The Centers for Medicare & Medicaid Services late today issued a final rule that will increase Medicare inpatient prospective payment system rates by a net 2.9% in fiscal year 2021, compared to FY 2020, for hospitals that are meaningful users of electronic health records and submit quality measure data. In addition, the rule will require disclosure of certain payer-negotiated rates and makes changes to disproportionate share hospital payments, Chimeric Antigen Receptor T-cell (CAR T) therapy payment and quality incentive programs. 
 
CMS finalized a policy to require hospitals to report on the Medicare cost report the median payer-specific negotiated rates for inpatient services, by Medicare severity-diagnosis related group, for Medicare Advantage organizations. This policy will be in effect for cost reporting periods ending Jan. 1, 2021 or after. 
 
“The AHA remains deeply disappointed that CMS continues to require hospitals and health systems to disclose privately negotiated contract terms with payers,” said AHA Senior Vice President for Public Policy Analysis and Development Ashley Thompson in a statement. “By continuing to focus on negotiated rates rather than expanding access to a patient’s out-of-pocket costs, the Administration fails to meet the goal it set for itself – assisting consumers in becoming more prudent purchasers of health care. We once again urge the agency to focus on what is really important to patients – ready access to their out-of-pocket costs. Additionally, this policy will require hospitals to divert critically needed resources during this historic pandemic to administrative tasks that will not benefit patients. We do not believe CMS has the authority to compel the disclosure of these terms and our legal challenge remains ongoing.” 
 
For FY 2021, the agency estimated that it will distribute $8.29 billion in DSH payments, a decrease of approximately $60.6 million compared to FY 2020. In addition, CMS finalized its proposal to use a single year of uncompensated care data from the 2017 Medicare cost report to determine the distribution of DSH uncompensated care payments for FY 2021. CMS also finalized its proposal to use the most recently available single year of audited uncompensated car
e data for FY 2022 and subsequent years. 
 
In addition, CMS created a new MS-DRG for CAR T-cell therapy based on available Medicare claims data. 
 
“While we appreciate the agency’s focus in addressing cost issues for life-saving CAR T therapy, we remain concerned that the policy the agency has put forth in this final rule is not adequate to address the extraordinary level of resources necessary to provide CAR T therapy to patients,” Thompson said. “We continue to urge CMS to consider an alternative method of determining the cost of CAR T therapy, as well as to consider carving out these very costly new technologies from the MS-DRG and paying for them on a pass-through basis.” 
 
CMS also finalized several policies governing what can be reported as Medicare bad debt.
 
For the inpatient quality reporting program, CMS finalized its proposal to, beginning with the calendar year 2021 reporting period, gradually increase the number of quarters of electronic clinical quality measure data required until it reaches a full year for the CY 2023 performance period. CMS also will begin publicly reporting eCQM measure results in late 2022, starting with data from CY 2021. 

Related News Articles

Headline
The Centers for Medicare & Medicaid Services today issued a final rule for the long-term care hospital prospective payment system for fiscal year 2021…
Headline
The AHA today urged the Centers for Medicare & Medicaid Services to reverse its calendar year 2021 Home Health Prospective Payment System Rate Update of 4.…
Headline
The Centers for Medicare & Medicaid Services yesterday updated its guidance related to the 20% inpatient prospective payment system diagnosis-related group…
Headline
The AHA today issued a Regulatory Advisory summarizing the Centers for Medicare & Medicaid Services’ inpatient rehabilitation facility prospective payment…
Headline
The Centers for Medicare & Medicaid Services today released the calendar year 2021 outpatient prospective payment system/ambulatory surgical center…
Headline
The AHA today issued a Regulatory Advisory with a summary of the July 31 Centers for Medicare & Medicaid Services’ final rule for the inpatient psychiatric…