WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would increase Medicare payment rates under the IRF Prospective Payment System (PPS) by a projected 1.5 percent in fiscal year 2012 – an estimated $120 million nationwide.
The projected update reflects a rebased and revised market basket specific to IRFs, inpatient psychiatric facilities, and long-term care hospitals (the RPL market basket) – currently estimated at 2.8 percent for FY 2012 – less a 1.3 percentage point reduction mandated by the Affordable Care Act.
The proposed rule would apply to more than 1,200 Medicare-participating IRFs, including 200 freestanding IRFs and 1,000 IRF units in acute care hospitals and critical access hospitals.
"The proposed rule would extend Medicare's ongoing efforts to use its payments to encourage better care for beneficiaries who are treated in inpatient rehabilitation facilities," said CMS Administrator Donald Berwick, MD. "The measures IRFs would report under the proposed rule will pave the way for Medicare to work with IRFs to improve patient safety."
Under the proposed quality reporting system, IRFs would submit data on two quality measures, "urinary catheter-associated urinary tract infection" and "pressure ulcers that are new or have worsened." A third measure that is currently under development is also discussed as a potential measure for future rulemaking cycles.
It would address readmissions within 30 days to another inpatient stay, whether in an acute care hospital, rehabilitation facility, or other setting.
IRFs that do not submit quality data would see their payments reduced by two percentage points beginning in FY 2014. CMS anticipates adding measures for reporting in the future through rulemaking and plans to establish a process for making the measures data available to the public. IRFs choosing to report quality data would have an opportunity to review the data for accuracy before it became public.
Other provisions in the proposed rule include proposals to: Update the case-mix group relative weights using FY 2010 IRF claims and FY 2009 IRF cost report data, and to set the high cost outlier threshold at $11,822 for FY 2012, compared with $11,410 for FY 2011.
CMS also plans to continue using the pre-reclassified and pre-floor hospital wage data to determine the proposed FY 2012 rates, and to update the rural, low-income patient, and teaching status adjustment factors using the most recent three years of data (FYs 2008 through 2010).
CMS will accept comments on the proposed rule until June 21, 2011, and will address all comments in a final rule to be issued by Aug. 1, 2011.