When the Medicare program for hospitals was authorized in 1965 it originally reflected the structure of the traditional indemnity insurance models that it was based on, and was also required to reimburse hospitals on a “reasonable cost” basis.
Home health (HH) agencies paid under Medicare’s prospective payment system (PPS) will see a 1.05 percent decrease in payments in calendar year (CY) 2014 as compared to CY 2013 under a final rule released by the Centers for Medicare & Medicaid Service (CMS). The decrease reflects the combined effects of an increase in the home health market basket update percentage of 2.3 percent, offset by a rebasing adjustment of negative 2.7 percent as required by the Affordable Care Act (ACA), and a .62 percent decrease due to a refinement of the HH PPS Grouper. The ACA requires CMS to begin phasing in rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates and the non-routine supply conversion factor to reflect changes since the inception of the HH PPS. For hospital-based facilities, CMS estimates the reduction will be smaller, negative .58 percent, for CY 2014.
Hospital-based dialysis facilities paid under the end-stage renal disease (ESRD) prospective payment system (PPS) will see an estimated 0.8 percent increase in payments for calendar year (CY) 2014 compared to CY 2013, according to a final rule issued by the Centers for Medicare & Medicaid Services (CMS). CMS estimates that independent ESRD facilities will see no increase in payments in CY 2014 as compared to CY 2013. The update reflects the effect of a 3.2 percent ESRD bundled market basket update; the Affordable Care Act-required productivity adjustment of 0.4 percent; the American Taxpayer Relief Act (ATRA)-required drug utilization adjustment of negative 3.3 percent; a 0.4 percent overall estimated increase in outlier payment from the updates to the fixed-dollar loss threshold and Medicare Allowable Payment amounts; and a 0.2 percent overall estimated increase in payments from the change in the blend of payments.
The Centers for Medicare & Medicaid Services (CMS) has notified hospitals regarding possible delays in the release of final rules for calendar year (CY) 2014 Medicare fee-for-service payment regulations as a result of the federal government shutdown. The affected regulations were expected to be released by Nov.1. However, CMS now expects them to be released by Nov. 27 to be effective Jan. 1, 2014. Affected regulations include the CY 2014 outpatient prospective payment system (PPS), CY 2014 end-stage renal disease PPS, CY 2014 home health PPS and CY 2014 physician fee schedule.
The U.S. House of Representatives Ways and Means Committee has released draft legislation that includes several provisions affecting payment policy for post-acute care (PAC) services. The committee held a hearing on the topic on June 14.
The latest legislative proposals mirror PAC proposals put forth by President Obama in his FFY 2014 budget, as well as discussions by Simpson-Bowles and the Bipartisan Policy Commission. The committee’s draft legislation specifically addresses the following changes:
Reducing market basket updates for home health agencies, skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs) and long-term care hospitals;
Creating site-neutral payments between IRFs and SNFs for certain procedures;
Modifying the criteria required for IRF status (the so-called “75 percent rule”);
The Centers for Medicare & Medicaid Services (CMS) has issued the final rule updating federal fiscal year (FFY) 2014 Medicare payment rates and the wage index for hospices. In the rule, CMS estimates that Medicare reimbursement will increase by 1 percent, or $160 million, for FFY 2014, which begins Oct. 1. The rule also makes changes to the hospice quality reporting program for 2014 and the future, including adding a Hospice Experience of Care survey in 2015.
The Centers for Medicare & Medicaid Services (CMS) has issued the final rule for the long-term care hospital (LTCH) prospective payment systems (PPS) for federal fiscal year (FFY) 2014. Under the provisions of the LTCH final rule, CMS estimates that payments to LTCHs will increase by 1.3 percent, as compared to FFY 2013. CMS also finalizes a proposal to phase in the full “25 percent rule,” starting with cost reporting periods beginning on or after Oct. 1, 2013. In addition, CMS confirms its plans to continue with research on a FFY 2015 proposal that would dramatically reduce LTCH payments by excluding patients who do not meet certain clinical criteria. CMS also finalizes proposals for changes and additions to the LTCH Quality Reporting Program (QRP), including adding three new measures for the 2017 LTCH QRP and one new measure for 2018.
The Centers for Medicare & Medicaid Services (CMS) has issued the final rules for the inpatient rehabilitation facility (IRF) and skilled-nursing facility (SNF) prospective payment systems (PPS) for federal fiscal year (FFY) 2014. Provisions of the final rules go into effect Oct. 1.
Under the IRF final rule, CMS estimates that payments to IRFs will increase by 2.3 percent. In an improvement over the proposed rule, CMS makes some changes to its proposal to update the list of codes that may count toward an IRF’s “60 percent rule” compliance assessment using the presumptive test. CMS will remove fewer codes than originally proposed, and the shortened list of eligible codes will not take effect for one year. CMS also finalizes proposals and adds several new measures to the IRF Quality Reporting Program, and makes changes to the IRF patient assessment instrument.
The Centers for Medicare & Medicaid Services (CMS) released two proposed rules today: one for the calendar year (CY) 2014 outpatient prospective payment system (OPPS) and one for the CY 2014 physician fee schedule. CHA will prepare a first-glance summary of the OPPS proposed rule for tomorrow’s CHA News. Comments on both of the attached proposed rules are due by 2 p.m. (PT) Sept. 6.