Posted on August 02, 2017
On July 31, the Centers for Medicare & Medicaid Services (CMS) released final rules to update the Medicare fee-for-service prospective payment systems for inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) for fiscal year (FY) 2018.
In the IRF final rule, the CMS refined the ICD-10-CM diagnostic code lists used to determine a facility’s presumptive compliance with the 60 percent rule. This rule requires that at least 60 percent of patients be treated for certain conditions in order for the facility to be paid as an IRF. For FY 2018, the CMS finalized its proposal that certain ICD-10-CM diagnosis codes for patients with traumatic brain injury and hip fracture conditions be included in the conditions counting toward the 60 percent parameter. It also finalized the revised presumptive methodology list for major multiple traumas by counting IRF cases that contain two or more of the ICD-10-CM codes from three major multiple trauma lists in the specified combinations. The agency did not finalize the removal of any codes from the presumptive methodology at this time and will continue to evaluate.
In addition, the CMS finalized its proposal to eliminate the 25 percent payment penalty that is currently applied if patient assessment reports are not received in a timely manner. In response to concerns expressed by the MHA, the American Hospital Association and others, the CMS opted to not finalize the addition of several new standardized patient assessment data elements proposed for the IRF and SNF quality reporting programs (QRPs). The CMS adopted its proposals to revise the current quality measure related to pressure ulcers and to remove the all-cause unplanned readmission measure from both QRPs. It also finalized proposals regarding program requirements for the SNF Value-based Purchasing program.
The final rules will take effect Oct. 1. Within the next few weeks, the MHA will provide additional information on both rules, including updated facility-specific impact analyses. Members with questions should contact Vickie Kunz at the MHA.
Tags: CMS, PPS, SNF, IRF, final rule
Posted in: Member News
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