|
FACT
SHEET
April
17, 2020
Contact:
CMS Media Relations
Fiscal
Year (FY) 2021 Inpatient Rehabilitation Facilities (IRF) Prospective
Payment System (PPS) (CMS-1729-P)
On
April 16, 2020, the Centers for Medicare & Medicaid Services (CMS)
issued a proposed rule that updates Medicare payment policies and
rates for facilities under the Inpatient Rehabilitation Facility
Prospective Payment System (IRF PPS) for fiscal year (FY) 2021. The IRF
PPS proposed rule is one of five proposed Medicare payment rules
released on a fiscal year cycle to define payment and policy for
inpatient hospitals, long-term care hospitals, inpatient rehabilitation
facilities, inpatient psychiatric facilities, skilled nursing
facilities, and hospices. As with these other rules, CMS
is publishing this proposed rule consistent with the legal
requirements to update Medicare payment policies for inpatient
rehabilitation facilities on an annual basis. In recognition of the
significant impact of the COVID-19 public health emergency, and
limited capacity of health care providers to review and provide comment
on extensive proposals, CMS has limited annual IRF rulemaking required by
statute to essential policies including Medicare payment to IRFs, as
well as proposals that reduce provider burden and may help providers in
the COVID-19 response.
Coronavirus
Disease 2019 (COVID-19) Pandemic:
The
health and safety of America’s patients and provider workforce in the
face of the Coronavirus Disease 2019 (COVID-19) pandemic is the top
priority of the Trump Administration and CMS. We are working around the
clock to equip the American healthcare system with maximum flexibility to
respond to the COVID-19 pandemic. Recently, at President Trump’s
direction, CMS issued an unprecedented array of temporary regulatory
waivers and new rules to equip the American healthcare system with
maximum flexibility to respond to the COVID-19 pandemic, including
waiving the “60 percent” rule for patients admitted solely to respond to
the emergency and allowing the required face-to-face physician
visits in IRFs to be done using telehealth. In addition, to reduce
provider burden, CMS removed of the post-admission physician evaluation
requirement since much of the same information continues to be included
in the pre-admission screening of the patient and the patient’s plan of
care.
This
fact sheet discusses several provisions of the proposed rule: coverage
requirements, the post-admission physician evaluation, and payment
requirements. CMS is not proposing any changes to the IRF
Quality
Reporting
Program (QRP) for FY 2021.
Medicare
Inpatient Rehabilitation Facility Coverage Requirements:
In
order for an IRF claim to be considered reasonable and necessary under
section 1862(a)(1) of the Social Security Act, there must be a reasonable
expectation that the patient meets all of the IRF
coverage requirements at the time of the patient’s admission to the
IRF.
In
the FY 2021 IRF PPS proposed rule, CMS is proposing to allow
non-physician practitioners to perform any of the IRF coverage service
and documentation duties that are currently required to be performed by
a rehabilitation physician, provided that the duties are within the
non-physician practitioner’s scope of practice under applicable state
law. CMS is also soliciting comments from stakeholders on further ideas
to reduce provider burden, as well as on proposals to codify
subregulatory guidance on preadmission screening documentation and
certain other IRF coverage requirements.
Post-Admission
Physician Evaluation:
Currently,
except during the public health emergency for the COVID-19 pandemic, IRFs
are required to conduct a post-admission physician evaluation within the
first 24 hours of the patient’s admission to the IRF to confirm that
no changes have occurred since the preadmission screening, and that the
patient is still appropriate for IRF admission. CMS is proposing to no
longer require a post-admission physician evaluation since
the post-admission evaluation covers much of the same information as
continues to be included in the pre-admission screening of the patient
and the patient’s plan of care. IRFs, in consultation with the
patient's physician or other treating clinician, would still have
the flexibility to conduct patient visits within the first 24 hours
of an IRF admission if the patient's condition warrants it.
Updates
to IRF Payment Rates:
For
FY 2021, CMS is proposing updates to the IRF PPS payment rates using the
most recent data to reflect an estimated 2.5 percent increase factor
(reflecting an IRF market basket increase factor of 2.9 percent, reduced
by a 0.4 percentage point multifactor productivity adjustment). An additional
0.4 percent increase to aggregate payments due to updating the
outlier threshold to maintain estimated outlier payments at
3.0 percent of total payments results in an overall update of 2.9
percent (or $270 million) for FY 2021, relative to payments in FY
2020. We are also proposing to adopt the most recent Office of
Management and Budget (OMB) statistical area delineations and apply a 5
percent cap on wage index decreases from FY 2020 to FY 2021.
CMS
encourages comments on this proposed rule and will accept comments until
June 15, 2020. The proposed rule [CMS-1737-P] can be downloaded from
the Federal Register
at:
###
|
No comments:
Post a Comment