Final rule increases proposed payments to inpatient rehab and psychiatric facilities
For both, CMS is modifying the COVID-19 Vaccination Coverage Among Healthcare Personnel measure that will affect the 2025 payments.
Photo: SolStock/Getty Images
The Centers for Medicare and Medicaid Services has issued final rules updating inpatient rehabilitation and psychiatric facility payments that are higher than what was proposed in April.
Overall inpatient rehab payments will increase by 4%, or $355 million, and total estimated payments to inpatient psychiatric facilities are estimated to increase by 2.3%, or $70 million, under the final rules released late Thursday.
For 2024, CMS is updating the Inpatient Rehabilitation Facility Prospective Payment System payment rates by 3.4% based on a market basket update of 3.6% reduced by a 0.2 percentage point productivity adjustment.
In addition, the final rule contains an adjustment to the outlier threshold to maintain outlier payments at 3% of total payments. CMS estimates this adjustment will result in a 0.6 percentage point increase in outlier payments.
Inpatient psychiatric facility payments are estimated to increase by 2.3%, or $70 million, in 2024 relative to 2023. CMS is updating the payment rates by 3.3%, based on the final 2021-based IPF market basket increase of 3.5% less a 0.2 percentage point productivity adjustment.
Additionally in the IPF rule, CMS is updating the outlier threshold so that estimated outlier payments remain at 2% of total payments. CMS estimates that updating the outlier threshold will result in a 0.9% decrease to aggregate payments. Due to rounding, the 3.3% increase to payment rates and the 0.9% decrease due to outlier payment changes result in a 2.3% overall increase in IPF payments.
WHY THIS MATTERS
In a proposed rule released in April, CMS proposed to update the inpatient rehabilitation facility payment rates by 3% based on the proposed market basket update of 3.2%, less a proposed 0.2 percentage point productivity adjustment.
In the April proposed rule for inpatient psychiatric facilities, payments were estimated to increase by 1.9%, or $55 million in 2024, relative to 2023. For 2024, CMS proposed to update the payment rates by 3%, based on the proposed 2021-based Inpatient Psychiatric Facility market basket increase of 3.2%, less a proposed 0.2 percentage point productivity adjustment.
THE LARGER TREND
The market basket used to update IPF PPS payments has been rebased and revised to reflect more recent data on IPF cost structures. CMS last rebased and revised the IPF market basket in the 2020 final rule.
For 2024, CMS is adopting a 2021-based IPF market basket and finalizing changes to the market basket cost weights, price proxies, the market basket percentage increase and labor-related share.
Additionally, the rule modifies regulations to allow hospitals to open and begin billing Medicare for an excluded IPF unit anytime within the cost reporting year. CMS said it believes this will help increase access to essential inpatient psychiatric services and available beds.
For the IPF Quality Reporting Program, CMS is adopting four new measures, modifying one existing measure, removing two existing measures, and adopting and implementing a data-validation pilot.
Three of the measures being adopted will help integrate information about facility commitment to health equity and social drivers of health data into IPF quality performance measurement. One being adopted is a patient experience survey measure.
CMS is also finalizing two new measures and is modifying another measure for the IRF Quality Reporting Program. In addition, CMS is finalizing the removal of three measures, and is finalizing one public reporting policy.
For both rehab and psychiatric facilities, CMS is modifying the COVID-19 Vaccination Coverage Among Healthcare Personnel measure, beginning with the fourth quarter of this year and affecting the FY 2025 payment determination. The current version of this measure reports only on whether healthcare personnel had received the primary vaccination series for COVID-19, while the modification of this measure would require IPFs to report the cumulative number of HCP who are up-to-date with recommended COVID-19 vaccinations in accordance with the CDC's most recent guidance.
CMS has proposed the same modification to this measure for other quality reporting programs, including, but not limited to, acute care hospitals and long-term care hospitals.
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
