The resulting figure is the wage-adjusted labor amount. 25. December 7, 2021 Early Discharges From Inpatient Rehabilitation Facilities to Home Health Services [Report No. Marshals "for one-day and further until they fully comply with the Court's Order," according to a notice from the federal court in Houston. 17-01, and on September 14, 2018, OMB issued OMB Bulletin No. In the aggregate, we do not estimate that these updates will affect overall estimated payments of IRFs. We also note that, as we previously discussed in the FY 2012 IRF PPS final rule (76 FR 47846 through 47848), only to the extent a receiving IRF would exceed its FTE cap by training displaced residents would it be eligible for a temporary adjustment to its resident FTE cap. Remember to keep your card, as future reward dollars will be added to it for each qualifying healthy activity you complete. https://doi.org/10.1080/02643294.2017.1417249. In addition to what was previously discussed, section 3401(d) of the PPACA also added section 1886(j)(3)(C)(ii)(I) of the Act (providing for a productivity adjustment for FY 2012 and each subsequent FY). Take healthy steps to earn My Health Pays rewards. Any reference to the FY 2006 IRF PPS final rule in this final rule also includes the provisions effective in the correcting amendments. (i) The application of the wage index is made on the basis of the location of the facility in an urban or rural area as defined in 412.602. Comment: Start Printed Page 47086 As noted above, forecast errors reflect both upward and downward adjustments, as appropriate. We invited providers to learn more about these important developments and how they are likely to affect IRFs. 100(10), 609-617. Centers for Medicare & Medicaid Services (CMS), HHS. (ii) Starting on October 1, 2022, CMS applies a cap on decreases to the wage index such that the wage index applied to an IRF is not less than 95 percent of the wage index applied to that IRF in the prior FY. As required by statute, the FY 2023 productivity adjustment is derived based on the 10-year moving average growth in economy-wide productivity for the period ending FY 2023. We proposed to use the listed steps to ensure that the FY 2023 IRF standard payment conversion factor reflects the proposed update to the wage indexes (based on the FY 2019 hospital cost report data) and the proposed update to the labor-related share, in a budget-neutral manner: Step 1. Individualized assessment with accurate screening tools and follow-up evaluations are essential to determining which patients need hearing- or vision-specific medical attention or assistive devices and accommodations, including auxiliary aids and/or services, and to ensure that person-directed care plans are developed to accommodate a patient's needs. The first contract to support the MIPS program was awarded in 2017 to IMPAQ International, which was acquired by AIR in 2020. Summary of Provisions of the Proposed Rule, IV. The hospital VBP Program rewards acute care hospitals with incentive payments based on the quality of care they provide, rather than just the quantity of services they provide. Using IGI's fourth quarter 2021 forecast, the 10-year moving average growth of TFP for FY 2023 was projected to be 0.4 percent. An interrupted stay is defined as a stay by a patient who is discharged from the IRF and returns to the same IRF within 3 consecutive calendar days. https://pubmed.ncbi.nlm.nih.gov/28562301/. More information and documentation can be found in our Due to the uncertainty regarding future price trends, forecast errors can be both positive and negative. We believe that if this proposal is finalized, it will make the assessment-based measures more robust and represent the IRF population as a whole, rather than limiting it to only those patients with Medicare FFS or Medicare Advantage benefits. General. However, as discussed in the FY 2023 proposed rule (87 FR 20230), we recognize there are circumstances that a 1-year mitigation policy, like the one adopted for FY 2021, would not effectively address future years in which providers continue to be negatively affected by significant wage index decreases. Performance period means the time period during which data are collected for the purpose of calculating hospital performance on measures with respect to a fiscal year. L. 117-2, March 11, 2021) rural payments may not be used to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. This longstanding policy derived from the fact that there are requirements that the receiving IRF identifies the residents who have come from the closed IRF or identifies the residents who have come from another IRF's closed residency program, and that the IRF that closed its program identifies the residents who were in training at the time of the residency program's closure. We considered the residents who were physically present at the IRF to be those residents who were training at the time of the program's closure, thereby granting them the status of displaced residents. Although we did not want to limit the displaced residents to only those physically present at the time of closure, it becomes much more administratively challenging for the following groups of residents at closing IRFs/residency programs to continue their training: (1) Residents who leave the program after the closure is publicly announced to continue training at another IRF, but before the actual closure; (2) Residents assigned to and training at planned rotations at other IRFs who will be unable to return to their rotations at the closing IPF or program; and. Closure of an IRF's residency training program https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/IRF-Quality-Reporting/IRF-Quality-Reporting-Data-Submission-Deadlines. For cost reporting periods beginning on or after October 1, 2011, an IRF may receive a temporary adjustment to its FTE cap to reflect displaced residents added because of the closure of another IRF's residency training program if the IRF is training additional displaced residents from the residency training program of an IRF that closed a program; and if no later than 60 days after the IRF begins to train the displaced residents the IRF submits to its Medicare Contractor a request for a temporary adjustment to its FTE cap, documents that it is eligible for this temporary adjustment by identifying the displaced residents who have come from another IRF's closed program and have caused the IRF to exceed its cap, specifies the length of time the adjustment is needed, and submits to its Medicare Contractor a copy of the FTE reduction statement by the hospital that closed its program, as specified in paragraph (e)(4)(ii)(A)( Selph, S.S., & McDonagh, M.S. L. 111-148) was enacted on March 23, 2010. Section 1886(j)(3)(C)(ii)(II) of the Act provides that the application of the productivity adjustment to the market basket update may result in an update that is less than 0.0 for a FY and in payment rates for a FY being less than such payment rates for the preceding FY. Table 10 categorizes IRFs by geographic location, including urban or rural location, and location for CMS' 9 Census divisions of the country. In this Issue, Documents The states usually exclude the values of the below-listed items. (b) * * * (1) A clinician of the inpatient rehabilitation facility must perform a comprehensive, accurate, standardized, and reproducible assessment of each Medicare Part A fee-for-service inpatient using the inpatient rehabilitation facility patient assessment instrument specified in paragraph (b) of this section as part of his or her patient assessment in accordance with the schedule described in 412.610. Step 2. of the proposed rule as follows: We received 61 timely responses from the public, many of which contained multiple comments on the FY 2023 IRF PPS proposed rule (87 FR 20218). After consideration of the comments we received, we are codifying the IRF PPS teaching status adjustment calculation in 412.602 and 412.624(e)(4), as proposed. notice was published on February 3, 2022 (87 FR 6175) to extend the information collection request (ICR). In developing Hospital Value-Based Purchasing (VBP), the Centers for Medicare & Medicaid Services (CMS) conducted extensive research and stakeholder outreach. If you have questions, please contact us at 1-866-246-4358. For example, standardized assessment of special services, treatments, and interventions used in the IRF can promote the pediatric or adolescent patient's safety through appropriate care planning (for example, mitigating risks such as infection or pulmonary embolism associated with central intravenous access), and identifying life-sustaining treatments that must be continued, such as mechanical ventilation, dialysis, suctioning, and chemotherapy, at the time of discharge or transfer. According to section 1886(j)(3)(A)(i) of the Act, the increase factor shall be used to update the IRF prospective payment rates for each FY. To be eligible, one must have income that is at or under the 200 percent mark of the federal poverty guideline. The effects of the updates that impact IRF PPS payment rates are shown in Table 14. Pain is not a surprising symptom in PAC patients and residents, where healing, recovery, and rehabilitation often require regaining mobility and other functions after an acute event. For the purposes of calculating the costs associated with the collection of information requirements, we obtained mean hourly wages for these staff from the U.S. Bureau of Labor Statistics' May 2020 National Occupational Employment and Wage Estimates. Most IRFs and most other providers and suppliers are small entities, either by having revenues of $8.0 million to $41.5 million or less in any 1 year depending on industry classification, or by being nonprofit organizations that are not dominant in their markets. The 60-day comment period for the extension ended April 4, 2022. However, as mentioned above, the data and methods are unchanged. ++ Guiding principles for the use and application of the results of disparity measurement. Two commenters supported the idea of performance disparity decomposition and believed that it would provide valuable data for IRFs while minimizing burden. An inpatient rehabilitation facility must use the CMS inpatient rehabilitation facility patient assessment instrument to assess Medicare Part A fee-for-service and Medicare Part C (Medicare Advantage) inpatients who are admitted on or after January 1, 2002, or were admitted before January 1, 2002, and are still inpatients as of January 1, 2002. Specifically, the assessments may be needed as part of a retrospective review conducted at the IRF for various purposes, including the fact that the completed patient assessments could be beneficial to other entities that appropriately have access to these records (for example, a State or Federal agency conducting an investigation due to a complaint of patient abuse). The first character is an alphabetic character that indicates the comorbidity tier. The description of each column is as follows: The average estimated increase for all IRFs is approximately 3.2 percent. (1) Starting on October 1, 2024, inpatient rehabilitation facilities must use the CMS inpatient rehabilitation facility patient assessment instrument to assess all inpatients, regardless of payer, who are admitted on or after October 1, 2024, or who were admitted before October 1, 2024 and are still inpatients as of October 1, 2024. To update the IRF outlier threshold amount for FY 2023, we proposed to use FY 2021 claims data and the same methodology that we used to set the initial outlier threshold amount in the FY 2002 IRF PPS final rule (66 FR 41362 through 41363), which is also the same methodology that we used to update the outlier threshold amounts for FYs 2006 through 2022. The resulting quotient is the FY 2023 budget-neutral wage adjustment factor of 1.0002. In the August 7, 2001 final rule (66 FR 41353 through 41355), we stated that we did not propose to include early discharges to home health care as part of the transfer payment policy because there were analytical challenges as a result of the recent implementation of the new home health prospective payment system. As we continue to explore the underlying reasons for the large change in the proposed outlier threshold amount, we welcomed comments from commenters on any observations or information related to the increase in the proposed update to outlier threshold amount for FY 2023. The Act intends for standardized post-acute care data to improve Medicare beneficiary outcomes through shared-decision making, care coordination, and enhanced discharge planning. Other commenters stated they would be willing to participate in a pilot prior to implementation of a digital quality measure (dQM). The applicable laws and regulations include, but are not limited to: the Privacy Act of 1974; the Federal Information Security Management Act of 2002; the Computer Fraud and Abuse Act of 1986; the Health Insurance Portability and Accountability Act of 1996; the E-Government Act of 2002; the Clinger-Cohen Act of 1996; the Medicare Modernization Act of 2003; and the corresponding implementing regulations. It is the official reference for determining eligibility for benefits and programs based on an individual or familys annual income. 2. After consideration of the comments we received, we are finalizing a FY 2023 IRF productivity-adjusted market basket increase of 3.9 percent based on the most recent data available. We will take these comments and suggestions into account in future development of payment policies. For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services amends 42 CFR chapter IV as set forth below: 1. However, in light of recently available data and our desire to ensure that the CMG relative weights and average length of stay values are as reflective as possible of recent changes in IRF utilization and case mix, we believe that it is appropriate to update the CMG relative weights and average length of stay values at this time to ensure that IRF PPS payments continue to reflect as accurately as possible the current costs of care in IRFs. L. 116-136, enacted on March 27, 2020). The QDWI Program is the qualified disabled and working individuals program; it is a Medicare Assistance program for low or limited income persons. Since we are making the updates to the IRF wage index, labor-related share and the CMG relative weights in a budget-neutral manner, they will not be expected to affect total estimated IRF payments in the aggregate. documents in the last year, by the Environmental Protection Agency One commenter indicated their interest in participating in a pilot or voluntary electronic submission of quality data. Would you support utilizing IRF EHRs as the mechanism of data collection and submission for IRF QRP measures? In summary, the changes to the IRF QRP will result in a burden As stated previously, based on these findings, CMS believes payments to IRFs continue to be more than adequate. As described previously, the IRF market basket measures price changes (including changes in the prices for wages and salaries) over time and would not reflect increases in costs associated with changes in the volume or intensity of input goods and services until the market basket is rebased. One commenter had concerns that the proposed market basket forecast is neither accurately nor adequately capturing the unique factors influencing the hospital and health care market today in general, and the market in which IRFs compete specifically. Hauer, J., Houtrow, A.J. Medicaid offers savings programsdesigned to assist participants with low or no income. Commenters suggested that CMS consider policies that would better target outlier payments, such as placing a 10 percent cap on the amount of outlier payments any IRF could receive or lowering the 3 percent outlier pool. relative weights, using the hospital-specific relative value method. Expanding the reporting of quality measures to include all patients, regardless of payer, will further inform our quality work at CMS, allowing for the continued improvement in quality of care. More specifically, we sought input on a cross-setting functional measure that would incorporate the domains of self-care and mobility. documents in the last year, 1460 We believe the 2016-based IRF market basket increase adequately reflects the average change in the price of goods and services hospitals purchase in order to provide IRF medical services, and is technically appropriate to use as the IRF payment update factor. We encourage PAC provider and health information technology (IT) vendor participation as the efforts advance. other services or items outside the scope of the IRF PPS. Specifically, we proposed to adopt conforming changes to the IRF PPS teaching status adjustment policy to align with the policy changes that the IPPS finalized in the FY 2021 IPPS final rule (85 FR 58432, 58865 through 58870) and that the IPF finalized in the FY 2022 IPF PPS final rule (86 FR 42608, 42618 through 42621). This final rule also implements section 1886(j)(3)(C) of the Act, which requires the Secretary to apply a productivity adjustment to the market basket increase factor for FY 2012 and subsequent years. In accordance with section1886(j)(7)(A) of the Act, the Secretary must reduce by 2 percentage points the annual market basket increase factor otherwise applicable to an IRF for a fiscal year if the IRF does not comply with the requirements of the IRF QRP for that fiscal year. Specific examples include the hearing, speech, and vision items; the https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS. [41] As discussed in further detail in section XIII.C.2. General. This repetition of headings to form internal navigation links However, given the magnitude of the increases we are consistently seeing in the teaching status adjustment we do not believe that they are true reflections of the higher costs of teaching IRFs. Residents rotating to more than one hospital or non-hospital setting will be counted in proportion to the time they are assigned to inpatient rehabilitation facility compared to the total time worked in all locations. (75 FR 37246 through 37252). Specifically, we are updating the proposed regulation text at 412.604(c), 412.606(a)(1), and 412.606(b)(1) to reflect that the facilities will need to start collecting the IRF-PAI assessment data for each patient receiving care in an IRF, regardless of payer, beginning on October 1, 2024, rather than October 1, 2023 as originally proposed. We clarify for commenters that CMS did not make any proposals for policies related to publicly reporting IRF QRP data collected on non-Medicare patients. The age limit is 64, and the applicant must no longer have had premium-free Medicare Part A upon return to work. rendition of the daily Federal Register on FederalRegister.gov does not An IRF-PAI for each patient discharged from the IRF must be submitted no later than 11:59 p.m. the day of the quarterly submission deadline. Some insurance might have a cash value that a State might count against the limit. However, one commenter added a caveat stating that not all IRFs would have the statistical expertise or resources to implement this approach. for 2020 was similar to the cost weight in the 2016-based IRF market basket (59 percent). Sensory limitations can lead to confusion in new settings, increase isolation, contribute to mood disorders, and impede accurate assessment of other medical conditions. For this final rule, we have incorporated more recent historical data and forecasts to capture the price and wage pressures facing IRFs and believe it is the best available projection of inflation to determine the applicable percentage increase for the IRF payments in FY 2023. The effects of the budget-neutral changes to the CMG relative weights and ALOS values under the authority of section 1886(j)(2)(C)(i) of the Act. Our policy principles, as noted in the FY 2022 final rule (86 FR 42378), with regard to the wage index are to use the most updated data and information available. Act Statement and a Data Collection Information Summary available in both English and Spanish. As price increases work through the private sector, they eventually cause Medicare prices to rise too. Apply the budget neutrality factor from step 3 to the FY 2023 IRF PPS standard payment amount after the application of the budget-neutral wage adjustment factor. Additionally, commenters stated that the IPPS implemented a policy to address disparities between high and low wage index hospitals beginning in FY 2020 and requested that CMS adopt a similar adjustment to address wage index disparities under the IRF PPS. These refinements included the adoption of the Office of Management and Budget's (OMB's) Core-Based Statistical Area (CBSA) market definitions; modifications to the CMGs, tier comorbidities; and CMG relative weights, implementation of a new teaching status adjustment for IRFs; rebasing and revising the market basket index used to update IRF payments, and updates to the rural, low-income percentage (LIP), and high-cost outlier adjustments. CMS provides the Baseline Measures Report and Percentage Payment Summary Report to hospitals each fiscal year. We refer readers to the regulatory text at 412.634(b) for information regarding the current policies for reporting IRF QRP data. on 18-04, which superseded the April 10, 2018 OMB Bulletin No. We invited public comments on the proposed labor related share for FY 2023. Multiplying the standard deviation of the national average CCR computed in step 2 by a factor of 3 to compute a statistically significant reliable ceiling. So, we also recognize that predictability in Medicare payments is important to enable providers to budget and plan their operations. 17-01, which provided updates to and superseded OMB Bulletin No. Accessed 6/2/2022. The Common Agreement defines Individual Access Services (IAS) as with respect to the Exchange Purposes definition, the services provided utilizing the Connectivity Services, to the extent consistent with Applicable Law, to an Individual with whom the QHIN, Participant, or Subparticipant has a Direct Relationship to satisfy that Individual's ability to access, inspect, or obtain a copy of that Individual's Required Information that is then maintained by or for any QHIN, Participant, or Subparticipant. The Common Agreement defines IAS Provider as: Each QHIN, Participant, and Subparticipant that offers Individual Access Services. The MAC processes the claim through its software system. HHS generally uses a revenue impact of 3 to 5 percent as a significance threshold under the RFA. IRF Budget-Neutral Wage Adjustment Factor Methodology, E. Description of the IRF Standard Payment Conversion Factor and Payment Rates for FY 2023, F. Example of the Methodology for Adjusting the Prospective Payment Rates, VII. Typically, the facility-level adjustment factors have been updated on an intermittent basis to reflect changes in the costs of caring for patients. The following is a summary of the public comments received on the proposed revisions to the FY 2023 standard payment conversion factor and our responses: Comment: Therefore, we estimate that these updates would result in a net increase in estimated payments of $275 million from FY 2022 to FY 2023. Although some of these changes may not necessarily be specific to the IRF PPS, the nature of the Medicare program is such that the changes may interact, and the complexity of the interaction of these changes could make it difficult to predict accurately the full scope of the impact upon IRFs. In the FY 2018 IRF PPS final rule (82 FR 36250 through 36251), we adopted the updates set forth in OMB Bulletin No. Commenters also encouraged CMS to establish high standards for stratification and reliability. We received several comments on the concept of the HESS. It is possible that not all commenters reviewed the FY 2023 IRF PPS proposed rule in detail, and it is also possible that some reviewers chose not to comment on the FY 2023 proposed rule. Step 4. A complete discussion of the IRF PPS provisions appears in the original FY 2002 IRF PPS final rule (66 FR 41316) and the FY 2006 IRF PPS final rule (70 FR 47880) and we provided a general description of the IRF PPS for FYs 2007 through 2019 in the FY 2020 IRF PPS final rule (84 FR 39055 through 39057). The QMB or Qualified Medicare Beneficiary Program is a Medicare Savings Program. Federal Register We interpret the commenters to be referring to how the data collected would be used for public reporting and specifically those activities associated with public reporting, such as risk adjustment for publicly reported measures and the confidential facility-level quality measure reports IRFs receive prior to publishing results on Care Compare. InMedicare Part B, there is a common relationship of 80 percent coverage by Medicare and 20 percent by the client. Manage employees' benefits online. This software system includes pricing programming called the Pricer software. DOI On January 18, 2022, ONC announced a significant milestone by releasing the Trusted Exchange Framework and Common Agreement Version 1. Office of the Assistant Secretary for Planning and Evaluation (ASPE). [43] Response: The changes in the ALOS values for FY 2023, compared with the FY 2022 ALOS values, are small and do not show any particular trends in IRF length of stay patterns. We appreciate the input provided by commenters. We disagree that this policy, if finalized, would take time away from patient care. In the Medicare Program; Prospective Payment System for Inpatient Rehabilitation Facilities final rule that appeared in the August 7, 2001 The commenter also stated that hospitals have had to increase quantities of materials such as PPE, which the commenter stated is not captured in the market basket forecasts. documents in the last year, 44 Additionally, we welcomed ideas and suggestions as to what could be driving the changes observed in these adjustment factors from year-to-year. In addition, section 1102(b) of the Act requires us to prepare an RIA if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. IRFs will be required to report these data with respect to admission and discharge for all patients, regardless of payer, discharged between October 1, 2024 and December 31, 2024. 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