on Individual providers determine the staffing resources necessary; therefore, we averaged the national average for these labor types and established a composite cost estimate. Commenters expressed support for CMS's intention to standardize data collection for all patients. Although not explicitly stated in the regulations, our current policy is that a displaced resident is one that is physically present at the hospital training on the day prior to or the day of hospital or residency program closure. http://www.cms.gov/manuals/downloads/clm104c25.pdf. Subject to the aforementioned proposal becoming final, we also proposed to revise the regulation text at 412.624(e)(1) to provide that starting October 1, 2022, CMS would apply a cap on decreases to the wage index such that the wage index applied is not less than 95 percent of the wage index applied to that IRF in the prior year. Assuming an average reading speed, we estimate that it would take approximately 3 hours for the staff to review half of this final rule. Addiction is a neuropsychological disorder characterized by a persistent and intense urge to engage in certain behaviors, often usage of a drug, despite substantial harm and other negative consequences.Repetitive drug use often alters brain function in ways that perpetuate craving, and weakens (but does not completely negate) self-control. Next, we compute the wage-adjusted Federal payment by adding the wage-adjusted labor amount to the non-labor portion of the Federal payment. For FY 2023, we proposed to change the IRF policy pertaining to displaced residents resulting from IRF closures and closures of IRF residency teaching programs. Go365 is not an insurance product and is not available with all Humana health plans. Step 3. documents in the last year, 79 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. Relevant information about this document from Regulations.gov provides additional context. In acknowledgement of the opioid crisis, these items were carefully considered, and stakeholder comment was specifically sought prior to adopting these items in light of those concerns. The assessment of these special services, treatments, and interventions in IRFs is important to ensure the continuing appropriateness of care for the pediatric or adolescent patients receiving them, and to support care transitions from one PAC provider to another, to an acute care hospital, or to discharge. https://www.cms.gov/files/zip/cms-irf-pai-manual-version-40-effective-october-1-2022.zip. These updates are effective for FY 2023, https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps. Thus, the adjusted payment for Facility A would be $28,817.54, and the adjusted payment for Facility B would be $28,257.27. We do not anticipate a financial impact associated with the codification of the IRF teaching status adjustment policies. Step 2. Comment: The proposed revisions were outlined in the regulation text of the proposed rule. The QMB is a Medicare Savings Program for low-income individuals and families that cansave a lot of money. Closure of an IRF's residency training program The Common Agreement defines Individual Access Services (IAS) as with respect to the Exchange Purposes definition, the services provided utilizing the Connectivity Services, to the extent consistent with Applicable Law, to an Individual with whom the QHIN, Participant, or Subparticipant has a Direct Relationship to satisfy that Individual's ability to access, inspect, or obtain a copy of that Individual's Required Information that is then maintained by or for any QHIN, Participant, or Subparticipant. The Common Agreement defines IAS Provider as: Each QHIN, Participant, and Subparticipant that offers Individual Access Services. This methodology is not dependent on Medicare claims to determine AIF compliance. (c) Furthermore, to maintain consistency with the IPPS IME policy, we proposed that the letter must also include: (2) The last four digits of each displaced resident's social security number; this will reduce the amount of personally identifiable information (PII); (3) The name of the IRF and the name of the residency program or programs in which each resident was training at previously; and. First, IRFs located in urban areas are categorized for their location within a particular one of the nine Census geographic regions. The estimated impacts of each policy described in this rule to the facility categories listed are shown in the columns of Table 14. Start Printed Page 47041 IRFs will be required to report these data with respect to admission and discharge for all patients, regardless of payer, discharged between October 1, 2024 and December 31, 2024. Depression in Children and Adolescents: Evaluation and Treatment. IRF specific CCRs are used in the development of the CMG relative weights and the calculation of outlier payments under the IRF PPS. The income must be in the range of the federal poverty guideline as adjusted by the review standards. Based on IGI's fourth quarter 2021 forecast with historical data through the third quarter of 2021, the proposed 2016-based IRF market basket increase factor for FY 2023 was projected to be 3.2 percent. If the patient returns to the IRF in 4 or more consecutive days (that is, it is not considered an interrupted stay), then all of the required documentation must be completed as with any new IRF patient. However, the regulatory changes in this proposal are necessary to correct an error and do not establish any new substantive rules. Another commenter referenced CMS Office of the Actuary analysis that compares the private non-farm multifactor productivity growth measure and a hospital-specific measure ( Over the past five years, we have worked collaboratively with CMS to explain the MIPS program, improve communications about policies and procedures, and provide support and technical assistance to clinicians who participate in the program, said David Baker, senior vice president for the AIR Health Division. 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. CMS does not expect to align rules with private insurers, since the completion of the IRF-PAI is for purposes of meeting the IRF QRP data collection requirements. Rewards have no cash value and can only be redeemed in the Go365 Mall. We also want to point out that the estimated burden included in section XI.B. Centers for Medicare & Medicaid Services. It is a user-requested and on-demand report, meaning that it can be pulled anytime by the IRF. These data are the most current and complete data available at this time. The Journal of the Academy of Nutrition and Dietetics is the premier source for the practice and science of food, nutrition, and dietetics. We believe the commenters are referring to the ASPE Issue Brief (HP-2022-13, May 3, 2022), titled One commenter had concerns that the proposed market basket forecast is neither accurately nor adequately capturing the unique factors influencing the hospital and health care market today in general, and the market in which IRFs compete specifically. Additionally, the IRF final rule is required for the implementation of a Federal program within CMS' authority. Therefore, we will update the outlier threshold amount from $9,491 for FY 2022 to $12,526 for FY 2023 to account for the increases in IRF PPS payments and estimated costs and to maintain estimated outlier payments at approximately 3 percent of total estimated aggregate IRF payments for FY 2023. In addition, the IMPACT Act requires assessment data to be standardized and interoperable to allow for exchange of the data among post-acute providers and other providers. corresponding official PDF file on govinfo.gov. Register documents. This commenter stated that they believe CMS should have included pharmacists and physicians in its cost estimate in addition to increasing the percentage of time physical therapists (PTs) and occupational therapists (OTs) are involved in the process. documents in the last year, 1391 Using IGI's fourth quarter 2021 forecast, the 10-year moving average growth of TFP for FY 2023 was projected to be 0.4 percent. Major depression. Response: In response to the question of whether IRFs would support utilizing EHRs as the mechanism of data collection and submission for IRF QRP measures, we received several supportive comments, citing the increased accuracy by relying on both microbiologic evidence of C. diff in stool and evidence of antimicrobial treatment using data derived from the electronic health record (EHR) and decreased provider burden associated with a digital measure. We refer readers to the regulatory text at 412.634(b) for information regarding the current policies for reporting IRF QRP data. One commenter provided a table showing the current estimates of the FY 2021 and FY 2022 IRF market basket increases (2.7 percent and 3.8 percent, respectively) relative to the FY 2021 and FY 2022 IRF market basket increases implemented in the final rules (2.4 percent and 2.6 percent, respectively). has the same meaning as a displaced resident as defined in 413.79(h)(1)(iii) as applied to an IRF, for purposes of accounting for indirect teaching costs. Second, by removing the link between the status of displaced residents and their presence at the closing IRF or residency program on the day prior to or the day of the IRF closure or program closure, we proposed to also allow the residents assigned to and training at planned rotations at other IRFs who will be unable to return to their rotations at the closing IRF or program and individuals (such as medical students or would-be fellows) who matched into resident programs at the closing IRF or residency program, but have not yet started training at the closing IRF or residency program, to be considered a displaced resident. Generally, OMB issues major revisions to statistical areas every 10 years, based on the results of the decennial census. Statements in languages other than English contained in the advertisement do not necessarily reflect the exact contents of the policy written in English, because of possible linguistic differences. [38] See CMS's Medicare Coverage Center Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. documents in the last year, 24 of this final rule, the FY 2023 labor-related share is 72.9 percent, which is the same as the labor-related share for FY 2022. to the courts under 44 U.S.C. 15-01 provides detailed information on the update to statistical areas since February 28, 2013. An IRF that agrees to train displaced residents who have been displaced by the closure of another IRF's program may receive a temporary FTE cap adjustment only if the hospital with the closed program temporarily reduces its FTE cap based on the FTE of displaced residents in each program year training in the program at the time of the programs closure. As discussed in section VIII. At that time, CMS did not finalize the majority of the standardized patient assessment data element proposals in recognition of the concern raised by many commenters that we were moving too fast to adopt the data elements. For IRFs using certified health IT systems, how can existing certification criteria under the Office of the National Coordinator (ONC) Health Information Technology (IT) Certification Program support reporting of this data? If an IRF is aware of inappropriate use of IRF-PAI data by MACs, we urge them to contact CMS' Privacy Office at With these policy principles in mind, for the FY 2023 proposed rule, we considered how best to address the potential scenarios about which commenters raised concerns in the FY 2022 final rule around IRF payment volatility; that is, scenarios in which changes to wage index policy may significantly affect Medicare payments. Other commenters appreciated that collecting all-payer data will allow IRF QRP measures to include all patients regardless of payer status to ensure representation of the quality of services provided on the population as a whole, rather than a subset limited to Medicare, and one commenter agreed with CMS that the inclusion of all-payer data will more accurately reflect the quality of care provided to IRF patients. of this final rule. Leaving AARP.org Website Close. In accordance with section 1886(d)(3)(E) of the Act, the FY 2023 pre-reclassification and pre-floor hospital wage index is based on data submitted for hospital cost reporting periods beginning on or after October 1, 2018, and before October 1, 2019 (that is, FY 2019 cost report data). Download the Buckeye Health Plan app to stay updated about the My Health Pays program and your rewards. The Department of Health and Human Services (HHS) has a number of initiatives designed to encourage and support the adoption of interoperable health information technology and to promote nationwide health information exchange to improve health care and patient access to their electronic health information. Section 1886(j)(3)(C)(ii)(I) of the Act requires the application of the productivity adjustment described in section 1886(b)(3)(B)(xi)(II) of the Act. [42] Beginning in FY 2014, section 1886(j)(7)(A)(i) of the Act requires the application of a 2-percentage point reduction to the market basket increase factor otherwise applicable to an IRF (after application of paragraphs (C)(iii) and (D) of section 1886(j)(3) of the Act) for a FY if the IRF does not comply with the requirements of the IRF QRP for that FY. We appreciate the suggestions to use FY 2019 data and not FY 2021 claims data in determining the outlier threshold for FY 2023. [3637]. [6] Table 7 illustrates the components of the adjusted payment calculation. The commenters stated that with higher rates of inflation, the currently used TFP measure will prove especially harmful to hospitals. The remainder of this response discusses the appropriateness of each of these item categories in the pediatric populations in more detail. Comment: In column 7 of Table 14, we present the effects of the budget-neutral update of the CMG relative weights and ALOS values. First, rather than link the status of displaced residents for the purpose of the receiving IRF's request to increase their FTE cap to the resident's presence at the closing IRF or program on the day prior to or the day of the residency program or IRF closure, we proposed to link the status of the displaced residents to the day that the closure was publicly announced (for example, via a press release or a formal notice to the Accreditation Council on Graduate Medical Education). We calculate the adjusted outlier threshold by adding the IRF PPS payment for the case (that is, the CMG payment adjusted by all of the relevant facility-level adjustments) and the adjusted threshold amount (also adjusted by all of the relevant facility-level adjustments). The Public Inspection page may also Therefore, CMS did not propose to adopt the revised OMB delineations identified in OMB Bulletin No. https://www.nimh.nih.gov/health/statistics/major-depression.shtml#part_155031. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues: This final rule refers to associated information collections that are not discussed in the regulation text contained in this document. Open for Comment, Economic Sanctions & Foreign Assets Control, National Oceanic and Atmospheric Administration, Taking Additional Steps To Address the National Emergency With Respect to the Situation in Nicaragua, Lowering Prescription Drug Costs for Americans. IRFs would be required to collect and submit the QRP data for all patients in the same manner and method they are accustomed to for patients with Medicare and Medicare Advantage. Beginning with the FY 2006 IRF PPS final rule (70 FR 47908 through 47917), the market basket index used to update IRF payments was a market basket reflecting the operating and capital cost structures for freestanding IRFs, freestanding inpatient psychiatric facilities (IPFs), and long-term care hospitals (LTCHs) (hereinafter referred to as the rehabilitation, psychiatric, and long-term care (RPL) market basket). To check your balance, login to your Secure Portal account. Individual applications are subject to eligibility requirements. Based on IGI's second quarter 2022 forecast of the 2016-based IRF market basket, the sum of the FY 2023 relative importance for Wages and Salaries, Employee Benefits, Professional Fees: Labor-related, Administrative and Facilities Support Services, Installation Maintenance & Repair Services, and All Other: Labor-related Services is 69.2 percent. The Qualified Medicare Beneficiary program can change the experience of participants and provide substantial relief from persistent costs. This variable was added to control for differences in cost structure between hospital-based and freestanding IRFs in the regression analysis, so that these differences would not inappropriately influence the adjustment factor estimates. We believe that data reporting on standardized patient assessment data elements using the IRF-PAI should include all IRF patients for the same reasons we believe that collecting data on Medicare beneficiaries for the IRF QRP's quality measures is important: to achieve equity in healthcare outcomes for our beneficiaries by supporting providers in quality improvement activities, enabling them to make more informed decisions, and promoting provider accountability for healthcare disparities. For Texas residents: Insured or offered by Humana Insurance Company, HumanaDental Insurance Company or DentiCare, Inc (d/b/a Compbenefits). If regulations impose administrative costs on private entities, such as the time needed to read and interpret this final rule, we should estimate the cost associated with regulatory review. It will improve the IRF QRP's ability to assess IRF quality and allow the IRF to foster better-quality care for patients regardless of the payer source. of the proposed rule, we proposed to update the data reporting requirements for the IRF QRP beginning with the FY 2025 IRF QRP. The attachment to OMB Bulletin No. We use the best data available, but we do not attempt to predict behavioral responses to these changes, and we do not make adjustments for future changes in such variables as number of discharges or case-mix. In the FY 2012 IRF PPS final rule, we also adopted the IPPS definition of closure of a hospital at 413.79(h)(1)(i) to refer to circumstances in which the IRF terminates its Medicare provider agreement, as specified in 489.52. An extraordinary situation may be due to, but is not limited to, fires, floods, earthquakes, or similar unusual events that inflect extensive damage to an inpatient facility. 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