This week in Medicare updates—8/10/2022
FY 2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS Final Rule
On August 1, CMS published a draft copy of the FY 2023 IPPS Final Rule, which is scheduled to be published in the Federal Register on August 10. CMS projects an increase in operating payment rates by 4.3% based on a projected hospital market basket update of 4.1% reduced by a 0.3% productivity adjustment and increased by a 0.5% statutory adjustment. This operating payment rate is significantly higher than the 3.2% rate from April’s proposed rule and follows a trend with the other final payment system rules released thus far in 2022 where the payment rate in the final rule is higher than that from the proposed rule.
CMS finalized a return to using the most recent available data (including the FY 2021 MedPAR claims and the FY 2020 cost reports) for FY 2023 rate-setting with some modifications to account for any impact COVID-19 may have had. This includes calculating two sets of relative weights–one including COVID-19 claims and one excluding COVID-19 claims–and averaging those out to determine FY 2023 relative weight values. A full accounting of additional modifications CMS will make for rate-setting is discussed in the rule.
Other policies finalized in the rule include:
- Approving 25 technologies for new technology add-on payments (NTAP) for FY 2023, but not continuing with a one-year extension for certain new technologies that are out of their newness period despite the authority to do so due to the PHE
- Due to certain statutory language and a recent federal court ruling (Milton S. Hershey Medical Center v. Becerra), CMS is modifying policies for teaching hospitals as well as for certain providers and cost years to address situations for applying the FTE cap when a hospital’s weighted FTE count is greater than its FTE cap.
- In FY 2023, using two years of audited data on uncompensated care costs from Worksheet S-10 of hospitals’ FY 2018 and 2019 cost reports to distribute uncompensated care payments to Medicare disproportionate share hospitals. CMS will use three years of audited data for FY 2024 and beyond.
- As it has in other payment system rules for FY 2023, CMS is finalizing a 5% cap on any decrease to a hospital’s wage index from its wage index the prior FY.
The rule also contains a variety of quality reporting program changes and several changes to policies regarding maternal health. CMS finalized a proposal to create a new “Birthing-Friendly” hospital designation effective fall 2023.
CMS published a Press Release and Fact Sheet on the rule overall and a Fact Sheet on the Maternal Health Policies on the same date. The IPPS Final Rule files are available on the IPPS page of the CMS website. The rule is effective October 1, 2022.
Request for Information (RFI) on Medicare Advantage
On August 1, CMS published an RFI in the Federal Register regarding how Medicare can work to improve equity, high-quality, and person-centered care through Medicare Advantage in a way that is affordable and sustainable. Some of the specific questions CMS asked for input on include effective approaches to handle social determinants of health, what types of supplemental benefits Medicare Advantage plans do or should provide, how MA plans use prior authorization, and more.
CMS published a Press Release on the RFI on July 28.
Comments are due by August 31.
Public Health Emergency: Monkeypox
On August 4, HHS declared a Public Health Emergency nationwide as a result of the monkeypox epidemic. HHS said that the PHE declaration will enable it to work with the FDA to explore new strategies to get vaccines to affected communities faster, and it provides CMS with the authority to collect testing and hospitalization data. HHS published a Press Release to accompany the PHE declaration.
New Waived Tests
On August 4, CMS published Medicare Claims Processing Transmittal 11547 regarding new CLIA-waived tests. There are eight newly added waived complexity tests in this update.
CMS published MLN Matters 12841 to accompany the transmittal.
Effective date: October 1, 2022
Implementation date: October 3, 2022
Inpatient Psychiatric Facilities (IPF) Prospective Payment System (PPS) Updates for FY 2023
On August 4, CMS published Medicare Claims Processing Transmittal 11543 regarding implementation of the changes to the IPF PPS as finalized in the FY 2023 IPF PPS final rule. Changes include updates to the federal per diem base rate, various PRICER changes, a wage index update, and more.
CMS published MLN Matters 12859 on the same date to accompany the transmittal.
Effective date: October 1, 2022
Implementation date: October 3, 2022
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2022 Update
On August 4, CMS published Medicare Claims Processing Transmittal 11544 regarding updated payment files for the MPFSDB. These files will be made available to contractors by August 19.
Effective date: October 1, 2022
Implementation date: October 3, 2022
Comment Request: Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(j)); more
On August 4, CMS published a Comment Request in the Federal Register regarding the submission of the following information collections for OMB review:
- Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(j))
- Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Health Insurance Marketplaces, Medicaid, and Children’s Health Insurance Program Agencies
Comments are due to the OMB desk officer by September 6.
Comment Request: Hospital Wage Index Occupational Mix Survey; Basic Health Program (BHP) Supporting Regulations
On August 4, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Hospital Wage Index Occupational Mix Survey
- Basic Health Program (BHP) Supporting Regulations
Comments are due by October 3.
Quarterly Listing of Program Issuances–April Through June 2022
On August 4, CMS published a Notice in the Federal Register regarding the quarterly list of CMS manual instructions, substantive and interpretive regulations, and other notices published from April through June 2022.
Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and Hospice Pricer FY 2023
On August 4, CMS published Medicare Claims Processing Transmittal 11542 regarding updates to the hospice pricer to reflect the changes made in the FY 2023 Hospice Payment Rate Update final rule. This includes changes to the aggregate cap amount, payment rates, wage index, and more.
Effective date: October 1, 2022
Implementation date: October 3, 2022
Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) Annual Update: Pricer Changes for FY 2023
On August 5, CMS published Medicare Claims Processing Transmittal 11540 to provide notification that the IRF PRICER software package will be released prior to October 1 to implement changes from the FY 2023 IRF PPS final rule. These updates include new payment rates and implementation of the 5% cap on decreases in the wage index.
CMS published MLN Matters 12807 on the same date to accompany the transmittal.
Effective date: October 1, 2022
Implementation date: October 3, 2022
Implementation of the Aware for the Jurisdiction N (J-N) Part A and Part B MAC (JN A/B MAC)
On August 5, CMS published One-Time Notification Transmittal 11539 to announce that First Coast Service Options, Inc., will remain the MAC for the JN A/B MAC jurisdiction.
Effective date: September 1, 2022 - Part A and B
Implementation date: September 1, 2022 - Part A and B
HIPAA Electronic Data Interchange (EDI) Front-End Updates for January 2023
On August 5, CMS published One-Time Notification Transmittal 11535 regarding the January 2023 Combined Common Edits/Enhancements Module (CCEM) edits for the Part A and Part B MACs.
Effective date: January 1, 2023
Implementation date: January 3, 2023
FY 2023 Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update
On August 5, CMS published Medicare Claims Processing Transmittal 11541 regarding updates to the payment rates for the SNF PPS Pricer as finalized in the FY 2023 SNF PPS final rule.
Effective date: October 1, 2022
Implementation date: October 3, 2022
Comment Request: Notice of Denial of Medical Coverage (or Payment); Programs of All-Inclusive Care for the Elderly (PACE); more
On August 5, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Notice of Denial of Medical Coverage (or Payment)
- Emergency and Foreign Hospital Services and Supporting Regulation in 42 CFR Section 424.103
- Programs of All-Inclusive Care for the Elderly (PACE)
Comments are due by October 4.