The Centers for Medicare & Medicaid Services (CMS) has issued the final rule for the inpatient rehabilitation facility prospective payment system (IRF PPS) for federal fiscal year (FFY) 2020. The provisions will be effective Oct. 1, 2020. According to CMS, this final rule represents continued movement toward the eventual transition to a unified post-acute care (PAC) PPS.
Below are highlights of the final rule.
As provided in the FFY 2019 final rule, CMS will reform the current IRF patient assessment and case-mix process by discontinuing the use of the functional independence measure (FIM), and instead incorporating similar data elements contained in Section GG of the IRF patient assessment instrument (IRF-PAI) for the purpose of assigning patients to a payment category, or case-mix group (CMG). Notably, in response to comments, CMS opts not to adopt a weighted motor score for CMG calculation.
The final rule updates the CMG relative weights and average length of stay values, and uses concurrent inpatient prospective payment system (IPPS) wage index data to align wage index data across settings of care. Overall, CMS projects that payments to IRFs will increase by 2.5%, or $210 million, as compared to FFY 2019, the result of a 2.9% market basket update, offset by statutorily mandated 0.4% cut for productivity.
CMS finalizes several proposals relating to the IRF Quality Reporting Program (QRP), including the addition of several standardized patient assessment data elements (SPADEs), several of which address social determinants of health. CMS also finalizes two new measures on transfer of health information, as well as a change to the existing “Discharge to Community” measure to exclude baseline nursing home residents. In response to comments, CMS does not finalize its proposal to collect IRF QRP data on all patients regardless of payer source.
For the first time, CHA members will be able to livestream the Disaster Planning for California Hospitals conference — taking place Sept. 10-11 in Pasadena — hearing and viewing the conference from the convenience of their own office or conference room. The livestream option allows multiple people to experience the conference with a single registration fee and no lodging or transportation expenses.
Last week, the Office of Statewide Health Planning and Development (OSHPD) sent a letter to hospitals that have not yet met the 2030 seismic safety requirements for all of their buildings, reminding them that they are required to submit to OSHPD, by Dec. 31, an attestation that their board of directors is aware of these requirements. The attestation can be sent via email to [email protected]
The Centers for Medicare & Medicaid Services (CMS) has issued its calendar year (CY) 2020 outpatient prospective payment system (OPPS) proposed rule, including significant proposals related to price transparency and changes to the hospital area wage index (AWI). Specifically, CMS would carry over hospital AWI policies proposed under the federal fiscal year 2020 inpatient PPS (IPPS) proposed rule, applying the finalized inpatient policies to outpatient payments.
Gov. Newsom has appointed Kelly Pfeifer, MD, as deputy director of mental health and substance use disorder services for the Department of Health Care Services (DHCS). Pfeifer has served as director of high-value care at the California Health Care Foundation since 2014, and was chief medical officer of San Francisco Health Plan from 2008 to 2014.
A new report from Covered California reflects its recent efforts to assess the performance of qualified health plans under current contract terms in preparation for updating standards and requirements in the fall.
The Department of Health Care Services has issued a draft report on primary, core specialty, and facility access to care for managed care beneficiaries, and requests stakeholder feedback by Aug. 19.
CHA has issued a summary — prepared by Health Policy Alternatives — of the proposed rule issued by the Centers for Medicare & Medicaid Services (CMS) that would establish two new mandatory payment models: the Radiation Oncology Model (RO model) and the End-Stage Renal Disease Treatment Choices Model.
CHA has submitted comments to the Department of Health Care Services (DHCS) on its draft proposal for value-based payments for behavioral health integration. In the letter, CHA applauds DHCS for recognizing the need to integrate primary and behavioral health services, and for taking steps to improve the health and wellness of those living with behavioral health challenges.
Earlier this month, the Assembly Appropriations Committee passed Senate Bill (SB) 778 (Committee on Labor, Public Employment and Retirement), which would extend the deadline for providing sexual harassment prevention training to Dec. 31, 2020. The bill is now pending on the Assembly Floor and should be heard when the Legislature returns the week of Aug. 12.