CMS issues IRF PPS proposed rule for 2020

The Centers for Medicare & Medicaid Services today issued a proposed rule for the inpatient rehabilitation facility prospective payment system for fiscal year 2020. Under the rule, net payments for IRFs would increase by 2.3 percent ($195 million) relative to FY 2019 payments, including a 3.0 percent market-basket update, offset by a statutorily mandated cut of 0.5 percentage points for productivity, and a 0.2 percent decrease in outlier payments. This update reflects the proposed revision and rebasing of the market basket using data from 2016 as the base year instead of 2012. The rule provides more detail about the revised IRF case mix groups that take effect in FY 2020; among other changes, they reflect the removal of data collected by the Functional Independence Measure patient assessment instrument from the payment-setting process. In addition, the agency provides updated impact data per IRF on the refined CMGs (overall a budget-neutral change) including updated CMG relative weights and average length of stay values based on FY 2017 and 2018 data. "We have repeatedly requested that CMS provide as much transparency as is feasible to offer insight into the policy decisions made related to the CMG revisions and we are appreciative that the agency has provided a description of the data and methodologies it used," said AHA Executive Vice President Tom Nickels. In addition, CMS proposes to update the IRF wage index in FY 2020 using the concurrent FY inpatient PPS wage index data.
 
CMS also proposes to modify one measure and adopt two new process measures to the IRF Quality Reporting Program and to adopt 22 standardized patient assessment data elements, plus seven more data elements related to social determinants of health. In addition, the agency proposes to require IRFs to report patient assessment data for the QRP for all patients, regardless of payer.