United States: Proposed IPPS Rule Changes

The Centers for Medicare & Medicaid Services (CMS) recently released its proposed rules for the Hospital Inpatient Prospective Payment System (IPPS) for fiscal year (FY) 2019. As discussed below, the proposed rule focuses on promoting interoperability to reduce administrative burdens, increase efficiency and improve patient access while providing high-quality patient care. Comments on the proposed rule are due June 25, 2018.

Electronic Health Records (EHR) Program Update

CMS proposed significant changes to the Medicare and Medicaid Electronic Health Record (EHR) Programs. For starters, it renamed the program to Promoting Interoperability (PI) Programs to better reflect its focus on interoperability and improving patient access to health information. To maintain alignment across programs, CMS noted that the name change applies to the Merit-Based Incentive Payment System Advancing Care Information performance category.

Keeping increased interoperability and patient access in mind, CMS steered away from the threshold-based methodology currently in use and proposed a new performance-based scoring methodology to reduce burdens and provide more flexibility. Under the proposed scoring methodology, each measure will be scored based on the provider's performance for that measure, except the Public Health and Clinical Data Exchange objection, and will contribute to the total PI score, with a provider receiving a maximum score of 100. A total score of 50 points or more satisfies the program requirement, enabling the provider to receive an incentive payment and/or avoid a payment penalty.

CMS also reinforced the requirement that, beginning in the 2019 reporting period, all eligible professionals and hospitals, and critical access hospitals must use the 2015 Edition Certified EHR Technology to demonstrate meaningful use for EHR reporting. The 2015 Edition, and specifically, the application programming interface functionality, simplifies the sharing of electronic health information between systems, making it easier for providers to satisfy the patient access requirement and further enhancing interoperability between systems.

Finally, CMS's proposed rule modified the EHR reporting periods in 2019 and 2020 to new and returning providers attesting to meaningful use to a minimum of any continuous 90-day period during the calendar year.

Meaningful Measures Initiative for Quality Reporting

As part of its "Meaningful Measures" framework, CMS proposes to remove several quality measures from the Hospital Inpatient Quality Reporting (Hospital IQR) Program over the next three program years. CMS developed this new initiative to recognize the measures that address the highest priorities for care improvement and individual outcomes. Under the new framework, CMS proposes to synchronize various quality reporting and value-based incentive programs so that provider measure submissions are not duplicative across the programs. For instance, CMS now proposes that the Hospital IQR Program include only measures that are not covered by another CMS quality program. To that end, CMS proposes that a quality measure may be removed from the Hospital IQR Program if "the costs associated with a measure outweigh the benefit of its continued use in the program." In total, CMS proposes to remove 39 quality measures from the Hospital IQR Program by 2023 to reduce provider burden and duplicative measure submission.

Chimeric Antigen Receptor (CAR) T-cell Therapy

After much anticipation, CMS proposed to assign ICD-10-PCS procedure codes XW033C3 (Introduction of engineered autologous CAR-T immunotherapy into peripheral vein, percutaneous approach, new technology group 3) and XW043C3 (Introduction of engineered autologous CAR-T immunotherapy into central vein, percutaneous approach, new technology group 3) to existing MS-DRG 016, while proposing to rename MS-DRG 016 "Autologous Bone Marrow Transplant with CC/MCC or T-cell Immunotherapies" in order to reflect the addition of CAR T-cell immunotherapies. CMS invited public comments on alternative approaches for new technology add-on payments for FY 2019.

Update to Disproportionate Share Hospital (DSH) Payment Methodology and Additional Payment for Uncompensated Care

In the proposed rule, CMS updates its estimation methodology for the three factors used to determine a DSH's proportion of uncompensated care payments for FY 2019. Under this proposed rule, CMS will adopt the following policies:

(1) providers with multiple cost reports for the same fiscal year that do not equal 12 months of data will use the longest cost report and annualize Medicaid data; (2) providers with multiple cost reports beginning in the same fiscal year and one report that also spans the entirety of the following fiscal year, the cost report that spans both fiscal years should be used for the latter fiscal year where the provider has no cost report for that fiscal year; and (3) providers will utilize statistical trim methods with potentially irregular cost-to-charge ratios and uncompensated care costs reported on Worksheet S-10.

For FY 2019, CMS also proposes to use only data regarding low-income insured days for FY 2013 to determine the amount of uncompensated care payments for Puerto Rico hospitals, Indian Health Service and Tribal hospitals, and all-inclusive rate providers.

The proposed rule notes that CMS will continue using uninsured estimates produced by CMS's Office of the Actuary in the calculation of the percentage of individuals who are uninsured, and incorporating data from Worksheet S-10 in the calculation of hospitals' share of the aggregate amount of uncompensated care. CMS estimates total Medicare DSH uncompensated care payments for FY 2019 will increase payments overall by approximately 1.3 percent compared to the uncompensated care payments that will be distributed in FY 2018.

Improving Healthcare Pricing Transparency

In keeping with CMS's goal to improve the public accessibility of charge information, CMS proposes an update to its guidelines for FY 2019 that would require hospitals to list their current standard charges on the internet in a machine-readable format, and to update this information at least annually, or more often as appropriate.

CMS seeks public comment on related topics that influence pricing transparency and further its objective to facilitate consumer-friendly communication between providers and patients regarding charge information. The first topic concerns the defining and reporting of "standard charges" and the ideal mechanism to measure such charge information. The agency also seeks feedback on ways to increase patient use of charge and cost information in decision-making. Regarding the enforcement of price transparency requirements, the proposed rule solicits ideas for appropriate enforcement mechanisms and monitoring of hospital compliance. CMS also requests feedback on Medigap coverage and the challenges that providers face with providing information about out-of-pocket costs. CMS ultimately aims to improve patient awareness of the potential financial liability associated with healthcare services and enable patients to compare charges for similar services across hospitals in the healthcare industry.

Proposed Elimination of the "25-Percent Threshold Policy" Adjustment

In the proposed rule, CMS eliminates the per-discharge payment adjustment in the long-term care hospital (LTCH) prospective payment system (PPS) for discharges from an LTCH when the number originating from any single referring hospital is more than the applicable threshold for a given cost reporting period, known as the 25-percent threshold policy. CMS plans to eliminate the 25-percent threshold policy based on the belief that the specific regulatory framework of the policy is no longer an appropriate mechanism to prevent LTCHs from operating as a de facto unit of an IPPS hospital in violation of the statute.

The 25-percent threshold policy would have reduced the LTCH PPS payments for certain discharges for FY 2019, and this proposed rule, if finalized, would result in an increase in aggregate LTCH PPS payments for FY 2019. Based on FY 2017 claims data, CMS estimates its proposed elimination of the 25-percent threshold policy would increase aggregate LTCH PPS payments by approximately $36 million. CMS seeks public comment on this proposal to eliminate the 25-percent threshold policy in a budget-neutral manner and further reduce the unnecessary regulatory burden.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Authors
Similar Articles
Relevancy Powered by MondaqAI
 
In association with
Related Topics
 
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
 
Related Video
Up-coming Events Search
Tools
Print
Font Size:
Translation
Channels
Mondaq on Twitter
 
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
 
Email Address
Company Name
Password
Confirm Password
Position
Mondaq Topics -- Select your Interests
 Accounting
 Anti-trust
 Commercial
 Compliance
 Consumer
 Criminal
 Employment
 Energy
 Environment
 Family
 Finance
 Government
 Healthcare
 Immigration
 Insolvency
 Insurance
 International
 IP
 Law Performance
 Law Practice
 Litigation
 Media & IT
 Privacy
 Real Estate
 Strategy
 Tax
 Technology
 Transport
 Wealth Mgt
Regions
Africa
Asia
Asia Pacific
Australasia
Canada
Caribbean
Europe
European Union
Latin America
Middle East
U.K.
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.

Disclaimer

The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.

General

Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions