CMS Releases Proposed FY 2021 IRF PPS Rule Provides 2.9% Payment Update; Proposes New Forms of Regulatory Relief for IRFs Editor’s Note: Below is AMRPA’s preliminary summary of the recently released FY 2021 IRF PPS Proposed Rule sent out to members in the form of a special edition Off the Record newsletter. In the coming weeks AMRPA will continue with a deep dive into the rule. A more in-depth summary of the rule and AMRPA’s comment letter to CMS will be included in an edition of AMRPA Magazine later this summer. Should you or your hospital have any questions related to the rule, please contact AMRPA policy staff. On April 16, the Centers for Medicare and Medicaid Services (CMS) released the federal fiscal year (FY) 2021 Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) Proposed Rule and accompanying fact sheet. The rule will be published in the April 21, 2020 edition of the Federal Register. This Off the Record: Special Edition provides section-by-section highlights of the proposed rule. A more in-depth analysis will be included in an upcoming issue of the AMRPA Magazine, as well as other forms of member communication. Comments are due to CMS on June 15, 2020. CMS acknowledges the impact of the COVID-19 public health emergency and the demands facing the IRF industry, and for that reason, CMS states that it 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.” With respect to payment, CMS proposes to implement its annual updates to the weights and average lengths of stays for the IRF PPS Case Mix Groups (CMGs), update the standard payment conversion factor due to growth in the IRF market basket, and increase the labor-related share. CMS is also proposing to use updated delineations to determine hospitals’ wage index, which may result in notable changes for some providers (described more below). Overall, CMS estimates payments to IRFs will increase by 2.9 percent, or approximately $270 million nationwide in FY 2021. For reference, CMS finalized a 2.5 percent update in its final FY 2020 IRF PPS rule. CMS also proposes several policy changes, including: Amending the IRF coverage requirements to remove the post-admission physician evaluation (PAPE) requirement; Modifying the IRF coverage requirements to allow non-physician practitioners to perform certain services that are currently required to be performed by a rehabilitation physician, such as completing the pre-admission screening, developing the individual overall plan of care (IPOC), performing three face-to-face visits per week; and leading interdisciplinary team meetings. CMS is also proposing to allow non-physician practitioners to complete the review and concurrence of the preadmission screening; Codifying existing documentation instructions and guidance to ensure uniformity between the Medicare Benefit Policy Manual and applicable regulations; Clarifying that, for the purposes of the intensity of therapy requirement, a “week” would be defined as a period of 7 consecutive calendar days beginning with the date of admission to the IRF For IRFs that fail to comply with quality data submission requirements for the purposes of the IRF quality reporting program (QRP), CMS proposes to apply a 2 percent reduction to the applicable FY 2021 market basket increase factor used to calculate an adjusted FY 2021 standard payment conversion factor. Such reductions to the market basket increase factor are not cumulative and will only apply to a particular FY. This is the only provision impacting the QRP in the FY 2021 rule. CMS notes that some of these proposed regulatory relief measures have been waived as part of the COVID-19 public health emergency, and that CMS will “use this experience to determine whether” several of these requirements “can be removed permanently to reduce paperwork burden for hospitals and clinicians while improving quality of care for patients.”
28 AMRPA Magazine / May 2020
COVID-19 Special Issue
