Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2017
SUMMARY: This final rule will update the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2017 as required by the statute. As required by section 1886(j)(5) of the Act, this rule includes the classification and weighting factors for the IRF prospective payment system's (IRF PPS's) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2017. This final rule also revises and updates quality measures and reporting requirements under the IRF quality reporting program (QRP).
EFFECTIVE DATE:
Effective Dates: These regulations are effective on
Applicability Dates: The updated IRF prospective payment rates are applicable for IRF discharges occurring on or after
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION: The IRF PPS Addenda along with other supporting documents and tables referenced in this final rule are available through the
Executive Summary
A. Purpose
This final rule updates the prospective payment rates for IRFs for FY 2017 (that is, for discharges occurring on or after
B. Summary of Major Provisions
In this final rule, we use the methods described in the FY 2016 IRF PPS final rule (80 FR 47036) to update the federal prospective payment rates for FY 2017 using updated FY 2015 IRF claims and the most recent available IRF cost report data, which is FY 2014 IRF cost report data. We are also finalizing revisions and updates to the quality measures and reporting requirements under the IRF QRP.
C. Summary of Impacts
Provision description....Transfers
FY 2017 IRF PPS payment..The overall economic impact of this final rule is
rate update..............an estimated..
........................ from the Federal government to IRFs during FY
........................ 2017.
Provision description....Costs
New quality reporting....The total costs in FY 2017 for IRFs as a result of
program requirements.... the new quality reporting requirements are
........................ estimated to be..
To assist readers in referencing sections contained in this document, we are providing the following Table of Contents.
Table of Contents
I. Background
A. Historical Overview of the IRF PPS
B. Provisions of the Affordable Care Act Affecting the IRF PPS in FY 2012 and Beyond
C. Operational Overview of the Current IRF PPS
D. Advancing Health Information Exchange
II. Summary of Provisions of the Proposed Rule
III. Analysis and Responses to Public Comments
IV. Update to the
V. Facility-Level Adjustment Factors
VI. FY 2017 IRF PPS Payment Update
A. Background
B. FY 2017 Market Basket Update and Productivity Adjustment
C. Labor-Related Share for FY 2017
D. Wage Adjustment
E. Description of the IRF Standard Payment Conversion Factor and Payment Rates for FY 2017
F. Example of the Methodology for Adjusting the Federal Prospective Payment Rates
VII. Update to Payments for High-Cost Outliers Under the IRF PPS
A. Update to the Outlier Threshold Amount for FY 2017
B. Update to the IRF Cost-to-Charge Ratio Ceiling and Urban/Rural Averages
VIII. Revisions and Updates to the IRF Quality Reporting Program (QRP)
A.
B. General Considerations Used for Selection of Quality, Resource Use, and Other Measures for the IRF QRP
E. Quality Measures Previously Finalized for and Currently Used in the IRF QRP
F. IRF QRP Quality, Resource Use and Other Measures Finalized for the FY 2018 Payment Determination and Subsequent Years
G. IRF QRP Quality Measure Finalized for the FY 2020 Payment Determination and Subsequent Years
H. IRF QRP Quality Measures and Measure Concepts Under Consideration for Future Years
I. Form, Manner, and Timing of Quality Data Submission for the FY 2018 Payment Determination and Subsequent Years
J. IRF QRP Data Completion Thresholds for the FY 2016 Payment Determination and Subsequent Years
K. IRF QRP Data Validation Process for the FY 2016 Payment Determination and Subsequent Years
L. Previously Adopted and Codified IRF QRP Submission Exception and Extension Policies
M. Previously Adopted and Finalized IRF QRP Reconsideration and Appeals Procedures
N. Public Display of Measure Data for the IRF QRP & Procedures for the Opportunity to Review and Correct Data and Information
O. Mechanism for Providing Feedback Reports to IRFs
IX. Miscellaneous Comments
X. Provisions of the Final Regulations
XI. Collection of Information Requirements
A. Statutory Requirement for Solicitation of Comments
B. Collection of Information Requirements for Updates Related to the IRF QRP
XII. Regulatory Impact Analysis
A. Statement of Need
B. Overall Impacts
C. Detailed Economic Analysis
D. Alternatives Considered
E. Accounting Statement
F. Conclusion
Acronyms, Abbreviations, and Short Forms
Because of the many terms to which we refer by acronym, abbreviation, or short form in this final rule, we are listing the acronyms, abbreviation, and short forms used and their corresponding terms in alphabetical order.
The Act The Social Security Act
ADC Average Daily Census
ADE Adverse Drug Events
The Affordable Care Act Patient Protection and Affordable Care Act (Pub. L. 111-148, enacted on
APU Annual Payment Update
ASAP Assessment Submission and Processing
ASCA The Administrative Simplification Compliance Act of 2002 (Pub. L. 107-105, enacted on
BMI Body Mass Index
CAH Critical Access Hospitals
CASPER Certification and Survey Provider Enhanced Reports
CAUTI Catheter-Associated Urinary Tract Infection
CBSA Core-Based Statistical Area
CCR Cost-to-Charge Ratio
CDI Clostridium difficile Infection
CFR Code of Federal Regulations
COA Care for Older Adults
CY Calendar year
DSH PP Disproportionate Share Patient Percentage
eCQMs Electronically Specified Clinical Quality Measures
D End-Stage Renal Disease
FFS Fee-for-Service
FY Federal Fiscal Year
GEMS General Equivalence Mapping
GPCI Geographic Practice Cost Index
HAI Healthcare Associated Infection
HCC Hierarchical Condition Category
HHA Home Health Agencies
HCP Home Care Personnel
HIPAA Health Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191, enacted on
Hospital VBP Hospital Value-Based Purchasing Program (also HVBP)
ICD-9-CM International Classification of Diseases, 9th Revision, Clinical Modification
ICD-10-CM International Classification of Diseases, 10th Revision, Clinical Modification
IGC Impairment Group Code
IGI IHS Global Insight
IMPACT Act Improving Medicare Post-Acute Care Transformation Act of 2014 (Pub. L. 113-185, enacted on
IME Indirect Medical Education
IPF Inpatient Psychiatric Facility
IPPS Inpatient prospective payment system
IQR Inpatient Quality Reporting Program
IRF Inpatient Rehabilitation Facility
--This is a summary of a
Final rule.
CFR Part: "42 CFR Part 412"
RIN Number: "RIN 0938-AS78"
Citation: "81 FR 52056"
Document Number: "CMS-1647-F"
Federal Register Page Number: "52056"
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