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Tags Posts tagged with "PPS"

PPS

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Last week, the Centers for Medicare and Medicaid Services (CMS) released the Fiscal Year (FY) 2026 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) proposed rule, as well as an accompanying fact sheet. The rule does not include proposed changes to the IRF coverage requirements. On the payment side, the rule would provide an overall 2.8% increase to estimated payments per discharge, compared to the 2.5% payment update that CMS finalized for FY 2025. The rule is more substantive with respect to the future Quality Reporting Program (QRP) changes. Specifically, the rule proposes to remove certain quality measures and standardized patient assessment data elements (SPADE) implemented in recent years relating to COVID-19 vaccination and social determinants of health (SDOH), and to modify the process for reconsideration of IRF QRP non-compliance penalties. Finally, the rule includes various requests for information (RFI), soliciting feedback on the IRF QRP and IRF-Patient Assessment Instrument (PAI).

The proposed rule will be published in the Federal Register on April 30, 2025. RCPA will provide a more detailed overview of the proposed rule following this date. Comments on the rule are due to CMS by June 10, 2025.

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NOTE TO INSPECTOR: The word "iridium" on the pen's nib is not a brand: it's the name of the metal of which the nib is made. Thanks. Inky old fountain pen on a $100 bill.

The Medicare Payment Advisory Commission (MedPAC) held their regular public meeting on January 16 – 17, 2025. During one of their presentations, “Assessing Payment Adequacy and Updating Payments: Skilled Nursing Facility Services; Home Health Agency Services; Inpatient Rehabilitation Facility Services; Outpatient Dialysis Services; and Hospice Services,” there was a draft recommendation specific to inpatient rehabilitation facilities (IRF). The draft recommendation was for fiscal year 2026 and noted that Congress should reduce the 2025 Medicare base payment rate by 7 percent. The PowerPoint presentation is available here.

During this public meeting, MedPAC voted to finalize this recommended payment reduction to fiscal year 2026 IRF Prospective Payment System (PPS) payments. Both AMRPA and other national hospital stakeholders, on behalf of IRFs, strongly opposed this proposed payment cut (prior to the public meeting). However, MedPAC advanced the recommended cut with limited discussion about the potential impacts on patient access and IRF operations.

MedPAC’s recommendations do require Congressional action. As a result, advocacy will be planned to continue to voice concerns with this recommendation. Members will be kept apprised of any upcoming changes.

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The Centers for Medicare and Medicaid Services (CMS) will conduct the hospital/quality initiative open door forum (ODF) tomorrow, September 6, 2023, at 2:00 pm. Some of the agenda topics for the call include:

  • FY 2024 Inpatient Prospective Payment System (IPPS)/Long-Term Care Hospital (LTCH) Final Rule:
    • IPPS Payment Updates
    • LTCH Payment Updates
    • Wage Index Proposals
    • Rural Emergency Hospital (REH) Graduate Medical Education (GME) Proposal
    • New Technology Add-on Payment Proposals
    • Social Determinants of Health
    • Physician-Owned Hospital Proposal
    • Quality Updates
    • Hospital Value-Based Payment (VBP) Updates
  • FY 2024 IPF PPS Final Rule
  • Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) Podcast Now Available — Updates to HCAHPS Survey Mode Adjustments
  • Hospital Outpatient Department (OPD) Prior Authorization — Facet Joint Interventions

NEW and UPDATED Open Door Forum Participation Instructions:
This call will be a Zoom webinar. To participate by webinar, register here. After registering, you will receive a confirmation email containing information about joining the webinar.

Webinar ID: 160 121 2402
Passcode: 860132

Note that, although the ODFs are now a Zoom webinar, we will only use the audio function. There is no need for cameras to be on.

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