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CMS

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On March 31, 2022, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2023 inpatient rehabilitation facility prospective payment system (IRF PPS) proposed rule.

Some of the key provisions contained in this proposed rule include:

Proposed Updates to the FY 2023 IRF PPS Payment Policies
CMS is proposing to update the IRF PPS payment rates by 2.8 percent based on the IRF market basket update of 3.2 percent less than a 0.4 percentage point productivity adjustment. CMS is proposing that if more recent data becomes available (for example, a more recent estimate of the market basket update or productivity adjustment), they would use this data, if appropriate, to determine the FY 2023 market basket update and the productivity adjustment in the final rule. In addition, the proposed rule contains an adjustment to the outlier threshold to maintain outlier payments at 3.0 percent of total payments. This adjustment will result in a 0.8 percentage point decrease in outlier payments. The estimated overall IRF payments for FY 2023 would increase by 2.0 percent (or $170 million), relative to payments in FY 2022.

Proposed Permanent Cap on Wage Index Decreases
CMS is proposing a permanent 5 percent cap on annual wage index decreases to smooth year-to-year changes in providers’ wage index payments.

Soliciting Comments on the Office of Inspector General (OIG) Recommendation to Include Home Health in the IRF Transfer Policy
A recent Office of Inspector General (OIG) report that evaluated early discharges from IRFs to home health recommended that CMS expand the IRF transfer payment policy to apply to early discharges to home health. CMS is requesting feedback from stakeholders about potentially including home health in the IRF transfer payment policy, as recommended by OIG. CMS plans to analyze home health claims to determine the appropriateness of including home health in the IRF transfer policy, and is seeking comments to inform this future analysis and any potential future rulemaking.

Soliciting Comments on the Methodology for Updating the Facility-Level Adjustment Factors
CMS is seeking public comments regarding the methodology used to determine the facility-level adjustment factors and suggestions for what may be driving the variability in the IRF teaching status adjustment factor.

IRF Teaching Status Adjustment Policy
CMS is proposing to codify the longstanding IRF teaching status adjustment policy in regulation and clarify certain teaching status adjustment policies.

Proposed Updates to the IRF Quality Reporting Program (QRP)
The IRF QRP is a pay-for-reporting program. IRFs that do not meet reporting requirements are subject to a 2.0 percentage point reduction in their Annual Increase Factor (AIF). CMS is proposing one policy change and is initiating three Requests for Information (RFIs) related to the IRF QRP.

Quality Data Reporting on All IRF Patients Regardless of Payer
CMS is proposing to expand the IRF qualify data reporting requirements, which currently apply to all admitted IRF patients with Medicare Part A fee-for-service (FFS) and Medicare Part C, such that IRFs would begin collecting data on all IRF patients, regardless of payer. This policy proposal would help to ensure all IRF patients are receiving the same quality of care and that provider metrics reflect performance across the spectrum of IRF patients. CMS is proposing that this expanded quality reporting requirement would take effect starting with the FY 2025 IRF QRP, meaning providers would need to start collecting the IRF-Patient Assessment Instrument (PAI) assessment on all patients receiving care in an IRF, regardless of payer, beginning on October 1, 2023.

Inclusion of the National Healthcare Safety Network (NHSN) Healthcare-Associated Clostridioides difficile (C. difficile) Infection Outcome Measure in the IRF QRP — Request for Information (RFI)
CMS is seeking stakeholder feedback on the future inclusion of the National Healthcare Safety Network (NHSN) Healthcare-associated Clostridioides difficile Infection (HA-CDI) Outcome Measure as a digital quality measure in the IRF QRP. This measure tracks the development of new C. difficile infection among patients already admitted to IRFs, using algorithmic determinations from data sources widely available in electronic health records. This measure improves on the existing NHSN Facility-wide Inpatient Hospital-onset Clostridium difficile Infection (CDI) Outcome Measure (NQF #1717) by requiring both microbiologic evidence of C. difficile in stool and evidence of antimicrobial treatment. Through this RFI, CMS would like to assess the feasibility of this digital measure in IRFs. If this type of measure is proposed and finalized in a future rule, this would be the first digital measure in the IRF QRP.

Overarching Principles for Measuring Equity and Healthcare Quality Disparities Across CMS Quality Programs — Request for Information (RFI)
CMS is committed to achieving equity in health care outcomes for beneficiaries. In this RFI, CMS provides an update on the equity work that is occurring across CMS. Included are: plans to expand the quality reporting programs to allow CMS to provide more actionable, comprehensive information on health care disparities; measuring health care disparities through quality measurement and reporting these results to providers; and providing an update on our methods and research around measure development and disparity reporting.

The proposed rule will be published in the April 6 Federal Register. Comments on the proposed rule are due by May 31, 2022.

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Webinar: How Blended, Braided or Sequenced Funding Can Help Drive Employment, Equity and Inclusion
Tuesday, March 22 | 3:00pm–4:30pm ET
Register for the webinar.

The Administration for Community Living, along with federal partners at the Department of Labor, Department of Education, and the Social Security Administration, invite you to attend a federal interagency webinar hosted by the LEAD Center.

Demand for workplace talent is high. Remote work opportunities may be with us to stay. These conditions offer new opportunities for expanded access to workforce activities for people with disabilities.

To ensure that workforce programs are ready to meet this demand and can support job seekers and career changers equitably, programs often need to draw on a range of different funding sources. The ability to blend, sequence, or braid funding with other resources becomes an essential ingredient to support employment, equity, and inclusion. Yet each source of funding usually comes with specific goals, target populations, and performance indicators.

In this federal interagency webinar hosted by the LEAD Center, state practitioners across the workforce system will discuss how they successfully applied innovative, collaborative resource sharing that benefits both businesses and job seekers with disabilities.

Contact Dallas Oberlee with questions.

ACL/CMS Promising Practices Webinar Series: Rethinking Day Services —The Without Walls Approach
Thursday, March 24 | 3:00 pm–4:30 pm ET
Register for the webinar.

This webinar will provide insight into how a without walls approach can be used as part of a COVID-19 response strategy, how to train staff to shift from center-based services to community-based services, and what a without walls approach looks like in practice. For more info, please visit this link.

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The purpose of the Office of Developmental Programs (ODP) Bulletin 00-22-01 is to communicate and clarify the requirements for Targeted Support Management (TSM) that were approved by the Centers for Medicare and Medicaid Services (CMS). Changes to TSM discussed in this bulletin include:

  • Expansion of TSM services, effective August 20, 2017, to individuals with autism.
  • Expansion of TSM services, effective July 1, 2021, to children age 8 or younger with a developmental disability who are eligible for Medical Assistance (MA) and who have been determined to need an Intermediate Care Facility for Other Related Conditions (ICF/ORC) level of care.
  • Expansion of TSM services, effective July 1, 2021, to individuals age 0 through 21 with a medically complex condition that is a chronic health condition that affects three or more organ systems, and that the individual requires medically necessary skilled nursing intervention to execute medical regimens to use technology for respiration, nutrition, medication administration, or other bodily functions. Individuals must be eligible for MA and have been determined to need an ICF/ORC level of care.
  • Clarification regarding the use of the LifeCourse framework and tools.
  • Clarification of expected assessment activities and the development of the Individual Support Plan (ISP).
  • Addition of enhanced qualification requirements for TSM providers and Targeted Support Manager Supervisors.
  • Clarification that individuals who are enrolled in and receiving case management services under any Home and Community-Based Services (HCBS) program administered via an 1115, 1915(b) and (c), or 1915(a), (b), or (c) waiver are not eligible to receive TSM.

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The Centers for Medicare and Medicaid Services (CMS) recently released a revised Medicare Learning Network (MLN) resource, Medicare Payment Systems, to reflect the 2022 regulation changes to payment, quality, and policy for all health settings. These include acute care hospitals, inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), home health, hospital outpatient, inpatient psychiatric facility, long-term care hospitals (LTCHs), ambulatory surgical centers (ASCs), and durable medical equipment, prosthetics, orthotics & supplies (DMEPOS).

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The Centers for Medicare and Medicaid Services (CMS) has announced a redesigned Accountable Care Organization (ACO) model that better reflects the agency’s vision of creating a health system that achieves equitable outcomes through high quality, affordable, person-centered care. The ACO Realizing Equity, Access, and Community Health (REACH) Model, a redesign of the Global and Professional Direct Contracting (GPDC) Model, addresses stakeholder feedback, participant experience, and Administration priorities, including CMS’ commitment to advancing health equity.

In addition to transitioning the GPDC Model to the ACO REACH Model, CMS is canceling the Geographic Direct Contracting Model (also known as the “Geo Model”), effective immediately. The Geographic Direct Contracting Model, which was announced in December 2020, was paused in March 2021 in response to stakeholder concerns. A comparison table of ACO REACH and GDCM is available for additional information.

CMS, through the Innovation Center, is testing new models of health care service delivery and payment to improve the quality of care that people receive, including those in underserved communities. The Innovation Center is making improvements to existing models and launching new models to increase participation in our portfolio, and CMS will be a strong collaborator to health care providers that participate in those models.”

As CMS works to achieve the vision outlined for the next decade of the Innovation Center, CMS wants to work with partners who share its vision and values for improving patient care, guided by three key principles. First, any model that CMS tests within Traditional Medicare must ensure that beneficiaries retain all rights that are afforded to them, including freedom of choice of all Medicare-enrolled providers and suppliers. Second, CMS must have confidence that any model it tests works to promote greater equity in the delivery of high-quality services. Third, CMS expects models to extend their reach into underserved communities to improve access to services and quality outcomes. Models that do not meet these core principles will be redesigned or will not move forward.

REACH ACOs will be responsible for helping all different types of health care providers — including primary and specialty care physicians — work together, so people get the care they need when they need it. In addition, people with Traditional Medicare who receive care through a REACH ACO may have greater access to enhanced benefits, such as telehealth visits, home care after leaving the hospital, and help with co-pays. They can expect the support of the REACH ACO to help them navigate an often complex health system.

The GPDC Model will continue until December 31, 2022, and then will transition to the ACO REACH Model. The first performance year of the redesigned ACO REACH Model will start on January 1, 2023, and the model performance period will run through 2026. CMS is releasing a Request for Applications for provider-led organizations interested in joining the ACO REACH Model. Current participants in the GPDC Model must agree to meet all the ACO REACH Model requirements by January 1, 2023, in order to participate.

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The Centers for Medicare and Medicaid Services (CMS) has released the updated Inpatient Rehabilitation Facility (IRF) Provider Preview Reports. These reports contain provider performance scores for quality measures and contain data submitted by IRFs from Quarter 3 (Q3) 2020 through Quarter 2 (Q2) 2021.

Providers have until February 25, 2022, to review their performance data. Providers can request CMS review their data during the preview period if they believe the scores are inaccurate. The final reports will be published on Care Compare and Provider Data Catalog (PDC) during the March 2022 refresh of the websites. For additional information, visit the CMS IRF QRP Public Reporting website.

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