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Centers for Medicare and Medicaid Services adjusts payment policies for inpatient rehab, skilled nursing and hospice

IRF quality reporting measures will change, hospices would see a 2.1 percent, or $350 million, increase in their payments for fiscal year 2017.

Jeff Lagasse, Associate Editor

CMS Headquarters-Windsor Mill, MDCMS Headquarters-Windsor Mill, MD

The Centers for Medicare and Medicaid Services announced a number of payment and policy changes last week, addressing Medicare inpatient rehabilitation facilities, hospice benefit and skilled nursing facilities.

CMS is updating the inpatient rehab facilities prospective payment system payments for fiscal year 2017 to reflect an estimated 1.65 percent increase factor. That's based on an IRF-specific market basket estimate of 2.7 percent, reduced by a 0.3 percent multi-factor productivity adjustment, and a 0.75 percentage point reduction, which is required by law.

In addition, there will be about a 0.3 percent increase to aggregate payments, due to updating the outlier threshold results in an overall estimated update of around 1.9 percent -- or $145 million -- relative to payments in fiscal year 2016.

[Also: CMS raises payment to inpatient psychiatric facilities 2.2% in final 2017 rule]

There will be no changes to the facility-level adjustments. For fiscal year 2017, CMS will continue to maintain the facility-level adjustment factors at current levels, and will continue to monitor the most current IRF claims data available to assess the effects of the fiscal year 2014 changes. As it pertains to the Rural Adjustment Transition, CMS plans to continue year two of the phase-out of the 14.9 percent rural adjustment for IRF providers in areas that were designated as rural, then changed to urban under the new Office of Management and Budget delineations. These IRFs will receive one-third of the rural adjustment for fiscal year 2017, and no rural adjustment for fiscal year 2018 and thereafter.

The IRF Quality Reporting Program will also see some changes. The quality measures finalized for the fiscal year 2018 payment determination are Medicare spending per beneficiary, discharge to community and potentially preventable 30-Day post-discharge readmission. The quality measure finalized for the fiscal year 2020 payment determination is a drug regimen review conducted with follow-up for identified Issues.

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CMS is also adopting an additional measure, "Potentially Preventable within Stay Readmission for IRFs," for fiscal year 2018 payment determination and subsequent years. The group will begin publicly reporting IRF quality data in fall 2016 and has adopted an extension of the time frame for submission of exception and extension requests for extraordinary circumstances from 30 days to 90 days from the date of the qualifying event.

The federal agency also issued a final rule outlining fiscal year 2017 Medicare payment rates and wage index, and the Hospice Quality Reporting Program for hospices serving Medicare beneficiaries. As finalized, hospices would see a 2.1 percent, or $350 million, increase in their payments for fiscal year 2017.

[Also: CMS mandates new bundled payment program, will qualify as MACRA advanced payment model]

A final rule also provides a description of the Hospice CAHPS Survey, including the model of survey implementation, the survey respondents, eligibility criteria for the sample and the languages in which the survey is offered, among other details. It outlines participation requirements for the fiscal year 2019 and 2020 annual payment updates; for the 2019 APU, hospices must collect survey data on an ongoing basis from January through December of calendar year 2017. For the 2020 APU, hospices must collect survey data on an ongoing basis from January through December of calendar year 2018. The final rule also includes survey data submission deadlines for the fiscal year 2018, 2019 and 2020 APU periods. Public display of the survey results will not occur until CMS has collected at least four quarters of data; the agency anticipates that public display of the data will occur in 2017.

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Pertaining new hospice quality measures, the rule finalizes those quality measures and provides an update on the Hospice QRP, which is implementing two new quality measures for FY 2017. The first, Hospice Visits When Death is Imminent, is a measure that will assess hospice staff visits to patients and caregivers in the last three and seven days of life. The second, Hospice and Palliative Care Composite Process Measure, will assess the percentage of hospice patients who received care processes consistent with guidelines.

Finally, changes have been made to payment and policy for Medicare skilled nursing facilities. CMS projects that aggregate payments to SNFs will increase in fiscal year 2017 by $920 million, or 2.4 percent, from payments in 2016. This estimated increase is attributable to a 2.7 percent market basket increase reduced by 0.3 percentage points.

SNF Quality Reporting Program measures finalized for fiscal year 2018 include Medicare Spending Per Beneficiary, Discharge to Community and Potentially Preventable 30-Day Post-Discharge Readmission. The finalized 2020 quality measure is Drug Regimen Review Conducted with Follow-Up for Identified Issues.

Twitter: @JELagasse