CMS Releases FY 2020 Payment Rules / by AzHHA

Debbie Johnston, Senior Vice President of Policy Development

The Centers for Medicare & Medicaid Services (CMS) has released the proposed FY 2020 Medicare payment rules for inpatient prospective payment system (IPPS) hospitals, inpatient psychiatric facilities (IPF), inpatient rehabilitation facilities (IRF), long-term acute care (LTAC) hospitals, skilled nursing facilities (SNF), and hospice. AzHHA members will received detailed analyses in the coming weeks, including their facility-specific estimated impacts. A short overview of each rule follows:

IPPS

The IPPS rule contains a net payment increase of 3.2% in FY 2020, compared to FY 2019, for hospitals that are meaningful users of electronic health records and submit quality measure data. Additionally, the rule makes changes to Disproportionate Share Hospital payments, new technology payments, the area wage index and quality incentive programs. Comments are due June 24th.

IPF

IPF rule contains a net payment increase of 1.7% and proposes one quality measure on medication continuation following discharge and requests comment on future topics for measurement. CMS will accept comments on through June 17th.

IRF

Under the IRF rule, net payments would increase 2.3% relative to FY 2019. The rule provides more detail about the revised IRF case mix groups (CMGs) that take effect in FY 2020 and provides updated impact data per IRF on the refined CMGs. CMS also proposes modifying one measure and adding two new process measures to the IRF Quality Reporting Program (QRP), and adopting 22 standardized patient assessment data elements, plus seven more data elements related to social determinants of health. In addition, the agency proposes to require IRFs to report patient assessment data for the QRP for all patients, regardless of payer. Comments are due June 17th.

LTAC

Under the proposed LTAC rule, payments would increase by $37 million as compared to FY 2019. CMS also proposes to modify its quality measures to include, among other changes, seven more data elements related to social determinants of health. Comments will be accepted through June 24th.

SNFs

CMS proposes a net payment increase of 2.5% compared to FY 2019. The rule also would implement a new SNF payment model that was finalized in last year’s rulemaking, which is expected to improve payments to hospital-based SNFs in FY 2020. For the SNF Quality Reporting Program, CMS proposes to modify one measure, adopt two new process measures and 22 standardized patient assessment data elements, plus seven more data elements related to social determinants of health. Comments are due June 18th.

Hospice

Payment for hospice would increase by 3.2%, but this would be adjusted downward by a statutorily-required 0.5% productivity factor. The rule would also rebase the rates hospices are paid for certain types of care. In addition, the rule would modify the beneficiary hospice election statement by adding more information on the coverage implications of electing the benefit. CMS will accept comments through June 18th.