News: Medicare payment policies updated for IPFs, SNFs, and hospices

CDI Strategies - Volume 14, Issue 32

CMS has updated Medicare payment rules for inpatient psychiatric facilities (IPFs), skilled nursing facilities (SNFs) and hospices.

For the fiscal year 2021 IPF Prospective Payment System Final Rule, a 2.2% payment rate update is being finalized, as well as CMS’ proposal to adopt revised Office of Management and Budget (OMB) statistical area delineations resulting in wage index values being more representative of the actual costs of labor. CMS is also finalizing updates that allow advanced practice providers (including physician assistants, nurse practitioners, psychologists, and clinical nurse specialist) to operate within the scope of practice allowed by state laws. They would qualify for this by documenting progress notes in the records of patients whom they are responsible for and receiving services in psychiatric hospitals.

The SNF Final Rule updates Medicare payments rates and quality programs for SNFs. Updates include routine technical rate-setting updates and finalizes adoption of the most recent OMB statistical area delineations, as well as applies a 5% cap on wage index decreases from years 2020 to 2021. ICD-10 code mapping changes will take effect in fiscal year 2021. CMS estimates aggregate payments to skilled nursing facilities will increase by 2.2% for 2021.

Hospice payment rates were updated 2.4% for fiscal year 2021 under the Hospice Final rule. However, hospices who fail to meet quality reporting requirements will receive a two-point reduction to the annual market basket increase. The hospice payment system includes a statutory aggregate cap which limits overall payments made annually to a hospice. The final cap for fiscal year 2021 is $30,683.93, which is equal to the 2021 cap amount updated by the final 2021 hospice payment update of 2.4%.

Editor’s note: The IPF Final Rule can be found here. The SNF Final Rule can be found here. The Hospice Final Rule can be found here.

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