On July 31, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a rule finalizing updates for fiscal year (FY) 2019 to Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) and to the IPF Quality Reporting (IPFQR) Program. The final updates for FY 2019 are summarized below.
SUMMARY OF FINAL PAYMENT UPDATES
Update to IPF Payments: CMS estimates IPF payments to increase by 1.10 percent or $50 million in FY 2019. This amount reflects a 2.9 percent IPF market basket update less the productivity adjustment of 0.80 percentage point and less the 0.75 percentage point reduction required by law, for a net market basket update of 1.35 percent. Additionally, estimated payments to IPFs are reduced by 0.24 percentage point due to updating the outlier fixed-dollar loss threshold amount.
Wage Index: CMS is updating the IPF wage index for FY 2019.
TECHNICAL CORRECTIONS TO IPF REGULATIONS
CMS is implementing updates to regulation language that is out-of-date. This includes replacing references to 1) ICD-9-CM with references to the current ICD-10-CM and 2) the former Rehabilitation, Psychiatric, and Long-Term Care (RPL) market basket with references to the current IPF-specific market. These corrections do not change any existing policy.
MEANINGFUL MEASURES
Inpatient Psychiatric Facility Quality Reporting Program
The IPFQR Program is a pay-for-reporting program established by the Affordable Care Act. For FY 2019, CMS is finalizing removal of 5 IPFQR Program measures beginning with the FY 2020 payment determination and subsequent years. Three other measures that were originally proposed for removal (Physical Restraint Use, Seclusion Use, and Tobacco Use Treatment at Discharge) are being retained in the program as a result of overwhelming public comment that emphasized their importance for patient safety and health issues specific to the patient population.
|
Measure Name |
Removal Rationale |
|
Federal Data Registry Measure |
|
|
Influenza Vaccination Coverage Among Healthcare Personnel (NQF #0431) |
Costs associated with the measure outweigh the benefit of its continued use in the program |
|
Chart Abstracted Measures |
|
|
Alcohol Use Screening, SUB-1 (NQF #1661) |
Costs associated with the measure outweigh the benefit of its continued use in the program |
|
Tobacco Use Screening, TOB-1 (NQF #1651) |
Measure performance among IPFs is so high and unvarying that meaningful distinctions and improvements in performance can no longer be made (“topped-out”) |
|
Structural Web-Based Measures |
|
|
Use of an Electronic Health Record |
Costs associated with the measure outweigh the benefit of its continued use in the program |
|
Assessment of Patient Experience of Care |
Costs associated with the measure outweigh the benefit of its continued use in the program |
In addition, CMS is finalizing its proposal to no longer require facilities to submit sample size counts for measures for which sampling is performed beginning with the FY 2020 payment determination and subsequent years.
The FY 2019 IPF PPS final rule can be downloaded from the Federal Register at: www.federalregister.gov/public-inspection.