CMS proposes fiscal year (FY) 2020 updates that will help align Inpatient Psychiatric Facilities (IPF) payment rates with the cost of providing care.
CMS has issued an advance release of a proposed rule that would update the IPF Prospective Payment System (PPS) and Quality Reporting requirements forIPF discharges occurring during FY 2020. The proposed rule would: (1) update the prospective payment rates, the outlier threshold, and the wage index for Medicare inpatient hospital services provided by IPFs; (2) revise and rebase the IPF market basket to reflect a 2016 base year; (3) use the concurrent hospital wage data as the basis of the IPF wage index rather than using the prior year’s Inpatient Prospective Payment System (IPPS) hospital wage data; and (4) update the IPF Quality Reporting (IPFQR) program.
IPF PPS. CMS last rebased and revised the market basket in 2016 by adopting a 2012-based market basket. For FY 2020, it proposes to revise and rebase the IPF market basket using 2016 as the base year to reflect more recent data. CMS would adjust this 2016-based IPF market basket update (estimated to be 3.1 percent) by a reduction for economy-wide productivity (estimated to be 0.5 percentage point), and would further reduce the 2016-based IPF market basket update by 0.75 percentage point, resulting in a proposed estimated IPF payment rate update of 1.85 percent for FY 2020.
CMS also proposes making the following technical changes to the FY 2020 IPF PPS to adjust for inflation, statutory requirements, and other factors:
- Changing the IPF PPS federal per diem base rate from $782.78 to $803.48.
- Setting the IPF PPS federal per diem base rate for providers who fail to report quality data at $787.70.
- Changing the electroconvulsive therapy (ECT) payment per treatment from $337.00 to $345.91.
- Setting the ECT payment per treatment for providers who fail to report quality data at $339.12.
- Changing the labor-related share from 74.8 percent to 76.8 percent (based on the proposed 2016-based IPF market basket).
- Setting the core-based statistical area (CBSA) rural and urban wage indices for FY 2020, using the FY 2020 pre-floor, pre-reclassified IPPS hospital wage index data and OMB designations from OMB Bulletin 17-01.
- Changing the wage index budget-neutrality adjustment from 1.0013 to 1.0078.
- Changing the fixed dollar loss threshold amount from $12,865 to $14,590 to maintain estimated outlier payments at 2 percent of total estimated aggregate IPF PPS payments.
CMS also proposes to align IPF wage index data with the concurrent IPPS wage index data by removing the one-year lag of the pre-floor, pre-reclassified IPPS hospital wage index upon which the IPF wage index is based. CMS invites comments on this change.
IPFQR program. The IPFQR program provides consumers with data about the quality of care provided to patients in psychiatric facilities. According to a CMS fact sheet, for FY 2020, CMS proposes to adopt of one new claims-based measure beginning with the FY 2021 payment determination. The measure would determine if patients admitted to IPFs with major depressive disorder, schizophrenia, or bipolar disorder filled a prescription for at least one evidence-based medication within two days prior to discharge or 30 days after their discharge.
Comments on the proposed rule must be submitted by June 17, 2019. The final version of the proposed rule will publish on April 23, 2019.
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