ACTION
Final Rule.
SUMMARY
This final rule will update the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs). These changes will be applicable to IPF discharges occurring during the fiscal year (FY) beginning October 1, 2014 through September 30, 2015. This final rule will also address implementation of ICD-10-CM and ICD-10-PCS codes; finalize a new methodology for updating the cost of living adjustment (COLA), and finalize new quality measures and reporting requirements under the IPF quality reporting program.
UNIFIED AGENDA
FY 2015 Inpatient Psychiatric Facilities Prospective Payment System--Rate Update (CMS-1606-P)
2 actions from May 6th, 2014 to June 30th, 2014
TABLE OF CONTENTSBack to Top
- DATES:
- FOR FURTHER INFORMATION CONTACT:
- SUPPLEMENTARY INFORMATION:
- Table of Contents
- Acronyms
- I. Executive Summary
- A. Purpose
- B. Summary of the Major Provisions
- C. Summary of Impacts
- II. Background
- A. Annual Requirements for Updating the IPF PPS
- B. Overview of the Legislative Requirements for the IPF PPS
- C. General Overview of the IPF PPS
- III. Provisions of the Proposed Regulations and Responses to Comments
- IV. Changing the IPF PPS Payment Rate Update Period From a Rate Year to a Fiscal Year
- V. Market Basket for the IPF PPS
- A. Background
- B. Development of an IPF-Specific Market Basket
- C. FY 2015 Market Basket Update
- D. Labor-Related Share
- VI. Updates to the IPF PPS for FY 2015 (Beginning October 1, 2014)
- A. Determining the Standardized Budget-Neutral Federal Per Diem Base Rate
- B. FY 2015 Update of the Federal Per Diem Base Rate and Electroconvulsive Therapy (ECT) Rate
- VII. Update of the IPF PPS Adjustment Factors
- A. Overview of the IPF PPS Adjustment Factors
- B. Patient-Level Adjustments
- 1. Adjustment for MS-DRG Assignment
- 2. Payment for Comorbid Conditions
- Direct Conversion of Comorbidity Categories
- Use of the General Equivalence Mappings to Assist in Direct Conversion
- Conversion of Gangrene and Uncontrolled Diabetes Mellitus With or Without Complications Comorbidity Categories
- Conversion of the Gangrene Comorbidity Category
- Conversion of the Uncontrolled Diabetes Mellitus With or Without Complications Comorbidity Category
- Other Differences between ICD-9-CM and ICD-10-CM Affecting Conversion of Comorbidity Categories
- Conversion of the Drug and/or Alcohol Induced Mental Disorders Comorbidity Category
- Conversion of the Poisoning Comorbidity Category
- Proposed Elimination of Codes for Nonspecific Conditions Based on Side of the Body (Laterality)
- 3. Patient Age Adjustments
- 4. Variable Per Diem Adjustments
- C. Facility-Level Adjustments
- 1. Wage Index Adjustment
- a. Background
- b. Wage Index for FY 2015
- c. OMB Bulletins
- 2. Adjustment for Rural Location
- 3. Teaching Adjustment
- a. FTE Intern and Resident Cap Adjustment
- b. Temporary Adjustment to the FTE Cap To Reflect Residents Added Due to Hospital Closure
- c. Temporary Adjustment to FTE Cap To Reflect Residents Affected by Residency Program Closure
- i. Receiving IPF
- ii. IPF That Closed Its Program
- 4. Cost of Living Adjustment for IPFs Located in Alaska and Hawaii
- 5. Adjustment for IPFs With a Qualifying Emergency Department (ED)
- D. Other Payment Adjustments and Policies
- 1. Outlier Payments
- a. Update to the Outlier Fixed Dollar Loss Threshold Amount
- b. Update to IPF Cost-to-Charge Ratio Ceilings
- 2. Future Refinements
- VIII. Inpatient Psychiatric Facilities Quality Reporting (IPFQR) Program
- 1. Statutory Authority
- 2. Application of the Payment Update Reduction for Failure to Report for the FY 2015 Payment Determination and Subsequent Years
- 3. Covered Entities
- 4. Considerations in Selecting Quality Measures
- 4. Considerations in Selecting Quality Measures
- 5. Quality Measures
- a. Quality Measures for the FY 2016 Payment Determination and Subsequent Years
- 1. Assessment of Patient Experience of Care
- 2. Use of an Electronic Health Record
- b. Quality Measures for the FY 2017 Payment Determination and Subsequent Years
- 1. Influenza Immunization (IMM-2) (NQF #1659)
- 2. Influenza Vaccination Coverage Among HealthCare Personnel (NQF #0431)
- 3. Tobacco Use Screening (TOB-1) (NQF #1651)
- 4. Tobacco Use Treatment Provided or Offered (TOB-2) and Tobacco Use Treatment (TOB-2a) (NQF #1654)
- c. Summary of Measures
- d. Additional Procedural Requirements for the FY 2017 Payment Determination and Subsequent Years
- e. Maintenance of Technical Specifications for Quality Measures
- 6. New Quality Measures for Future Years
- 7. Public Display and Review Requirements
- 8. Form, Manner, and Timing of Quality Data Submission
- a. Procedural and Submission Requirements
- b. Reporting Periods and Submission Timeframes
- c. Population, Sampling, and Minimum Case Threshold
- d. Data Accuracy and Completeness Acknowledgement (DACA) Requirements
- 9. Reconsideration and Appeals Procedures
- 10. Exceptions to Quality Reporting Requirements
- IX. Provisions of the Final Regulations
- X. Collection of Information Requirements
- A. ICRs Regarding the Inpatient Psychiatric Facilities Quality Reporting (IPFQR) Program
- B. FY 2014 and FY 2015 Burden Adjustments (OCN 0938-1171, CMS-10432)
- C. ICRs Regarding the Hospital and Health Care Complex Cost Report (CMS-2552-10)
- D. ICRs Regarding Exceptions to Quality Reporting Requirements
- E. Submission of PRA-Related Comments
- XI. Comments Beyond the Scope of the Final Rule
- XII. Regulatory Impact Analysis
- A. Statement of Need
- B. Overall Impact
- C. Anticipated Effects
- 1. Budgetary Impact
- 2. Impact on Providers
- 3. Results
- 4. Effects of Updates to the IPF QRP
- 5. Effect on Beneficiaries
- D. Alternatives Considered
- E. Accounting Statement
- Addendum A—Rate and Adjustment Factors
- Addendum B—FY 2015 CBSA Wage Index Tables
- Addendum C
- Footnotes
