From Advancing States newsletter:
In May 2021, CMS released a final rule regarding vaccination education, access, and reporting for residents and staff of nursing and care facilities for individuals with intellectual and developmental disabilities. Recently, CMS sent detailed implementation guidelines to the state agencies responsible for overseeing ICFs/IID. This memo details the responsibilities of ICFs/IID within the new guidelines.
Click here to learn more.
On July 20, 2021, the Centers for Medicare and Medicaid Services (CMS) issued the fiscal year (FY) 2022 inpatient rehabilitation facility prospective payment system (IRF PPS) final rule. This final rule updates the Medicare payment policies and rates for IRFs, as well as the policies under the IRF Quality Reporting Program (QRP). CMS also finalizes a Medicare Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) payment provision adopted in an interim final rule with comment period (IFC) issued on May 11, 2018, as well as a provision that was included in a DMEPOS proposed rule published in the Federal Register on November 4, 2020. Other key provisions included in this final rule include:
Updates to IRF Payment Rates:
CMS updates the IRF PPS payment rates by 1.9 percent based on the IRF specific market basket estimate of 2.6 percent, less a 0.7 percentage point productivity adjustment. In addition, the final rule contains an adjustment to the outlier threshold to maintain outlier payments at 3 percent of total payments. This adjustment will result in a 0.4 percentage point decrease in outlier payments.
IRF QRP Final Rule Updates:
The IRF QRP is a pay-for-reporting program. IRFs that do not meet reporting requirements are subject to a two-percentage point reduction in their annual increase factor. CMS is adopting one measure and finalizing its proposal to update the specifications for another measure. In addition, CMS is finalizing its proposal to modify the number of quarters used for public reporting of IRF quality measures due to the public health emergency and sought comments for two Requests for Information (RFI).
Closing the Health Equity Gap – RFI:
CMS is working to make health care quality more transparent to consumers and providers, enabling them to make better choices as well as promoting provider accountability around health equity. CMS’s ongoing commitment to closing the health equity gap in IRFs has been demonstrated by the adoption of standardized patient assessment data elements, which include several social determinants of health (SDOH) that were finalized in the FY 2020 IRF PPS final rule for the IRF QRP (84 FR 39149 through 39161).
CMS sought feedback in this RFI on ways to attain health equity for all patients through policy solutions and has indicated that they would take all comments received into consideration as they continue to address and develop policies on this topic. The provision of stratified measure results will allow IRFs to understand how they are performing with respect to certain patient risk groups and to support these providers in their efforts to ensure equity.
COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) Measure:
In the ongoing efforts to address the COVID-19 public health emergency (PHE), CMS is finalizing the adoption of the COVID-19 Vaccination Coverage among HCP Measure. This measure is designed to help assess whether IRFs are taking steps to limit the spread of COVID-19 among their HCP, reduce the risk of transmission within their facilities, and help sustain the ability of IRFs to continue serving their communities through the PHE and beyond. Public reporting of the COVID-19 Vaccination Coverage among HCP measure will begin with the September 2022 Care Compare refresh or as soon as technically feasible based on data collected for Q4 2021 (October 1, 2021 through December 31, 2021).
Transfer of Health (TOH) Information to the Patient-Post Acute Care (PAC) Quality Measure:
CMS is finalizing updates to the denominator for the TOH Information to the PAC quality measure. Currently, the measure denominators for both the TOH Information to the Patient-PAC and to the Provider-PAC quality measures include patients discharged home under the care of an organized home health service organization or hospice. In order to avoid counting these patients in both TOH measures, CMS is removing this location from the definition of the denominator for the TOH Information to the Patient-PAC measure.
Public Reporting of Quality Measures with Fewer than Standard Numbers of Quarters Due to COVID-19 PHE Exemptions:
In March 2020, and in response to the COVID-19 PHE, CMS granted an exception to the IRF QRP requirements for calendar year Q1 2020 (January 1, 2020–March 31, 2020) and Q2 2020 (April 1, 2020–June 30, 2020). CMS also stated that any IRF QRP data that might be significantly impacted in terms of measure reportability and reliability by these exceptions would not be publicly reported for Q1 and Q2 of 2020 due to the absence of useable data these exceptions created. CMS is finalizing its proposal to update the number of quarters used for public reporting to account for this exception.
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Policy Issues:
Exclusion from Fee Schedule Adjustments for Accessories (Including Seating Systems) and Seat and Back Cushions Furnished in Connection with Group 3 or Higher Complex Rehabilitative Power Wheelchairs and Complex Rehabilitative Manual Wheelchairs
CMS is finalizing an exclusion from fee schedule adjustments based on information from the DMEPOS Competitive Bidding Program (CBP) for wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with group 3 or higher complex rehabilitative power wheelchairs. CMS is also extending this fee schedule adjustment exclusion to wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with complex rehabilitative manual wheelchairs. Additionally, CMS is modifying the regulatory definition of “item” under the DMEPOS CBP at 42 CFR 414.402 to exclude complex rehabilitative manual wheelchairs and certain other manual wheelchairs and related accessories when furnished in connection with these wheelchairs from the DMEPOS CBP, as required by section 106(a) of the 2020 Further Consolidated Appropriations Act.
All of the provisions contained in this final rule will be reviewed and discussed in greater detail at the upcoming RCPA Outpatient Rehabilitation Committee and Medical Rehabilitation Committee meetings.
On August 11, 2021, from 2:00 pm–3:30 pm, the Centers for Medicare and Medicaid Services (CMS) will host a webinar on Price Transparency focusing on how hospitals can meet the requirements that were included in the Hospital Price Transparency final rule for posting standard charge information in the comprehensive machine-readable file.
Effective January 1, 2021, each hospital operating in the United States is now required to provide publicly accessible standard charge information online about the items and services they provide in two ways:
CMS will also review the document, “8 Steps to a Machine-Readable File of All Items & Services,” and highlight specific good and bad examples of hospital compliance.
Registrants should use this link to register in advance of this webinar:
Meeting ID: 160 926 0288
Passcode: 971693
After registering, you will receive a confirmation email containing information about joining the webinar.
US: +1 669 254 5252 or +1 646 828 7666 or 833 568 8864 (Toll Free)
Webinar ID: 160 926 0288
Passcode: 971693
The accompanying presentation will be available here approximately one week prior to the webinar. For additional information regarding hospital price transparency, please review the information on our website including the following resources.
Feedback and questions regarding the Hospital Price Transparency Final Rule can be sent here.
The Centers for Medicare and Medicaid Services has issued a revised nursing home guidance that provides updated guidance for visitation in nursing homes during the COVID-19 public health emergency, including the impact of the COVID-19 vaccination. As a result of this guidance, the Department of Human Service issued a notification to long-term care facilities, personal care homes, and assisted living residences in Pennsylvania to implement this guidance immediately.
CMS sent out QSO-21-14 this week. It gives some extensive expectations on visitation (outdoor, indoor, virtual, compassionate care), COVID-19 testing of staff/clients/visitors, communal dining and activities, survey considerations, and recommended resources. Additionally, Kevin Dressler sent the following updates:
Incident Management Bulletin
Reminder: We sent out the draft IM bulletin a few months ago and have not received any feedback. I would love to hear everyone is fine with the way the IM bulletin is written; however we fully expect some comments. The Bulletin mirrors the IM bulletin for the 6400 covered locations for the private ICFs and has some increased requirements for the public ICFs (state centers). Please send all comments to Chris Blauser by March 15, 2021. Thank you.
Vaccine Administration
We want to verify that all ICFs have established a provider to administer COVID vaccines to the people served and staff at each of your ICF locations; if you do not have a provider identified, we can assist in locating a provider for you.
Health Alert Network Updates
Please review the updated Health Alert Network guidance from the PA Department of Health. I listed some of the recent updated or newly developed HANs that may be of interest:
ICF Task Force Meeting Proposed Dates
The meetings for 2021 will be video conferencing through Skype or Microsoft Teams.
Proposed Dates and times:
Let us know if there are any major conflicts with dates.
ICF Taskforce Meeting Topics
As always we would like to make the ICF Task Force Meetings as meaningful as possible. So, please submit to us any topics and ideas that would be of value to you and your organization and we will work to incorporate them into the meetings.
The Centers for Medicare and Medicaid Services (CMS) has released an Interim Final Rule with Comment Period that will establish a new COVID-19 treatments add-on payment (NCTAP) under the Medicare Inpatient Prospective Payment System (IPPS), which is effective from November 2, 2020, until the end of the Public Health Emergency (PHE) for COVID-19. To mitigate potential financial disincentives for hospitals to provide new COVID-19 treatments during the COVID-19 PHE, the Medicare program will provide an enhanced payment for eligible inpatient cases that involve the use of certain new products with current Food and Drug Administration (FDA) approval or emergency use authorization to treat COVID-19. Comments will be accepted until the close of business on January 4, 2021.
The Centers for Medicare and Medicaid Services (CMS) issued Medicare Learning Network (MLN) Matters article MM12063 entitled “Calendar Year (CY) 2021 Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule”. It becomes effective on January 1, 2021. This article includes material on the data files, update factors, and other information related to the update of the fee schedule. The DMEPOS fee schedule is updated on an annual basis. For CY 2021, an update factor of 0.2 percent is applied to certain DMEPOS fee schedule amounts. Additional details specific to supplies are provided in the article.
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