The FY 2021 IPPS/LTCH proposed rule creates a pathway for antimicrobial products and strengthens quality efforts surrounding interoperability.
In the fiscal year (FY) 2021 inpatient prospective payment system (IPPS) and long-term acute care hospital (LTCH) proposed rule, CMS updated payment rates for both payment systems and proposed changes regarding new technology add-on payments for certain antimicrobial products. CMS also included proposals to electronic clinical quality measures (eCQM) that would make more robust data available to the public. The proposed rule will be published in the Federal Register on May 29, 2020.
IPPS payment rates. The proposed increase in operating payment rates for general acute care hospitals paid under the IPPS, participating in the Hospital Inpatient Quality Reporting (IQR Program), and are meaningful electronic health record (HER) users is approximately 3.1 percent. This reflects a projected market basket update of 3.0 percent, reduced by a 0.4 percentage point productivity adjustment and a proposed +0.5 percentage point adjustment required by legislation. CMS projects the rate increase will increase IPPS operating payments by about 1.6 percent after proposed changes in uncompensated care payments, new technology add-on payments, and capital payments.
LTCH payment rates. For FY 2021, CMS expects LTCH-PPS payments to decrease by approximately 0.9 percent or $36 million. For discharges paid using the standard LTCH payment rate are expected to increase by 2.1 percent, following a proposed annual standard federal rate update of 2.5 percent and an estimated decrease in outlier payments, as well as other factors. For cases that will compete the statutory transition to lower payment rates under the dual rate system are expected to decrease by about 20 percent.
Antimicrobial products. In response to concerns regarding antimicrobial resistance, CMS proposed changes regarding new technology add-on payments for certain antimicrobials. CMS proposed to expand the alternative new technology add-on payment pathway for antimicrobial products designated by the FDA as Qualified Infectious Disease Products (QIDPs) to include products approved under the Limited Population Pathway for Antibacterial and Antifungal Drugs (LPAD pathway). Under the proposal, an antimicrobial drug approved under the LPAD pathway would be considered new and not substantially similar to an existing technology and would not need to demonstrate that it meets the substantial clinical improvement criterion. CMS also proposed to provide conditional approval for antimicrobial products that meet the new technology add-on payment (NTAP) alternative pathway criteria but did not receive FDA approval in time for consideration in the final rule.
Quality of care. CMS proposed changes to reporting and public reporting of eCQM and the current validation process. These proposals include progressively increasing the number of quarters of eCQM data reported from one to four quarters of data and beginning the public display of eCQM data on the Hospital Compare website. CMS also proposed changes to the Hospital IQR Program validation process, including reducing the number of hospitals selected for validation to up to 400, rather than up to 800.
CMS proved estimated and newly established performance standards for certain measures for FY 2023 through FY 2026 and did not propose to add new measures or remove measures from the Hospital Value-Based Purchasing (VBP) Program. Because of the impact of the COVID-19 public health emergency and the limited capacity of health care providers to review and provide comment on extensive proposals, CMS limited its annual rulemaking required by statute under the Hospital Star Rating program to essential policies and policies reducing provider burden.
Interoperability. CMS proposed an electronic health records (HER) reporting period of a minimum of 90 continuous days in calendar year (CY) 2020 for new and returning participants in the Medicare Promoting Interoperability Program attesting to CMS. CMS seeks public comment on proposals relating to eCQM reporting periods and a proposal to publicly report eCQM performance data for the first time beginning with data reported for CY 2021.
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