Medicare payment policies and rates are set to be adjusted for the 2022 fiscal year as a result of the moves.
The Centers for Medicare & Medicaid Services (CMS) brought a four-pack of final rules to the backyard barbecue as the dog days of summer continue.
The federal agency unveiled the plans on Thursday, noting that it had finalized changes to Medicare payment policies, rates, and other measures for skilled nursing facilities (SNFs), hospices, inpatient rehabilitation facilities (IRFs), and inpatient psychiatric facilities (IPFs).
What follows is a brief overview of the most notable changes, as related in an edition of the CMS MLN Connects Newsletter.
In addition to rate adjustments, the SNF Final Rule includes several policies that update the SNF Quality Reporting Program and the SNF Value-Based Program (VBP) for the 2022 fiscal year (FY).
CMS has estimated that the aggregate impact of the changes would result in an increase of approximately $410 million in Medicare Part A payments to SNFs in FY 2022, resulting from an update to the payment rates of 1.2 percent, based on a 2.7-percent SNF market basket update, minus a 0.8-percentage point forecast error adjustment and a 0.7-percentage point productivity adjustment.
Officials noted that the Final Rule also features new methodology for recalibrating the Patient-Driven Payment Model (PDPM) parity adjustment; changes to Section 134 of the Consolidated Appropriations Act, 2021 – New Blood Clotting Factor Exclusion from SNF Consolidated Billing; and changes in PDPM ICD-10 code mappings.
To view a comprehensive CMS fact sheet on the SNF Final Rule, go online here: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2022-skilled-nursing-facility-snf-prospective-payment-system-pps-final-rule-cms-1746
To review the SNF Final Rule in its entirety, go to the Federal Register entry here: https://www.federalregister.gov/public-inspection/2021-16309/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities
The Final Rule for hospices updates Medicare payments and the aggregate cap amount for FY 2022, done in accordance with existing statutory and regulatory requirements.
“This rule rebases the hospice labor shares and clarifies certain aspects of the hospice election statement addendum requirements. In addition, this rule finalizes changes to the Hospice Conditions of Participation and Hospice Quality Reporting Program (HQRP),” the MLN Connects newsletter post read. “The Final Rule also finalizes a Home Health Quality Reporting Program policy that becomes effective on Oct. 1, 2021, to prepare for public reporting beginning in January 2022.”
Under the new rule, hospices would see a 2.0-percent increase ($480 million) in their payments for FY 2022, relative to FY 2021, resulting from a 2.7-percent market basket percentage increase, reduced by a 0.7-percentage point productivity adjustment. Hospices that fail to meet quality reporting requirements receive a 2-percentage point reduction to the annual hospice payment update percentage increase for the year.
The updates also include a change to the statutory aggregate cap amount, which limits the overall payments per patient that are made to a hospice annually. The new amount is just over $31,000, up 2 percentage points from 2021.
The Final Rule also includes additional Medicare hospice payment policies; a request for information (RFI) on the Closing the Health Equity Gap in the HQRP initiative; and a second RFI on the Fast Healthcare Interoperability Resources in Support of the HQRP initiative.
To view a comprehensive CMS fact sheet on the Hospice Final Rule, go online here: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2022-hospice-payment-rate-update-final-rule-cms-1754-f
To review the Hospice Final Rule in its entirety, go to the Federal Register entry here: https://www.federalregister.gov/public-inspection/2021-16311/medicare-program-fy-2022-hospice-wage-index-and-payment-rate-update-hospice-conditions-of
In addition to updated policies and rates for the IRF Prospective Payment System (PPS), the IRF Final Rule features the finalization of a Medicare Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) payment provision adopted in an interim final rule, as well as a provision that was included in a DMEPOS proposed rule published in the Federal Register last fall.
For FY 2022, CMS is updating the IRF PPS payment rates by 1.9 percent, based on the IRF specific market basket estimate of 2.6 percent, minus a 0.7-percentage point productivity adjustment. In addition, the Final Rule contains an adjustment to the outlier threshold to maintain outlier payments at 3.0 percent of total payments.
MLN Connects estimated that the overall IRF payments for FY 2022 would increase by 1.5 percent (or $130 million), relative to payments in FY 2021.
To view a comprehensive CMS fact sheet on the IRF Final Rule, go online here: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2022-inpatient-rehabilitation-facility-irf-prospective-payment-system-pps-final-rule
To review the IRF Final Rule in its entirety, go to the Federal Register entry here: https://www.federalregister.gov/public-inspection/2021-16310/medicare-program-inpatient-rehabilitation-facility-prospective-payment-system-for-federal-fiscal
The IPF Final Rule updates policies and payment rates for these providers, and also finalizes changes to the IPF Quality Reporting Program, along with introducing updates to the IPF teaching policy.
For FY 2022, CMS is updating the IPF PPS payment rates by 2.0 percent, based on the final IPF market basket estimate of 2.7 percent, minus a 0.7-percentage point productivity adjustment. In addition, the Final Rule updates the outlier threshold to maintain outlier payments at 2.0 percent of total payments.
Total payments to IPFs are estimated to increase by 2.1 percent, or $80 million, in FY 2022 relative to IPF payments in 2021.
To view a comprehensive CMS fact sheet on the IPF Final Rule, go online here: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2022-inpatient-psychiatric-facility-ipf-prospective-payment-system-pps-final-rule-cms
To review the IPF Final Rule in its entirety, go to the Federal Register entry here: https://www.federalregister.gov/public-inspection/2021-16336/medicare-program-fy-2022-inpatient-psychiatric-facilities-prospective-payment-system-and-quality
EDITOR’S NOTE: The ICD10monitor annual IPPSpalooza is here. It’s a 10-week period that starts when the Inpatient Prospective Payment System final rule is released and continues through October 1st – when the regulations, including the ICD-10 codes, are effective. Talk Ten Tuesdays and the ICD10monitor editorial board will be focusing on relevant information leading up to the release of the new ICD-10 codes and will provide not only the news but in-depth analyses of all IPPS related regulations.