Health Reform WK-EDGE IRFs could get $160M pay bump, see QRP changes in FY 2022
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Tuesday, April 20, 2021

IRFs could get $160M pay bump, see QRP changes in FY 2022

By Sheila Lynch-Afryl, J.D., M.A.

CMS proposed a new QRP measure on COVID-19 vaccination rates among health care personnel and requested comments on its efforts to close health equity gaps in its quality programs.

Payments to inpatient rehabilitation facilities (IRFs) would increase 1.8 percent, or $160 million, in fiscal year (FY) 2022 compared to FY 2021, according to an advance release of the FY 2022 IRF prospective payment system (PPS) proposed rule. CMS also proposed to make several updates to the IRF Quality Reporting Program (QRP), including the addition of a measure that assesses COVID-19 vaccination rates among health care personnel (Proposed rule, 86 FR 19086, April 12, 2021).

Payment update. CMS proposed, pursuant to Soc. Sec. Act §1886(j), a FY 2022 IRF update of 2.2 percent (2.4 percent market basket update, less 0.2 percentage point productivity adjustment mandated by section 3401(d) of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148)). CMS noted that, while the Medicare Payment Advisory Commission (MedPAC) recommended that IRF PPS payment rates be reduced by 5 percent for FY 2022, section 1886(j)(3)(C) does not give the HHS Secretary the authority to apply a different update factor.

Outliers. CMS would update the outlier threshold amount to $9,192 to maintain estimated outlier payments at approximately 3 percent of total estimated aggregate IRF payments for FY 2022. In addition, the proposed national average cost-to-charge ratio for FY 2022 is 0.478 for rural IRFs and 0.393 for urban IRFs.

IRF Quality Reporting Program. The IRF QRP currently has 17 measures for the FY 2022 program year. CMS proposed to add one new measure beginning with the FY 2023 IRF QRP, the COVID-19 Vaccination Coverage among Healthcare Personnel measure, and to update the denominator for the Transfer of Health Information to the Patient–Post-Acute Care measure to exclude patients discharged home under the care of an organized home health service or hospice. CMS also proposed to modify the number of quarters used for publicly reporting certain IRF QRP measures due to the public health emergency.

In addition, CMS is seeking comment on the following: (1) certain measures and concepts under consideration for the IRF QRP; (2) future plans to define digital quality measures (dQMs) for the IRF QRP and the potential use of Fast Healthcare Interoperability Resources for dQMs, aligning where possible with other quality programs; and (3) consistent with Executive Order 13985, efforts to close the health equity gap in CMS’ quality programs.

FederalRegisterIssuances: ProposedRules AgencyNews InpatientFacilityNews MedicarePartANews QualityNews

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