CMS releases FY 2018 IPPS proposed rule

On Friday, April 14, CMS released the fiscal year (FY) 2018 IPPS proposed rule with updates to quality initiatives and 2018 ICD-10-CM and ICD-10-PCS code proposals.

CMS proposes to modify the EHR reporting periods for new and returning participants attesting to CMS or their state Medicaid agency from the full year to a minimum of any continuous 90-day period during the 2017 calendar year.

CMS is also proposing to make five changes to existing hospital-acquired conditions (HAC) reduction program policies:

• Specify the dates of the time period used to calculate hospital performance for the FY 2020 HAC Reduction Program
• Request comments on additional measures for potential future adoption
• Request comments on accounting for social risk factors
• Request comments on accounting for disability and medical complexity in the Centers for Disease Control and Prevention’s National Healthcare Safety Network measures in Domain 2
• Update the Extraordinary Circumstance Exception policy

The proposed rule also notes a requirement for updating diagnosis and procedure codes twice a year instead of a single update on October 1.

This requirement, CMS said, will improve the recognition of new technologies under the IPPS system by providing information on these new technologies at an earlier date. Data will be available six months earlier than what is now possible with updates occurring only on October 1. CMS notes that the addition of new codes will not lead to payment adjustments or DRG classification changes until the following fiscal year.

The agency released proposals for 2018 ICD-10-CM and ICD-10-PCS code updates, deletions, and revisions, which can be viewed on CMS’ website.  

CMS also released a wide-ranging request for information asking stakeholders for feedback on solutions for increased transparency, flexibility, program simplification, and innovation. These ideas could be based on regulatory, sub-regulatory, policy, practice, and procedural changes, according to CMS, but the agency will not respond to these requests in the final rule. Instead, they will be considered for future guidance and rulemaking.

CMS is proposing an increase in operating payment rates of approximately 1.6% for general acute-care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting Program and are electronic health record (EHR) users, the rule says.

The proposed rule also projected a hospital market basket update of 2.9% adjusted by negative 0.4% required for productivity.

“This reflects a -0.6% adjustment to remove the one-time adjustment of 0.6% made in FY 2017 for the FYs 2014–2016 effect of the adjustment to offset the estimated costs of the two midnight policy, a proposed +0.4588 percentage point adjustment required by the statute, as recently amended by the 21 Century Cures Act, and the -0.75 percentage point adjustment to the update required by the Affordable Care Act,” said CMS.

For more information on the rule, see CMS’ fact sheet. Comments are due to CMS by June 13, and the agency expects to issue a final rule by August 1. Once finalized, changes will become effective October 1.