Practical and Licensed Vocational Nurses (LVN), Respiratory Therapists (RT), Speech-Language Pathologists (SLP), Occupational Therapists (OT), Physical Therapists (PT), and/or Psychologists (Psy), depending on the item. We believe that data reporting on standardized patient assessment data elements using the IRF-PAI should include all IRF patients for the same reasons we believe that collecting data on Medicare beneficiaries for the IRF QRP's quality measures is important: to achieve equity in healthcare outcomes for our beneficiaries by supporting providers in quality improvement activities, enabling them to make more informed decisions, and promoting provider accountability for healthcare disparities. Further, we are unable to provide crosswalk tables related to IPPS wage index policies. The Healthy Rewards program is provided by Cigna Health and Life Insurance Company. (B) The patient stops being furnished inpatient rehabilitation services. documents in the last year, 675 Comment: Further, we believe that it would be appropriate to use a 5-percent cap on wage index decreases for purposes of the IRF PPS wage index adjustment for the reasons discussed in this section and in the proposed rule. 25. These commenters urged CMS to engage stakeholders in developing these risk adjustment methods. At that time, CMS did not finalize the majority of the standardized patient assessment data element proposals in recognition of the concern raised by many commenters that we were moving too fast to adopt the data elements. In the aggregate, we do not estimate that these updates will affect overall estimated payments of IRFs. https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf). The IRF prospective payment system (IRF PPS) Addenda along with other supporting documents and tables referenced in this final rule are available through the internet on the CMS website at documents in the last year, by the International Trade Administration Several commenters disagreed with implementing the proposal for FY 2025 because they noted the landscape for IRF providers is vastly different than in 2020 when the proposal was last made. Update the CMG relative weights and average length of stay values for FY 2023, in a budget neutral manner, as discussed in section IV. In addition, we note that section 1886(j)(7) of the Act does not limit the Secretary to collecting data only on individuals with Medicare, and therefore this proposal is not inconsistent with CMS' statutory obligations. Many individuals and families are dual eligible and get benefits from both major programs. With regard to the scope of data collection, IRFs would be required to submit quality measure and standardized patient assessment data elements required by the IRF QRP. Centers for Medicare & Medicaid Services. It can pay deductibles that can total more than $1,400 per year for Part A and more than $190 for Part B. Starting the assessment schedule day count. Because providers are usually experienced with this level of wage index fluctuation, we believe applying a 5-percent cap on all wage index decreases each year, regardless of the reason for the decrease, would effectively mitigate instability in IRF PPS payments due to any significant wage index decreases that may affect providers in a year. The following is a summary of the public comments received on the proposed FY 2023 market basket update and productivity adjustment and our responses: Comment: A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. A few commenters requested that CMS elaborate on the specific productivity gains that are the basis of this proposed reduction to the market basket as it does not align with actual hospital experience or ongoing losses from the pandemic and a nationwide labor shortage. Response: We acknowledge that IRFs may continue to be impacted by the PHE and that collecting quality data on all patients regardless of payer may create additional burden for some IRFs. After consideration of the comments received and considering the most recent available data, we are finalizing the outlier threshold amount of $12,526 to maintain estimated outlier payments at approximately 3 percent of total estimated aggregate IRF payments for FY 2023. This report describes the workforce shortages tied to COVID-19 surges. We are finalizing the IRF budget-neutral wage adjustment factor methodology as described in this final rule. Comment: The updates provided in OMB Bulletin No. Thus, in accordance with section 1886(j)(3)(C) of the Act, we proposed to base the FY 2023 market basket update, which is used to determine the applicable percentage increase for the IRF payments, on IGI's fourth quarter 2021 forecast of the 2016-based IRF market basket. Example: Final Decision: However, for the reasons discussed in section XI.F.2., CMS is finalizing this policy to begin with the FY 2026 IRF QRP in order to give IRFs more time to prepare for the new data collection. 2) We appreciate the input provided by commenters. Humana is the brand name for plans, products and services provided by one or more of the subsidiaries and affiliate companies of Humana Inc. (Humana Entities). https://doi.org/10.1016/S0140-6736(12)60149-4. 156(1), 76-90. has the same meaning as a displaced resident as defined in 413.79(h)(1)(iii) as applied to an IRF, for purposes of accounting for indirect teaching costs. Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program, Hospital Outpatient Quality Reporting Program, HCAHPS: Patients' Perspectives of Care Survey, Medicare Payment and Volume Information for Consumers, PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program, Inpatient Prospective Payment System (IPPS). Table 7 illustrates the components of the adjusted payment calculation. Response: Response: 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. U.S. District Judge Kenneth Hoyt ordered Gregg Phillips and Catherine Englebrecht, leaders of True the Vote, detained by U.S. The Secretary is required to update the IRF PPS wage index on the basis of information available to the Secretary on the wages and wage-related costs to furnish rehabilitation services. [40] Second, to determine the appropriate amount of additional payment for the teaching status adjustment (if applicable), we multiply the teaching status adjustment (0.0784, in this example) by the wage-adjusted and rural-adjusted amount (if applicable). The QMB is a Medicare Savings Program for low-income individuals and families that cansave a lot of money. Law Office of Gretchen J. Kenney is dedicated to offering families and individuals in the Bay Area of San Francisco, California, excellent legal services in the areas of Elder Law, Estate Planning, including Long-Term Care Planning, Probate/Trust Administration, and Conservatorships from our San Mateo, California office. 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. Specifically, we proposed to replace a reference to 412.23(b)(2) with the correct reference to 412.29(b)(1). The statutoryrequirements of the Hospital VBP Program are set forth in Section 1886(o) of the Social Security Act. In this Issue, Documents 8. Available at Intermediary Manual, Part 3, section 3600). The proposed revisions are outlined in 412.604, 412.606, 412.610, 412.614, and 412.618 in the regulation text of the proposed rule. In addition to what was previously discussed, section 3401(d) of the PPACA also added section 1886(j)(3)(C)(ii)(I) of the Act (providing for a productivity adjustment for FY 2012 and each subsequent FY). Individually or collectively, these items can have a major effect on an individual's health status, self-image, and quality of life. Medicare expenses have risen over the past twenty years ashealth care costs have risenacross the country in in nearly every part of the industry. For IRFs using certified health IT systems, how can existing certification criteria under the Office of the National Coordinator (ONC) Health Information Technology (IT) Certification Program support reporting of this data? Specifically, we interpret the commenters to be concerned that they will not be able to complete these new items because they do not believe the IRF-PAI is appropriate for pediatric patients, and as a result, they will not be able to meet the 95 percent data completion threshold. of this final rule, we discuss the use of the existing methodology to calculate the standard payment conversion factor for FY 2023. https://doi.org/10.1542/peds.2010-0852. The relative weights associated with these CMGs include both increases and decreases, and the variation for FY 2023 is similar to the typical year-to-year variation that we observe. Medicaid office in the state and county of residence, https://www.ssa.gov/legislation/SSA-L447.pdf, https://www.medicaid.gov/Federal-Policy-Guidance/downloads/CIB-01-06-12.pdf, http://obamacarefacts.com/obamacare-medicare/, http://obamacarefacts.com/obamacare-control-costs/, https://www.ssa.gov/disabilityresearch/wi/qdwi.htm, https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/DualEligibleDefinitions.pdf, https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html, https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html, https://www.medicare.gov/pharmaceutical-assistance-program/state-programs.aspx?varstate=ID, http://obamacarefacts.com/2016-2017-federal-poverty-guidelines/, https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicare-savings-program/medicare-savings-programs.html. and the comment periods will be separate from those associated with this rulemaking. on 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. After consideration of the comments we received, we are finalizing a FY 2023 IRF productivity-adjusted market basket increase of 3.9 percent based on the most recent data available. We invited public comment on our proposal to amend 412.602 and 412.624(e)(4) to codify our longstanding policies regarding the teaching status adjustment. Additionally, CMS recognizes that the effort of having to separate out Medicare beneficiaries from other patients has clinical and work flow implications that introduce burden, and collecting data on all patients admitted would remove the burden of having to verify the patient's payer's requirements before beginning IRF-PAI collection. We will address each of these comments here. The prevalence was highest among adolescents reporting two or more races (29.9%). Passwords are 6-20 characters with at least one number and letter. The BIMS was developed to be a brief, objective screening tool, with a focus on learning and memory. Use the PDF linked in the document sidebar for the official electronic format. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/MarketBasketResearch. After consideration of the comments we received, we are finalizing the standard payment conversion factor for FY 2023 as proposed. 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, we proposed to update the data reporting requirements for the IRF QRP beginning with the FY 2025 IRF QRP. CMS safeguards the IRF-PAI data in a data system. In addition, we constructed five special CMGs to account for very short stays and for patients who expire in the IRF. the National Quality Forum (NQF)-convened Measures Application Partnership (MAP) defined priorities and core measure concepts for PAC, including IRFs, in order to improve care coordination for patients. Accessed June 6, 2022. We estimate an overall impact for rural IRFs in all areas between 0.5 percent and 4.0 percent. We believe this approach would address concerns about instability that commenters raised in the FY 2022 IRF PPS rule. The following is a summary of the public comments received on the proposed update to the FY 2023 outlier threshold amount and our responses. 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. The effects of applying the budget-neutral permanent cap on wage index decreases policy. https://www.whitehouse.gov/wp-content/uploads/2018/09/Bulletin-18-04.pdf. The labor market designations made by the OMB include some geographic areas where there are no hospitals and, thus, no hospital wage index data on which to base the calculation of the IRF PPS wage index. market basket increase factor of 2.8 percent. Furthermore, to maintain consistency with the IPPS IME policy, we proposed that the letter must also include: (2) The last four digits of each displaced resident's social security number; this will reduce the amount of personally identifiable information (PII); (3) The name of the IRF and the name of the residency program or programs in which each resident was training at previously; and. We describe the estimated burden for the proposal in section XI.B. CMS provides the Baseline Measures Report and Percentage Payment Summary Report to hospitals each fiscal year. 37. 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