CMS has released its annual proposed payment updates for inpatient facilities, kidney care facilities, home health, skilled nursing facilities, hospices, inpatient psychiatric facilities and inpatient rehabilitation facilities.
Here are 21 things to know about the proposed rules:
End-stage renal disease treatment facilities
1. CMS on July 1 proposed increasing the base rate for end-stage renal disease to $255.55, an increase of $2.42 to the current base rate of $253.13. CMS also proposed lifting the payment rate for renal dialysis services for individuals with acute kidney injury to $255.55.
2. CMS is proposing to update the outlier services' fixed-dollar loss amounts for 2022 using 2020 data. For pediatric beneficiaries, the fixed-dollar loss amount would decrease from $44.78 to $30.38, and the Medicare allowable payment amount would decrease from $30.88 to $28.73. The fixed-dollar loss amounts for adult beneficiaries would decrease from $122.49 to $111.18, and the Medicare allowable payment amount would decrease from $50.92 to $47.87.
3. CMS is proposing to modify scoring and payment methodologies to ensure that no facility receives a payment reduction in performance year 2022 because of the COVID-19 pandemic. Providers still can see payment increases due to performance.
Read more about the proposed kidney disease payment rule here.
Home health
1. On June 28, CMS proposed increasing payments to home health agencies by 1.8 percent in calendar year 2022.
2. CMS estimates the rate increase will increase payments to home health agencies by $330 million. CMS added that home health agencies may see an aggregate $20 million decrease in payments due to reductions made in the rural add-on payment.
3. CMS is proposing a nationwide expansion of the home health value-based payment program.
Read more about the home health proposed payment rule here.
Inpatient facilities
1. On April 27, CMS proposed a payment rate adjustment for inpatient facilities. Acute care hospitals that report quality data and are meaningful users of EHRs will see a net 2.8 percent increase in Medicare rates in fiscal year 2022, compared to 2021.
2. CMS said the payment rate adjustment will mean hospitals see an increase of about $3.4 billion in payments for hospitals in fiscal year 2022.
3. CMS also proposed repealing the requirement to report median payer-specific negotiated rates by Medicare severity-diagnosis related group, with Medicare Advantage insurers. CMS said this will reduce administrative burden on hospitals by about 64,000 hours.
Read more about the inpatient facility proposed payment rule here.
Skilled nursing facilities
1. On April 8, CMS proposed increasing the skilled nursing facilities payment rate by 1.3 percent in fiscal year 2022.
2. CMS estimates that the payment rate update and other measures in the rule would increase Medicare Part A payments to these facilities by $444 million in fiscal 2022.
3. CMS proposed suppressing the 30-day all-cause readmission measure for the 2022 skilled nursing program value-based payment program performance year due to the COVID-19 pandemic. CMS said the COVID-19 pandemic affected the measure and could affect the performance score significantly.
Read more about the skilled nursing facility proposed payment rule here.
Hospices
1. On April 8, CMS proposed increasing the hospice payment rate by 2.3 percent in fiscal year 2022.
2. CMS expects the rate change to increase payments to hospices by an aggregate $530 million in fiscal year 2022.
3. CMS proposed a new measure for the Hospice Quality Reporting Program called the Hospice Care Index. The single measure includes 10 indicators of quality that are calculated from claims data.
Read more about the proposed hospice payment rate updates here.
Inpatient psychiatric facilities
1. On April 7, CMS proposed increasing IPF payment rates 2.3 percent over this year in fiscal year 2022.
2. CMS estimates the rate boost would increase total payments to the facilities by about $90 million.
3. CMS also plans to update a policy to ensure that medical residents won't be displaced if their teaching hospital or program closes, preventing them from getting board-certified. This change would align the inpatient psychiatric facility teaching policy with changes finalized in the fiscal year 2021 Inpatient Prospective Payment System rule.
Read more about the inpatient psychiatric facility proposed payment rule here.
Inpatient rehabilitation facilities
1. On April 7, CMS proposed increasing IRF payment rates by 2.2 percent in fiscal year 2022.
2. CMS estimates this rate increase would increase total payments to the rehab facilities by $160 million.
3. CMS proposed adopting one new measure and updating the specifications for another measure used for the Inpatient Rehabilitation Facility Quality Reporting Program, a pay-for-reporting program.
Read more about the inpatient rehabilitation facilities proposed payment rule here.