CHA News

CMS Issues FFY 2020 Long Term Care Hospital PPS Final Rule

The Centers for Medicare & Medicaid Services (CMS) has issued the final rule for the long-term care hospital (LTCH) prospective payment system (PPS) for federal fiscal year (FFY) 2020. The provisions of the final rule will be effective Oct. 1, 2020.  

Below are highlights of the final rule.  

Payment Impact
As provided in the FFY 2016 final rule, LTCHs are reimbursed under a dual-rate system; patients who meet specified criteria are reimbursed by the LTCH PPS standard federal payment amount and remaining patients are reimbursed at the lower site-neutral payment rate. Implementation of the dual-rate payment system included a transition period during which facilities received a blended rate.  For cost reporting periods beginning in FFY 2020, the transition period will end and LTCHs will be paid exclusively on the site-neutral payment rate for patients who do not meet LTCH PPS criteria.   

Overall, CMS projects that LTCH PPS payments will increase by approximately 1%, or $43 million. For cases reimbursed at the site-neutral rate, CMS projects a decrease of approximately 5.9%.  

Quality Reporting/SPADEs
CMS finalizes several proposals relating to the LTCH 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 addressing transfer of health information and changes the existing “Discharge to Community” measure to exclude baseline nursing home residents. 

CDPH Notifies Nursing Facilities About Revised Minimum Data Set Section S Form

The California Department of Public Health has issued All Facilities Letter 19-25, notifying nursing facilities, skilled-nursing facilities, intermediate care facilities, and swing bed hospitals of revisions to two forms – the Minimum Data Set (MDS) 3.0 Section S form and the California Physician Orders for Life-Sustaining Treatment (POLST) form. Beginning Oct. 1, all Medicare and Medicaid health care facilities must use the revised MDS form specific to California.

CMS Releases Final, Proposed Rules

This week, CMS released the following rules: 

Inpatient Psychiatric Facility Prospective Payment System (PPS) Final Rule
Hospice Payment Final Rule 
Long-Term Acute Care Hospital PPS Final Rule

CMS Issues FFY 2020 Inpatient Psychiatric Facility PPS Final Rule

The Centers for Medicare & Medicaid Services (CMS) released its final rule for the federal fiscal year (FFY) 2020 inpatient psychiatric facility (IPF) prospective payment system (PPS).

CMS finalized a 2.9% market basket update, offset by reductions including a productivity adjustment of 0.4% and an Affordable Care Act-mandated 0.75% reduction, resulting in a payment increase of approximately 1.75%. After accounting for a $10 million decrease as a result of an update to the outlier threshold, CMS estimates overall payments will increase by $65 million compared to FFY 2019. CMS also finalized its proposals to revise and rebase the market basket to reflect a 2016 base year rather than a 2012 base year, and remove the one-year lag in wage index data used under the IPF PPS. As a result, CMS will apply the FFY 2020 pre-floor, pre-reclassified inpatient prospective payment system wage index data. 

For the IPF Quality Reporting Program, CMS finalized the adoption of one new measure — Medication Continuation Following Inpatient Psychiatric Discharge (National Quality Forum #3205) — beginning with the FFY 2021 payment determination and subsequent years.

The proposed rule is effective Oct. 1. Additional information is available in a CMS fact sheet.

CMS Issues FFY 2020 Skilled-Nursing Facility PPS Final Rule

The Centers for Medicare & Medicaid Services (CMS) has issued the federal fiscal year (FFY) 2020 final rule for the skilled-nursing facility prospective payment system (SNF PPS). The provisions in the proposed rules will be effective Oct. 1, 2020.

Highlights of the final rule include:  

  • Patricia Blaisdell, FACHE
    Vice President, Policy
  • Sheree Lowe
    Vice President, Policy