By Linda Rouse O’Neill, Vice President, Government Affairs, HIDA
CMS releases first series of annual payment rate proposals
The Centers for Medicare & Medicaid Services (CMS) recently released a series of proposed annual payment regulations for hospitals, skilled nursing facilities (SNFs), and inpatient rehabilitation facilities (IRFs). Along with rule and policy change proposals, the agency is recommending overall payment increases for each market effective Oct. 1, 2014 (FY 2015).
There are slight differences and nuances for each market, so it’s important to understand how these proposed changes would affect provider operations:
Hospitals
- Would receive a 1.3 percent annual payment increase.
- Coronary artery bypass graft (CABG) surgical procedures would be added to the Hospital Readmissions Reduction Program in FY 2017.
- The Value Based Purchasing Program would include several new performance measures in FY 2017, including infection outcome rates for hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) and clostridium difficile (c-diff).
- The Long-Term Care Hospital Quality Reporting Program would include three additional quality measures in FY 2018: a ventilator-associated event (VAE) outcome measure and two functional outcome measures.
SNFs
- Would receive an overall 2 percent increase in Medicare payments, or $750 million collectively: rural area payments would increase by 2 percent; urban area payments would increase by 1.9 percent; rural Pacific region payments would increase by 4.5 percent; and urban East South Central region payments would increase by 1 percent.
- A new Office of Management and Budget delineation would be used to determine whether a SNF should be considered urban or rural, ultimately affecting the facility’s Medicare reimbursement rate.
- Medicare’s Change of Therapy assessment policy would be revised to clarify that states may use civil penalty monies collected from SNFs only after receiving CMS approval.
IRFs
- Would receive a 2.2 percent annual payment increase, or $160 million collectively.
- CMS proposes freezing facility level adjustment factors for FY 2015.
- Two additional quality metrics would be added to the IRF Quality Reporting Program measuring facility-wide inpatient hospital-onset MRSA and c-diff infection rates.
HIDA Government Affairs is currently working to provide more detailed summaries of these proposed rules for sales reps and other supply chain professionals. CMS is accepting public comments for each of these proposals until the end of June, at which time it will consider whether revisions are necessary before issuing final rules and beginning implementation.
CMS will also release a subsequent series of payment rate proposals that could affect markets excluded from the above, such as physician, laboratory, and home health. These rules and regulations would not be effective until Jan. 1, 2015 (CY 2015) if implemented, hence the staggered release process.
For more information on these current and future market proposals, visit www.HIDA.org or contact us at HIDAGovAffairs@hida.org.
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