Feb. 16 Deadline Nears for SUD Provider Compliance With Final Rule on 42 CFR Part 2: Notice of Privacy Practices
Final Rule
Webinar on Sept. 24 to Focus on Changes in FY 2026 IRF PPS Final Rule
On September 24, 2025, WellSky will be conducting a webinar on the fiscal year (FY) 2026 inpatient rehabilitation facility prospective payment system (IRF PPS) final rule that was released by the Centers for Medicare and Medicaid Services (CMS) in early August. The webinar will begin at 12:00 pm. There is no cost to participate in this webinar.
Topics will include:
- The key changes in the 2026 IRF Final Rule impacting reimbursement;
- The technical changes and their indirect effects on your program;
- The amendments to the QRP and the appeal process; and
- The latest concerns about potential IRF reimbursement denials.
To participate in the webinar, register here.
DDAP Webinar to Examine Real-World Implications of 42 CFR Part 8 Final Rule
The Pennsylvania Department of Drug and Alcohol Programs (DDAP) will host a webinar at 10:00 am on Monday, March 3, to discuss the changes to 42 CFR Part 8 and their real-world implications in treatment settings. The interactive session will feature Dr. Sarah Kawasaki and Elizabeth Ward, both from the Pennsylvania Psychiatric Institute’s Advancement in Recovery Opioid Treatment Program.
Add the meeting to your calendar.
Email DDAP to receive calendar invitations to upcoming webinars, which are held the first Monday of every month.
Philadelphia Inquirer: A New Overtime Rule Has Been Stayed By a Federal Court. What Should Employers Do? [Paywalled]
National Council to Hold CMS 2025 PFS & OPPS Rule Briefing November 21
CMS Releases Physician Fee Schedule CY 2025 Final Rule
The Center for Medicare and Medicaid Services (CMS) has released the Physician Fee Schedule CY 2025 Final Rule. You can view CMS’ press release, fact sheet, and final rule page in the Federal Register for more information. There were critical areas addressed in this year’s Physician Fee Schedule (PFS), including:
- The extension of some telehealth flexibilities permitted under CMS’ authority absent Congressional action;
- Updated payment for social determinants of health risk assessments as a part of Opioid Use Disorder intake activities furnished at Opioid Treatment Programs (OTP);
- The establishment of a new add-on code to account for coordinated care, referral services, and peer supports at OTPs;
- Payment for safety planning intervention and post-discharge follow-up;
- The establishment of six G codes that mirror current interprofessional consultation Common Procedural Terminology codes used by practitioners who are eligible to bill E/M visits; and
- Recognition of responses to CMS’ request for information on Certified Community Behavioral Health Clinics.
For the OPPS Final Rule, please see links to CMS’ press release, fact sheet, and final rule page in the Federal Register. Some highlights from this final rule include:
- The maintenance of the Partial Hospitalization Program and Intensive Outpatient Program rate structures;
- Narrowing the definition of “custody” in Medicare’s payment exclusion rule to mitigate barriers to Medicare access by individuals who have recently been released from incarceration or are on parole, probation, or home detention; and
- Changes to Medicaid regulation, allowing states implementing the Medicaid clinic services benefit to cover clinic services outside the “four walls” of behavioral health clinics.
If you have any further questions regarding these final rulings or the application of the “four walls” impacts on Pennsylvania, please contact RCPA COO and Mental Health Director Jim Sharp.
DDAP Grants Statewide Exceptions to Multiple NTP Regulations to Align With Federal Changes
The Pennsylvania Department of Drug and Alcohol Programs (DDAP) issued Licensing Alert 07-2024 today to grant statewide exceptions to narcotic treatment programs (NTP) to expand access to medication for the treatment of opioid use disorder in alignment with the federal government’s Final Rule on 42 CFR Part 8.
The statewide exceptions to DDAP regulations that are being granted will enable:
- People with less than one year of physical dependence on opioids to be treated at an NTP;
- Verbal consent to treatment;
- A wider range of dosages based on physician discretion;
- Eight drug screens per year instead of 12;
- An increase in take-home medication; and
- Clinicians to determine counseling requirements unique to each person’s needs instead of mandatory minimums.
DDAP granted the statewide exceptions using 28 Pa. Code § 701.11, which gives it the authority to do so. Through Licensing Alert 07-2024, DDAP is granting these exceptions if the NTPs comply with the rules in 42 CFR Part 8. There is no need for NTPs to submit exception requests or to inform DDAP they are using these exceptions.
DDAP plans to include the changes to the federal rules when it updates its own state rules.
You can email DDAP with questions about this licensing alert.
Webinar on September 18 to Focus on FY 2025 IRF Final Rule
WellSky will be offering a one-hour webinar entitled “60 Minutes With the IRF Final Rule” that will focus on the fiscal year (FY) 2025 Inpatient Rehabilitation Facility (IRF) Final Rule, which was finalized on July 31, 2024. It will go into effect October 1, 2024. As with past final rules, it will have a financial impact on reimbursement for IRFs as well as operational changes from both this final rule and past final rules going into effect. Join long-term care expert Jane Snecinski, FACHE, MRMC, MBA, for a live webinar and learn about:
- The algorithm for IRF reimbursement (and key factors you should know);
- The financial impact the rule will have on your IRF reimbursement;
- Changes to the quality reporting factors; and
- Changes included in previous years’ IRF final rules that may go into effect October 1, 2024.
The webinar is scheduled for September 18, 2024, from 12:00 pm – 1:00 pm ET. To participate in the webinar, register here.
CMS Hospital/Quality Initiative Open Door Forum Scheduled for Tomorrow, Sept. 10
The Centers for Medicare and Medicaid Services (CMS) will host the next hospital/quality initiative (QI) open door forum call tomorrow, September 10, at 2:00 pm. Agenda topics for this call will include:
- FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule CMS-1808-F
- FY 2025 Inpatient Psychiatric Facilities PPS Final Rule
- Open Question and Answer
The call will be held via Zoom webinar. Attendees must register in advance for this webinar. Register here. After registering, you will receive a confirmation email containing information about joining the webinar.
FY 2025 IRF PPS Final Rule Released
The Centers for Medicare and Medicaid Services (CMS) released and published the fiscal year (FY) 2025 inpatient rehabilitation facility prospective payment system (IRF PPS) final rule in the August 6, 2024, Federal Register. Some of the key provisions contained in the provider rule are noted below.
Payment Updates
CMS estimates aggregate payments to IRFs will increase by 2.8 percent in FY 2025, compared to the 4.0 percent payment update that CMS finalized for FY 2024. This update is the result of an annual market basket update, reduced by a productivity adjustment, budget neutrality adjustments for changes to CMG weights and labor/wage changes, and adjustments to the outlier case threshold.
As in previous years, CMS will adopt new delineations for the Core-Based Statistical Areas (CBSA) as identified by the Office of Management and Budget (OMB). [Additional and more detailed information on these new CBSAs can be found in OMB Bulletin No. 23-01] These changes will result in certain counties being reclassified from urban to rural and vice-versa, as well as some counties shifting to different CBSAs. As a result, CMS projects that approximately 10 percent of providers will have a higher wage index, but 16 percent will face a decrease in wage index values (primarily for those reclassified as urban, thus losing the rural adjustment). Thus, CMS finalized a transitional “phase-out” policy for those negatively impacted, such that IRFs set to lose their rural adjustment will retain two-thirds of the adjustment in FY 2025, one-third of the adjustment in FY 2026, and fully “lose” the rural adjustment in FY 2027. CMS estimates that 8 IRFs would be reclassified as urban and thus lose the 14.9 percent rural adjustment.
CMS increased the outlier threshold amount from $10,423 for FY 2024 to $12,043 for FY 2025 (slightly lower than the proposed rule’s projection). This change will account for an estimated 0.2 percent decrease to aggregate payments across the IRF PPS in FY 2025.
Quality Reporting Program (QRP) Updates
CMS finalized its proposal to adopt four new items as Standardized Patient Assessment Data Elements (SPADE) under the social determinants of health (SDOH) category beginning with the FY 2028 IRF QRP: one Living Situation item; two Food items; and one Utilities item. CMS notes that these new SPADES are intended to assist IRFs in “better addressing those identified needs with the patient, their caregivers, and community partners during the discharge planning process, if indicated.”
Transportation Item Modification Finalized Beginning with the FY 2028 IRF QRP (October 1, 2026 Implementation)
Consistent with the AHC HRSN Screening Tool, CMS finalized a proposal to modify the A1250. Transportation item currently collected in the IRF–PAI in two ways: (1) revise the look-back period for when the patient experienced lack of reliable transportation; and (2) simplify the response options.
- A1250. Transportation currently collected in the IRF-PAI asks: “Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?” The response options are: (A) Yes, it has kept me from medical appointments or from getting my medications; (B) Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need; (C) No; (X) Patient unable to respond; and (Y) Patient declines to respond.
- The finalized Transportation item asks, “In the past 12 months, has a lack of reliable transportation kept you from medical appointments, meetings, work or from getting things needed for daily living?” The final response options are: (0) Yes; (1) No; (7) Patient declines to respond; and (8) Patient unable to respond.
Finalized Proposal to Remove the Admission Class Item From the IRF-PAI Beginning October 1, 2026, with Minor Modification
- CMS asserts that the Admission Class Item is currently not used in the calculation of quality measures already adopted in the IRF QRP. It further notes that it is not used for previously established purposes unrelated to the IRF QRP, such as payment, survey, or care planning. This removal will be effective beginning with the FY 2028 IRF QRP (beginning with patients admitted on October 1, 2026); however, IRFs will not be required to collect this item beginning with patients admitted on October 1, 2024.
For additional information, CMS published a fact sheet that provides an overview of the provisions contained in the final rule.
