Medicare Program; FY 2017 Inpatient Psychiatric Facilities Prospective Payment System–Rate Update
SUMMARY: This notice updates the prospective payment rates for
DATES: Effective: The updated IPF prospective payment rates are effective for discharges occurring on or after
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION:
Availability of Certain Tables Exclusively Through the
In the past, tables setting forth the Wage Index for Urban Areas Based on Core-Based Statistical Area (CBSA) Labor Market Areas and the Wage Index Based on CBSA Labor Market Areas for Rural Areas were published in the
To assist readers in referencing sections contained in this document, we are providing the following table of contents.
Table of Contents
I. Executive Summary
A. Purpose
B. Summary of the Major Provisions
C. Summary of Impacts
II. Background
A. Overview of the Legislative Requirements of the IPF PPS
B. Overview of the IPF PPS
C. Annual Requirements for Updating the IPF PPS
III. Provisions of the Notice
A. Updated FY 2017 Market Basket for the IPF PPS
1. Background
2. FY 2017 IPF Market Basket Update
3. IPF Labor-Related Share
B. Updates to the IPF PPS Rates for FY Beginning
1. Determining the Standardized Budget-Neutral Federal Per Diem Base Rate
2. Update of the Federal Per Diem Base Rate and Electroconvulsive Therapy Payment per Treatment
C. Updates to the IPF PPS Patient-Level Adjustment Factors
1. Overview of the IPF PPS Adjustment Factors
2. IPF-PPS Patient-Level Adjustments
a. MS-DRG Assignment
i. Code First
b. Payment for Comorbid Conditions
3. Patient Age Adjustments
4. Variable Per Diem Adjustments
D. Updates to the IPF PPS Facility-Level Adjustments
1. Wage Index Adjustment
a. Background
b. Updated Wage Index for FY 2017
c. OMB Bulletins
d. Adjustment for Rural Location and Continuing Phase Out the Rural Adjustment for IPFs That Lost Their Rural Adjustment Due to CBSA Changes Implemented in FY 2016
e. Budget Neutrality Adjustment
2. Teaching Adjustment
3. Cost of Living Adjustment for IPFs Located in
4. Adjustment for IPFs With a
E. Other Payment Adjustments and Policies
1. Outlier Payment Overview
2. Update to the Outlier Fixed Dollar Loss Threshold Amount
3. Update to IPF Cost-to-Charge Ratio Ceilings
IV. Update on IPF PPS Refinements
V. Waiver of Notice and Comment
VI. Collection of Information Requirements
VII. Regulatory Impact Analysis
A. Statement of Need
B. Overall Impact
C. Anticipated Effects
1. Budgetary Impact
2. Impact on Providers
3. Results
4. Effect on Beneficiaries
D. Alternatives Considered
E. Accounting Statement
Addendum A--IPF PPS FY 2017 Rates and Adjustment Factors
Addendum B--Changes to the FY 2017 ICD-10-CM/PCS Code Sets Which Affect the FY 2017 IPF PPS Comorbidity Adjustments
Acronyms
Because of the many terms to which we refer by acronym in this notice, we are listing the acronyms used and their corresponding meanings in alphabetical order below:
ADC Average Daily Census
BBRA Medicare,
CBSA Core-Based Statistical Area
CCR Cost-to-Charge Ratio
CPI Consumer Price Index
CPI-U Consumer Price Index for all Urban Consumers
CY Calendar Year
DRGs Diagnosis-Related Groups
ECT Electroconvulsive Therapy
ESRD End State Renal Disease
FTE Full-time equivalent
FY Federal Fiscal Year (
GDP Gross Domestic Product
GME Graduate Medical Education
HCRIS Healthcare Cost Report Information System
ICD-9-CM International Classification of Diseases, 9th Revision, Clinical Modification
ICD-10-CM International Classification of Diseases, 10th Revision, Clinical Modification
ICD-10-PCS International Classification of Diseases, 10th Revision, Procedure Coding System
IPF Inpatient Psychiatric Facility
IPFQR Inpatient Psychiatric Facilities Quality Reporting
IPPS Inpatient Prospective Payment System
IRFs Inpatient Rehabilitation Facilities
LOS Length of Stay
LRS Labor-related Share
LTCHs Long-Term Care Hospitals
MAC Medicare Administrative Contractor
MedPAR Medicare Provider Analysis and Review File
MFP Multifactor Productivity
MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003
MSA Metropolitan Statistical Area
NDAA National Defense Authorization Act
OPPS Outpatient Prospective Payment System
POS Provider of Services
PPS Prospective Payment System
RFA Regulatory Flexibility Act
RPL Rehabilitation, Psychiatric, and Long-Term Care
RY Rate Year (
SCHIP State Children's Health Insurance Program
SNF Skilled Nursing Facility
TEFRA Tax Equity and Fiscal Responsibility Act of 1982 (Pub. L. 97-248)
I. Executive Summary
A. Purpose
This notice updates the prospective payment rates for
B. Summary of the Major Provisions
In this notice, we are updating the IPF Prospective Payment System (PPS), as specified in 42 CFR 412.428. The updates include the following:
* Effective for the FY 2016 IPF PPS update, we adopted a 2012-based IPF market basket. For FY 2017, we adjusted the 2012-based IPF market basket update (2.8 percent) by a reduction for economy-wide productivity (0.3 percentage point) as required by section 1886(s)(2)(A)(i) of the Social Security Act (the Act). We further reduced the 2012-based IPF market basket update by 0.2 percentage point as required by section 1886(s)(2)(A)(ii) of the Act, resulting in an estimated IPF payment rate update of 2.3 percent for FY 2017.
* The 2012-based IPF market basket resulted in a labor-related share of 75.1 percent for FY 2017.
* We updated the IPF PPS per diem rate from
* We updated the electroconvulsive therapy (ECT) payment per treatment from
* We used the updated labor-related share of 75.1 percent (based on the 2012-based IPF market basket) and
* We updated the fixed dollar loss threshold amount from
C. Summary of Impacts
Provision................Total transfers
description
FY 2017 IPF PPS payment..The overall economic impact of this notice is an
update.................. estimated..
........................ IPFs during FY 2017.
II. Background
A. Overview of the Legislative Requirements for the IPF PPS
--This is a summary of a
Notice.
RIN Number: "RIN 0938-AS76"
Citation: "81 FR 50502"
Document Number: "CMS-1650-N"
Federal Register Page Number: "50502"
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