Health Reform WK-EDGE $100M raise proposed for IPFs in FY 2021
Friday, April 17, 2020

$100M raise proposed for IPFs in FY 2021

By Sheila Lynch-Afryl, J.D., M.A.

Psychiatric facilities negatively affected by the implementation of revised OMB delineations will have their wage index reduction capped at 5 percent in FY 2021.

Inpatient psychiatric facilities (IPFs) would see a payment increase of $100 million in fiscal year (FY) 2021 relative to FY 2020, according to an advance release of the FY 2021 IPF prospective payment system (PPS) proposed rule. The deadline for submitting comments is June 9, 2020 (Proposed rule, 85 FR 20625, April 15, 2020).

Payment update. CMS proposed, pursuant to Soc. Sec. Act §1886(s), a FY 2021 IPF update of 2.6 percent (3 percent market basket update, less 0.4 percentage point productivity adjustment mandated by section 10319(e) of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148)). FY 2021 is the first year that the ACA’s "other adjustment" (see Soc. Sec. Act §1886(s)(3)) will not apply. CMS proposed a FY 2021 per diem base rate of $817.59 and an electroconvulsive therapy per treatment payment of $351.99.

Wage index. In the proposed rule, CMS implemented changes made by Office of Management and Budget (OMB) Bulletin No. 18-04 to statistical area delineations, including some new core-based statistical areas (CBSAs), urban counties that would become rural, rural counties that would become urban, and existing CBSAs that would be separated. For FY 2021, IPFs that experience negative impacts due to this implementation would be subject to a 5 percent cap on the decrease in their wage index versus FY 2020. No cap would be applied in FY 2022.

Other proposals. CMS also made the following proposals:

  • no changes to the IPF Quality Reporting Program;
  • deletion of 18 ICD-10-PCS codes deleted from the IPF Code First table; and
  • increasing the outlier threshold amount of $16,520 to keep estimated outlier payments at 2 percent of total estimated aggregate IPF payments for FY 2021.

MainStory: TopStory ProposedRules AccessNews AgencyNews InpatientFacilityNews MedicarePartANews ProviderPaymentNews QualityNews

Back to Top

Interested in submitting an article?

Submit your information to us today!

Learn More

Health Reform WK-EDGE: Breaking legal news at your fingertips

Sign up today for your free trial to this daily reporting service created by attorneys, for attorneys. Stay up to date on health reform legal matters with same-day coverage of breaking news, court decisions, legislation, and regulatory activity with easy access through email or mobile app.