The significance of the information (including, but not limited to health literacy, transportation, race, ethnicity, social isolation, high-risk medications) will assist IRFs in supporting patients as they make health decisions. These refinements included the adoption of the Office of Management and Budget's (OMB's) Core-Based Statistical Area (CBSA) market definitions; modifications to the CMGs, tier comorbidities; and CMG relative weights, implementation of a new teaching status adjustment for IRFs; rebasing and revising the market basket index used to update IRF payments, and updates to the rural, low-income percentage (LIP), and high-cost outlier adjustments. However, the revisions affect the distribution of payments within CMGs and tiers. This is a bad outcome because the state governments have freedom to adjust the income and assets that they consider. documents in the last year, 507 The impact analysis in Table 14 of this final rule represents the projected effects of the updates to IRF PPS payments for FY 2023 compared with the estimated IRF PPS payments in FY 2022. L. 104-4), Executive Order 13132 on Federalism (August 4, 1999), and the Congressional Review Act (5 U.S.C. Viner, R.M., Ozer, E.M., Denny, S., Marmot, M., Resnick, M., Fatusi, A., & Currie, C. (2012). PACIO Functional Status Implementation Guide. We believe that codifying these longstanding policies would improve clarity and reduce administrative burden on IRF providers and others trying to locate all relevant information pertaining to the teaching hospital adjustment. We disagree that this policy, if finalized, would take time away from patient care. Start Printed Page 47083. It has held the Marketplace Operations Support contract for the Center for Consumer Information and Insurance Oversight (CCIIO) since 2013, providing technical assistance to the Affordable Care Acts Federal Health Insurance Marketplace. The only federal welfare program that benefits undocumented immigrants is Medicaid. AIR experts will also provide one-on-one support to clinicians to help them understand their specific reporting requirements, exemption qualifications, and performance reports. Closure of an IRF's residency training program To this end, as discussed in the FY 2021 IRF PPS proposed (85 FR 22075 through 22079) and final (85 FR 48434 through 48440) rules, we adopted the revised OMB delineations identified in OMB Bulletin No. The Qualified Medicare Beneficiary Program can cover premiums, deductibles, copays, and coinsurance. Start Printed Page 47063 With relief aimed at persistent costs like deductible, copays, and coinsurance, Original Medicare subscribers can have a lot of relief from costs and expenses. Start Printed Page 47076 We note, however, that these data would not be used by CMS for purposes of updating the IRF PPS payment rates annually. We will notify stakeholders when the draft IRF PAI is available. (2) 13-01. Section 4003 of the Cures Act required HHS to take steps to advance interoperability through the development of a trusted exchange framework and common agreement aimed at establishing full network-to-network exchange of health information nationally. documents in the last year, by the International Trade Administration Sections 3004(b) of the PPACA and section 411(b) of the MACRA (Pub. https://www.hl7.org/fhir/. Start Printed Page 47053. Response: of this final rule as follows: However, among adolescents with a major depressive episode with severe impairment, only about 46.9 percent received treatment. https://www.bls.gov/oes/current/oes_nat.htm). Hello, and welcome to Protocol Entertainment, your guide to the business of the gaming and media industries. Response: Another commenter believes CMS excluded several healthcare personnel who are contributors to the IRF-PAI collection in addition to disregarding crucial administrative complexities associated with IRF-PAI submission, which in turn underestimated the overall cost and burden. We will adopt a permanent cap policy in order to smooth the impact of year-to-year changes in IRF payments related to certain changes to the IRF wage index, as discussed in section VI. Additionally, we believe that applying a 5-percent cap on all wage index decreases would support Sign up to get the latest information about your choice of CMS topics. Table 4 shows the FY 2023 final labor-related share and the FY 2022 final labor-related share using the 2016-based IRF market basket relative importance. OMB issued further revised CBSA delineations in OMB Bulletin No. As we do not have an IRF-specific wage index, we are unable to determine the degree, if any, to which a geographic reclassification adjustment or a rural floor policy under the IRF PPS would be appropriate. For an individual provider, these fluctuations can be difficult to predict. We continue to believe that maintaining the outlier pool at 3 percent of aggregate IRF payments optimizes the extent to which we can reduce financial risk to IRFs of caring for highest-cost patients, while still providing for adequate payments for all other non-outlier cases as discussed in the FY 2002 IRF PPS final rule (66 FR 41362 through 41363). (i) The application of the wage index is made on the basis of the location of the facility in an urban or rural area as defined in 412.602. After considering the public comments received, for the reasons discussed above and in the FY 2023 IRF PPS proposed rule (87 FR 20254), we are finalizing our proposal to begin collection of IRF-PAI assessment on each patient receiving care in an IRF, regardless of payer. In response to the solicitation of comments about challenges IRFs anticipate in the adoption of the NHSN HA-CDI measure, we received one comment about the challenges posed by the adoption of new terminology to end users as well as the challenges associated with implementing new technology into IRF workflows. To compute the wage-adjusted prospective payment, we multiply the labor portion of the Federal payment by the appropriate wage index located in the applicable wage index table. In addition, we constructed five special CMGs to account for very short stays and for patients who expire in the IRF. Completion of patient assessment instrument. We will use this information from public commenters in conjunction with our future analysis for potential rulemaking. This final rule codifies CMS' existing teaching status adjustment policy through amendments to the regulation text and updates and clarifies the IRF teaching status adjustment policy with respect to IRF hospital closures and displaced residents. Lastly, regarding commenters' concerns about payment adequacy under the IRF PPS, MedPAC did a full analysis of payment adequacy for IRF providers in its March 2022 Report to Congress ( Comment: The Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP) is authorized by section 1886(j)(7) of the Act, and it applies to freestanding IRFs, as well as inpatient rehabilitation units of hospitals or Critical Access Hospitals (CAHs) paid by Medicare under the IRF PPS. CMS also provides hospitals with a Mortality and Complication Hospital-Specific Report (HSR) and a Medicare Spending per Beneficiary (MSPB) HSR for each fiscal years performance period. We proposed that the portion of Capital-Related costs that are influenced by the local labor market is 46 percent. Many individuals and families are dual eligible and get benefits from both major programs. In particular, the commenter was concerned that the methods used to estimate inflation in IRF spending are not capturing the pandemic-initiated shocks to the health care market that are significantly driving up costs, especially labor, across the spectrum of hospital inputs. Based on individual or family usage of medical services and benefits. While every effort has been made to ensure that Specifically, we were concerned that incentives might exist for IRFs to discharge patients prematurely, as well as to admit patients that may not be able to endure intense inpatient therapy services. ensure that CMS has full and complete data in order to assess the relative quality of care provided by IRFs to all patients, and to better evaluate the quality of care received by Medicare patients, including whether disparities appear to exist. One commenter stated having an all-payer policy in place in some, but not all PAC settings, limits the ability of providers and consumers to interpret the information. Start Printed Page 47085 This estimated net increase includes the effects of the IRF market basket increase factor for FY 2023 of 3.9 percent, which is based on a IRF market basket update of 4.2 percent, less a 0.3 percentage point productivity adjustment, as required by section 1886(j)(3)(C)(ii)(I) of the Act. Using the national mean hourly wage data from the May 2021 BLS for Occupational Employment Statistics (OES) for medical and health service managers (SOC 11-9111), we estimate that the cost of reviewing this rule is $115.22 per hour, including overhead and fringe benefits ( Official websites use .govA However, these updates would affect the distribution of payments across providers. Adjustment for area wage levels. (e) regulatory information on FederalRegister.gov with the objective of Start Printed Page 47080 Since then, 4 additional years have passed and CMS has provided a number of educational resources and training materials for IRFs to take advantage of, reducing the burden to IRFs in creating their own training resources. For cost reporting periods beginning on or after October 1, 2011, an IRF may receive a temporary adjustment to its FTE cap to reflect displaced residents added because of another IRFs closure if the IRF meets the following criteria: ( Set by annual income and number of household members, there is a large difference between states that either did or did not expand Medicaid. As we have discussed in the proposed rule, we believe this methodology would maintain the IRF PPS wage index as a relative measure of the value of labor in prescribed labor market areas, increase the predictability of IRF PPS payments for providers, and mitigate instability and significant negative impacts to providers resulting from significant changes to the wage index. of the FY 2023 IRF PPS proposed rule. 11/03/2022, 243 Additionally, commenters recommended that changes in the outlier threshold should be limited to changes in the market basket in a given year. We received one comment on the information provided in this section. We estimate the effects that comorbidities have on costs. Tebb, K.P., Pica, G., Twietmeyer, L., Diaz, A., & Brindis, C.D. Relatedly, some suggested strategies include establishing a minimum case count for IRFs or pooling data across years. Medicare patients are currently given a Privacy Act Statement and therefore one would be given to every patient under the IRF QRP. Section 1135 of the Act authorizes the Secretary to waive or modify only statutory provisions and regulations that pertain to the specific types of requirements that are enumerated under section 1135(b) of the Act. 21. The system limits data access to authorized users and monitors such users to ensure against unauthorized data access or disclosures. It was not an estimate of burden associated with the transition from the IRF-PAI version 3.0 to the IRF-PAI version 4.0 (that is, the collection of new data elements) since this burden was accounted for in the FY 2020 IRF PPS proposed and final rules (84 FR 17333 and 84 FR 39166). [40] Go365 is not an insurance product. Divide the amount calculated in step 1 by the amount calculated in step 2 to determine the budget neutrality factor of 0.9979 that would maintain the same total estimated aggregate payments in FY 2023 with and without the changes to the CMG relative weights. It was viewed 866 times while on Public Inspection. Medicare Insurance, DBA of Health Insurance Associates LLC, Specified Low-income Medicare Beneficiary Program, Qualified Disabled and Working Individuals Program, Reside in the state where the applicant makes the request, Investments( stocks, bonds, Certificates of ownership). of the proposed rule, we discuss the method for applying the 2 percentage point reduction to IRFs that fail to meet the IRF QRP requirements. Step 2. As described in section X.F.2.c. https://www.cms.gov/newsroom/fact-sheets/cms-data-element-library-fact-sheet. Using this method, we proposed a national CCR ceiling of 1.40 for FY 2023. Section 1886(b)(3)(B)(xi)(II) of the Act sets forth the definition of this productivity adjustment. One commenter stated that the rising labor costs over the last several years mean that IRFs may be particularly undercompensated given that the IHS Global Inc. market basket forecast uses more generalized hospital goods and services, and fails to account for the specialized training and experience IRFs require of their therapists, nurses, and other clinicians, who in turn require a higher salary than those in a more generalized hospital setting. Effects of Codification and Clarifications of IRF Teaching Status Adjustment Policy, 9. Performance period means the time period during which data are collected for the purpose of calculating hospital performance on measures with respect to a fiscal year. We proposed to make changes to the current IRF teaching status adjustment policy related to displaced residents as discussed below. Approvals give the precise dates that they take effect. Find answers to many of your My Health Paysrewards program questions below: Once you complete a qualifying healthy activity, we are notified, and your card will be mailed to you. Some commenters were concerned about CMS' timeline for collecting data on all IRF patients. In the proposed rule we noted that if finalized as proposed, we would revise the IRF-PAI in order for IRFs to submit data pursuant to the finalized policy. establishing the XML-based Federal Register as an ACFR-sanctioned and services, go to Section 1886(j)(6) of the Act requires the Secretary to adjust the proportion of rehabilitation facilities' costs attributable to wages and wage-related costs (as estimated by the Secretary from time to time) by a factor (established by the Secretary) reflecting the relative hospital wage level in the geographic area of the rehabilitation facility compared to the national average wage level for those facilities. The below-listed descriptions cover the basics of the Medicare Savings Programs. 2. Relatedly, one commenter noted that collecting assessment data on subsets of populations could be interpreted as providing different levels of care. Patient assessment instrument record retention. As discussed in further detail in section XIII.C.2. However, we believe the FY 2021 data reflect changes in IRF utilization related to the PHE and will therefore be more likely to reflect IRF utilization in FY 2023, as COVID-19 will continue to impact IRFs in the future. We are also finalizing updates to the data reporting requirements for the IRF QRP and corresponding amendments to the regulations consistent with these requirements. The analysis above, together with the remainder of this preamble, provides an RIA. We discuss the calculation of the standard payment conversion factor for FY 2023 in section VI.E. A few commenters emphasized the importance of disability status and recommended CMS define, collect standardized data for, and measure disability status, particularly for IRF care access and outcomes. Assuming an average reading speed, we estimate that it would take approximately 3 hours for the staff to review half of this final rule. Response: For more discussion regarding the methodology for adjusting the caps for the receiving IRF and the IRF that closed its program, refer to the FY 2012 IRF PPS final rule (76 FR 47847). The QMB is a Medicare Savings Program for low-income individuals and families that cansave a lot of money. Table 10 shows the potential estimated impacts of updating the facility-level adjustments for FY 2023. the authority for data collection is given under section 1886(j)(2)(D) of the Act, which authorizes the Secretary to collect the data necessary to establish and administer the IRF PPS, and to help evaluate whether the IRF meets quality standards and gives appropriate healthcare to its patients. The next 12 rows of Table 14 contain IRFs categorized according to their geographic location, designation as either a freestanding hospital or a unit of a hospital, and by type of ownership; all urban, which is further divided into urban units of a hospital, urban freestanding hospitals, and by type of ownership; and all rural, which is further divided into rural units of a hospital, rural freestanding hospitals, and by type of ownership. https://www.healthit.gov/sites/default/files/page/2022-01/Common_Agreement_for_Nationwide_Health_Information_Interoperability_Version_1.pdf. While it is true that there are approximately 106 response options for these 21 new data elements, we want to note that three of the new items have a response option (None of the above) IRFs can select for patients who are not receiving special nutritional approaches, high-risk drug classes, and special treatments, procedures, and programs. As noted previously in this final rule, section 1886(j)(3)(C) of the Act requires the Secretary to update the IRF PPS payment rates by an increase factor that reflects changes over time in the prices of an appropriate mix of goods and services included in the covered IRF services and section 1886(j)(3)(C)(ii)(I) of the Act requires the Secretary to apply a productivity adjustment to the market basket increase factor for FY 2023. Opioids are frequently prescribed to children and adolescents after surgery or major injury. We establish a permanent cap policy to smooth the impact of year-to-year changes in IRF payments related to decreases in the IRF wage index. Availability of Certain Information Through the Internet on the CMS Website, A. Statutory Basis and Scope for IRF PPS Provisions, B. The system limits data access to authorized users and monitors such users to ensure against unauthorized data access or disclosures. The OIG recommends that the IRF PPS should update its transfer payment policy, similar to the IPPS transfer payment policy, to include home health. We acknowledge that this assumption may understate or overstate the costs of reviewing this final rule. We will update the IRF PPS payment rates for FY 2023 by the market basket increase factor, based upon the most current data available, with a productivity adjustment required by section 1886(j)(3)(C)(ii)(I) of the Act, as described in section VI. Response: We received several comments on the concept of the HESS. The IRF QRP currently has 18 measures for the FY 2023 program year, which are set out in Table 11. Several commenters were generally supportive of the inclusion of the PACCOVID-19 Vaccination Coverage among Patients measure in the IRF QRP. We received several comments on this RFI, which are summarized below: Comment: This repetition of headings to form internal navigation links As the commenter pointed out in their example, after the patient assessment is completed, the IRF-PAI is coded with the information and submitted to iQIES, and it is these steps (after the patient assessment) that the estimated burden and cost captures. That is, we have continued to calculate the facility-level adjustment factors using the following the steps: (Steps 1 and 2 are performed independently for each of three years of IRF claims data). Response: the official SGML-based PDF version on govinfo.gov, those relying on it for You can find past Hospital VBP Program value-based incentive payment adjustment factors as posted in Table 16B: The payment adjustment factors are listed by CMS Certification Number (CCN). We invited public comment on our proposals regarding the Wage Adjustment for FY 2023. Sign In. Therefore, in the absence of IRF-specific data, we believe that the highly skilled hospital workforce captured by the ECI for hospital workers (inclusive of therapists, nurses, other clinicians, etc.) Another commenter challenged CMS statutory authority to require IRFs to submit the data, stating they believe CMS' proposal violates the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, the Privacy Act of 1974 (5 U.S.C. A number of commenters suggested the 5-percent cap be applied in a non-budget neutral manner. One commenter noted that larger facilities may have more resources to invest in this area, and as such, perform better than smaller facilities on this type of measure. HHS generally uses a revenue impact of 3 to 5 percent as a significance threshold under the RFA. There are 146 IRFs located in rural areas included in our analysis. notice was published on February 3, 2022 (87 FR 6175) to extend the information collection request (ICR). 23. As stated in the FY 2023 IRF proposed rule, we also proposed that if more recent data became available, we would use such data, if appropriate, to determine the FY 2023 labor-related share for the final rule. [45] of this final rule, we discuss the use of the existing methodology to calculate the standard payment conversion factor for FY 2023. One commenter opposes the proposal to collect IRF QRP information on all patients regardless of payer because they are concerned that Medicare Administrative Contractors (MACs) may inappropriately access PAI information without authority to do so. In column 6 of Table 14, we present the effects of the budget-neutral permanent cap on wage index decreases policy.
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