Section 4003 of the Cures Act required HHS to take steps to advance interoperability through the development of a trusted exchange framework and common agreement aimed at establishing full network-to-network exchange of health information nationally. Solicit comments on the methodology used to update the facility-level adjustment factors, as discussed in section VIII. The inpatient rehabilitation facility must encode and transmit data for each inpatient, (1) Electronically transmit complete, accurate, and encoded data from the patient assessment instrument for each inpatient to our patient data system in accordance with the data format specified in paragraph (a) of this section; and. Receiving IRF(s). One Office of the Assistant Secretary for Planning and Evaluation (ASPE). Response: For Texas residents: Insured or offered by Humana Insurance Company, HumanaDental Insurance Company or DentiCare, Inc (d/b/a Compbenefits). You will need to have your card with you to complete activation. Regarding burden, MedPAC noted that since it has long been common practice for providers to collect IRF-PAI data on all patients, expanding IRF quality measures to include all patients should not be particularly onerous and may even relieve burden, to the extent that providers must now separate out assessment data for Medicare patients from that of all patients.. Given the changes in the teaching status adjustment and the rural adjustment from their 2014 levels and the potential payment impacts associated with these adjustments, we solicited comments from interested parties on the methodology used to determine the facility-level adjustment factors and suggestions for possible updates and refinements to this methodology. Impact of the Update to the CMG Relative Weights and ALOS Values. One commenter stated having an all-payer policy in place in some, but not all PAC settings, limits the ability of providers and consumers to interpret the information. All Highmark Medicare Advantage members are automatically enrolled in the Highmark Wellness Rewards Program. Under the Paperwork Reduction Act of 1995, we are required to provide 60-day notice in the 11/03/2022, 43 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256029/ Another commenter raised concerns about cyber security, and noted the potential security risk might not outweigh the time involved in manual submission. $100 for annual comprehensive diabetes care - must complete all of the following once in the calendar year: HbA1c test, kidney screening and retinopathy These data are the most current and complete data available at this time. Regarding commenters' request that CMS consider other methods and data sources to calculate the final rule market basket update, including the authority under section 1886(j) of the Act, while we generally agree that the Secretary has broad authority under the statute to establish the methodology for updating the IRF PPS payments, we note that our longstanding policy since the inception of the IRF PPS has been to update IRF PPS payments based on an appropriate market basket. Based on the more recent data available from IGI's second quarter 2022 forecast, the current estimate of the productivity adjustment for FY 2023 is 0.3 percentage point. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/IRF-Quality-Reporting. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/IRF-Quality-Reporting/IRF-Quality-Reporting-Program-Measures-Information. documents in the last year, 24 Dimitrov, L., & Gossman, W. (2022). For these reasons, we thought that the number of commenters would be a fair estimate of the number of reviewers of this final rule. Programs are provided through third party vendors who are solely responsible for their products and services. We also sought input on measures of health equity, such as structural measures that assess an organization's leadership in advancing equity goals or assess progress toward achieving equity priorities. The PTR allows providers to monitor their compliance status regarding the required data submission for the IRF QRP measures for the current Annual Increase Factor (AIF). We thank the commenters for the various suggested revisions to the outlier threshold methodology. It also includes the approximate 0.6 percent overall decrease in estimated IRF outlier payments from the update to the outlier threshold amount. Other commenters appreciated that collecting all-payer data will allow IRF QRP measures to include all patients regardless of payer status to ensure representation of the quality of services provided on the population as a whole, rather than a subset limited to Medicare, and one commenter agreed with CMS that the inclusion of all-payer data will more accurately reflect the quality of care provided to IRF patients. We do not have the statutory authority to make changes to the standard payment conversion factor outside of the annual market basket update and to ensure that any adjustment or update to the IRF wage index made as specified under section 1886(j)(6) of the Act will be made in a budget neutral manner that assures that the estimated aggregated payments under this subsection in the FY year are not greater or less than those that will have been made in the year without such adjustment. Therefore, for FY 2023 a final IRF productivity-adjusted market basket update of 3.9 percent (4.2 percent less 0.3 percentage point) will be applicable, compared to the 2.8 percent that was proposed. documents in the last year, by the Environmental Protection Agency 7. Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. These documents are intended to give patients notice of a data collection as required by section 552a(e)(3) of the Privacy Act of 1974, and serve as resources for IRF providers to provide to all patients upon admission to the IRF to notify them of their privacy rights as well as the authority for the data collection under the statute. In pain management, a critical part of providing comprehensive care is performance of a thorough initial evaluation, including assessment of both the medical and any biopsychosocial factors causing or contributing to the pain, with a treatment plan to address the causes of pain and to manage pain that persists over time. Closure of an IRF or IRF residency training program. Similarly, we proposed to estimate a national average CCR of 0.393 for urban IRFs, which we calculated by taking an average of the CCRs for all urban IRFs using their most recently submitted cost report data. Quality Measures Currently Adopted for the FY 2023 IRF QRP, C. IRF QRP Quality Measure Concepts for Future Years: Request for Information (RFI), D. Inclusion of the National Healthcare Safety Network (NHSN) Healthcare-Associated Clostridioides difficile Infection Outcome Measure in the IRF QRPRequest for Information, E. Overarching Principles for Measuring Equity and Healthcare Quality Disparities Across CMS Quality ProgramsRequest for Information, F. Proposals Relating to the Form, Manner, and Timing of Data Submission Under the IRF QRP, 2. We describe the estimated burden for the proposal in section XI.B. It is one of four Medicare Savings Programs. This methodology is consistent with the determination of the labor-related share since the implementation of the IRF PPS. We received support from IRFs to our RFI in the FY 2018 IRF PPS proposed rule, as well as our proposal in the FY 2020 IRF PPS proposed rule (the FY 2020 proposal was not subsequently finalized). The 2020 asset or allowed financial resource limit was $7,860 for an adult individual or $11,800 for a married couple. The OIG conducted an audit of calendar year 2017 and 2018 Medicare claims data and determined that if CMS had expanded its IRF transfer payment policy to include early discharges to home health it could have realized a significant savings of approximately $993 million over the 2-year period to Medicare. electronic version on GPOs govinfo.gov. CMS may waive the consequences of failure to submit complete and timely IRF-PAI data specified in paragraph (d) of this section when, due to an extraordinary situation that is beyond the control of an inpatient rehabilitation facility, the inpatient rehabilitation facility is unable to transmit the patient assessment data in accordance with paragraph (c) of this section. of this final rule. Register now to access the Humana Employer Portal. Thus, the adjusted payment for Facility A would be $28,817.54, and the adjusted payment for Facility B would be $28,257.27. Pain is not a surprising symptom in PAC patients and residents, where healing, recovery, and rehabilitation often require regaining mobility and other functions after an acute event. The Act also requires the submission of data pertaining to measure domains of resource use, and other domains. We have utilized various market baskets through the years in the IRF PPS. provide legal notice to the public or judicial notice to the courts. Step 3. This system conforms to all applicable Federal laws and regulations as well as Federal government, HHS, and CMS policies and standards as they relate to information security and data privacy. A Go365 Wharton Study*, PDF showed that employees who engaged in the wellness and rewards program had: They can log activities, track progress and claim rewards using smartphones, tablets or desktops. Start Printed Page 47055 SB 1382 by Senator Lena Gonzalez (D-Long Beach) Air pollution: Clean Cars 4 All Program: Sales and Use Tax Law: zero emissions vehicle exemption. Step 4. documents in the last year, 675 Initially, home health was not added to the IRF transfer policy due to a lack of home health claims data under the newly-established prospective payment system that we could analyze to determine the impact of this policy change. However, as described in more detail in each section, they will be expected to affect the estimated distribution of payments among providers. However, we did not receive any comments on the proposed revisions to the IRF CCR ceiling and the urban/rural averages for FY 2023, and therefore, we are finalizing a national average urban CCR at 0.392, the national average rural CCR at 0.466, and the national average CCR ceiling at 1.41 for FY 2023. The CMG relative weights are updated each year based on the most recent available data for the full population of IRF Medicare fee-for-service beneficiaries. National Institute of Mental Health. As we described in section XI.F.2.b. Response: on Additional information on the regression analysis used to calculate the facility-level adjustment factors can be found on the CMS website at Adolescence and the social determinants of health. The intent of the hearing, speech, and vision items is to document the patient's ability to hear (with assistive devices, if they are used), understand, and communicate with others, and the patient's ability to see objects nearby in their environment. We received several comments on the RFI for Overarching Principles for Measuring Equity and Healthcare Quality Disparities Across CMS Quality Programs. We invited public comments on the proposed labor related share for FY 2023. Collecting the data as proposed will provide the basis for our periodic analyses of the relationship between an individual's health status and other factors and quality, resource use, and other measures, as required by section 2(d)(2) of the IMPACT Act, and to assess appropriate adjustments. MACs are not considered to be 379(9826), 1641-1652. We believe that these data accurately reflect the severity of the IRF patient population and the associated costs of caring for these patients in the IRF setting. Start Printed Page 47074 Comment: IRF labor market areas are delineated based on the CBSAs established by the OMB. 1900 S. Norfolk St., Suite 350, San Mateo, CA 94403 ++ Other options for measures that address health equity. Additionally, CMS has several reports available to providers to monitor their compliance with the QRP reporting requirements during the year. These commenters stated that they appreciated us clarifying the definition of a displaced resident for the purpose of reallocating the FTE to a new IRF, mitigating prior delayed transfer issues. L. 114-10, enacted on April 16, 2015) also addressed the IRF PPS. Divide the amount calculated in step 1 by the amount calculated in step 2. We note that we reviewed the Bureau of Labor Statistics Occupational Employment Statistics (OES) data for NAICS 622100 (General Medical and Surgical Hospitals). This reflected our belief that it is important to minimize the inherent incentives specifically associated with the early transfer of patients in a discharge-based payment system. Making Medicare changes Making Medicare Among these, there are 134 IRF units of hospitals located in rural areas and 12 freestanding IRF hospitals located in rural areas. We apply the national urban and rural CCRs in the following situations: Specifically, for FY 2023, we proposed to estimate a national average CCR of 0.463 for rural IRFs, which we calculated by taking an average of the CCRs for all rural IRFs using their most recently submitted cost report data. IRFs will be required to report these data with respect to admission and discharge for all patients, regardless of payer, discharged between October 1, 2024 and December 31, 2024. Among other changes, the May 8, 2020 IFC included a waiver of the 3-hour rule at 412.622(a)(3)(ii) to reflect the waiver required by section 3711(a) of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) (Pub. In updating the rates for FY 2023, we are implementing the standard annual revisions described in this final rule (for example, the update to the wage index and market basket increase factor used to adjust the Federal rates). The process to calculate the CMG relative weights for this final rule is as follows: Step 1. To determine the non-labor portion of the prospective payment rate, we subtract the labor portion of the Federal payment from the unadjusted prospective payment. Addiction is a neuropsychological disorder characterized by a persistent and intense urge to engage in certain behaviors, often usage of a drug, despite substantial harm and other negative consequences.Repetitive drug use often alters brain function in ways that perpetuate craving, and weakens (but does not completely negate) self-control. ++ Principles to be considered for the selection of social risk factors and demographic data for use in collecting disparity data including the importance of expanding variables used in measure stratification to consider a wide range of social risk factors, demographic variables, and other markers of historic disadvantage. While their numbers reflect average IRF payer penetration, they do not represent all IRFs' payer penetration. Centers for Medicare & Medicaid Services. Governor Newsom previously signed: AB 2251 by Assemblymember Lisa Calderon (D-Whittier) Urban forestry: statewide strategic plan. A few commenters expressed concern regarding reductions in the relative weight values associated with stroke and traumatic spinal cord injury and suggested that this would inappropriately reduce payments. The MSPs help break the pattern of increases. However, since this item is replacing another item already accounted for in the PRA, we do not believe this would add any additional burden to the estimate described above. However, to date, the analytical challenges would not present an issue as we believe the home health payment system is well established with an adequate supply of claims data. We appreciate the commenters' suggestion to adopt the IPPS reclassification and rural floor policies for the IRF wage index. Specifically, we proposed to adopt the FY 2021 IPPS final rule definition of displaced resident as defined at 413.79(h)(1)(ii), for the purpose of calculating the IRF's teaching status adjustment. Another commenter requested that CMS work with Congress to permanently eliminate the reduction to hospital We did not propose any new policies regarding the public display of measure data. An inpatient rehabilitation facility cannot claim time spent by the resident at another inpatient rehabilitation facility or hospital. In the proposed rule we noted that if finalized as proposed, we would revise the IRF-PAI in order for IRFs to submit data pursuant to the finalized policy. Response: Therefore, we estimate that the total cost of reviewing this regulation is $21,085.26 ($345.66 x 61 reviewers). Thus, we proposed to use the core based statistical areas (CBSAs) labor market area definitions and the FY 2023 pre-reclassification and pre-floor hospital wage index data. the United States began responding to an outbreak of a virus named SARS-CoV-2 and the disease it causes, which is named coronavirus disease 2019 (abbreviated COVID-19). 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