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CMS Issues Calendar Year 2020 ESRD/DMEPOS Proposed Rule

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The Centers for Medicare & Medicaid Services (CMS) has issued its proposed rule revising the end-stage renal disease (ESRD) prospective payment system (PPS) and policies related to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) for calendar year (CY) 2020. CHA has made available a detailed summary of the proposed rule, prepared by Health Policy Alternatives. Comments on the proposed rule are due Sept. 27.

2017-19 Hospital Fee Program Invoices Due Aug. 22

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Last week, the Department of Health Care Services (DHCS) sent hospitals invoices covering the first phase of managed care directed payments (MC2 DP(A)) for the 2017-19 Hospital Fee Program. The invoices cover July 1 – Dec. 31, 2017, and are due Aug. 22.

Updates for the Week of Aug. 5

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The Centers for Medicare & Medicaid Services this week released the following information:

Reminder: Aug. 15 Deadline for Inpatient Rehabilitation Facility (IRF), Long-Term Care Hospital (LTCH), and Skilled-Nursing Facility (SNF) Quality Reporting Program Data Submission

IRF Quality Reporting Data Submission Deadlines
LTCH Quality Reporting Data Submission Deadlines
SNF Quality Reporting Program Data Submission Deadlines

Hospice CASPER Review and Correct Reports Available for Download

On Immigration Status, Caregivers Don’t Care

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Among the many tragedies born of the mass shooting in El Paso, Texas, which killed 22 and injured another two dozen, was the news that some victims might not have sought care at hospitals because of their immigration status.

This fear was so widespread that the West Texas wing of U.S. Customs and Border Protection tweeted: “We are not conducting enforcement operations at area hospitals, the family reunification center or shelters.”

CMS Issues Final Rule for FFY 2020 Hospice Payment

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The Centers for Medicare & Medicaid Services (CMS) has issued its final rule updating hospice payment rates for federal fiscal year (FFY) 2020. CMS finalizes a net payment increase of 2.6%, or $520 million, as compared to FFY 2019. The rule also rebases the rates hospices are paid for certain types of care. In addition, the rule modifies the beneficiary hospice election statement to reduce the time spent trying to obtain information needed for treatment decisions and accurate claims submissions.

CMS Issues FFY 2020 Long Term Care Hospital PPS Final Rule

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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

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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

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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