Medicare Program; FY 2025 Inpatient Psychiatric Facilities Prospective Payment System-Rate Update

DEPARTMENT OF HEALTH AND HUMAN SERVICES <SUBAGY>Centers for Medicare & Medicaid Services</SUBAGY> <CFR>42 CFR Part 412</CFR> <DEPDOC>[CMS-1806-P]</DEPDOC> <RIN>RIN 0938-AV32</RIN> <SUBJECT>Medicare Program; FY 2025 Inpatient Psychiatric Facilities Prospective Payment System—Rate Update</SUBJECT> <HD SOURCE="HED">AGENCY:</HD> Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS). <HD SOURCE="HED">ACTION:</HD> Proposed rule. <SUM> <HD SOURCE="HED">SUMMARY:</HD> This rulemaking proposes to update the prospective payment rates, the outlier threshold, and the wage index for Medicare inpatient hospital services provided by Inpatient Psychiatric Facilities (IPF), which include psychiatric hospitals and excluded psychiatric units of an acute care hospital or critical access hospital. This rulemaking also proposes to revise the patient-level adjustment factors, the Emergency Department adjustment, and the payment amount for electroconvulsive therapy. These proposed changes would be effective for IPF discharges occurring during the fiscal year beginning October 1, 2024 through September 30, 2025 (FY 2025). In addition, this proposed rule seeks to adopt a new quality measure and modify reporting requirements under the IPF Quality Reporting Program beginning with the FY 2027 payment determination. Furthermore, this proposed rule solicits comments through Requests for Information (RFIs) regarding potential future revisions to the IPF PPS facility-level adjustments and regarding the development of a standardized IPF Patient Assessment Instrument. </SUM> <EFFDATE> <HD SOURCE="HED">DATES:</HD> To be assured consideration, comments must be received at one of the addresses provided below, by May 28, 2024. </EFFDATE> <HD SOURCE="HED">ADDRESSES:</HD> In commenting, please refer to file code CMS-1806-P. Comments, including mass comment submissions, must be submitted in one of the following three ways (please choose only one of the ways listed): 1. <E T="03">Electronically.</E> You may submit electronic comments on this regulation to <E T="03">http://www.regulations.gov.</E> Follow the “Submit a comment” instructions. 2. <E T="03">By regular mail.</E> You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1806-P, P.O. Box 8010, Baltimore, MD 21244-8010. Please allow sufficient time for mailed comments to be received before the close of the comment period. 3. <E T="03">By express or overnight mail.</E> You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1806-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. For information on viewing public comments, see the beginning of the <E T="02">SUPPLEMENTARY INFORMATION</E> section. <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> Nick Brock (410) 786-5148, for information regarding the inpatient psychiatric facilities prospective payment system (IPF PPS). Kaleigh Emerson (470) 890-4141, for information regarding the inpatient psychiatric facilities quality reporting program (IPFQR). </FURINF> <SUPLINF> <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD> <E T="03">Inspection of Public Comments:</E> All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following website as soon as possible after they have been received: <E T="03">http://www.regulations.gov.</E> Follow the search instructions on that website to view public comments. CMS will not post on <E T="03">Regulations.gov</E> public comments that make threats to individuals or institutions or suggest that the commenter will take actions to harm an individual. CMS continues to encourage individuals not to submit duplicative comments. We will post acceptable comments from multiple unique commenters even if the content is identical or nearly identical to other comments. <E T="03">Plain Language Summary:</E> In accordance with 5 U.S.C. 553(b)(4), a plain language summary of this rule may be found at <E T="03">https://www.regulations.gov/.</E> <HD SOURCE="HD1">Availability of Certain Tables Exclusively Through the Internet on the CMS Website</HD> Addendum A to this proposed rule summarizes the proposed FY 2025 Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) payment rates, outlier threshold, cost of living adjustment factors for Alaska and Hawaii, national and upper limit cost-to-charge ratios, and adjustment factors. In addition, Addendum B to this proposed rule shows the complete listing of ICD-10 Clinical Modification and Procedure Coding System codes, the FY 2025 IPF PPS comorbidity adjustment, and electroconvulsive therapy procedure codes. The A and B Addenda are available on the CMS website at: <E T="03">https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientPsychFacilPPS/tools.html.</E> Tables setting forth the FY 2025 Wage Index for Urban Areas Based on Core-Based Statistical Area Labor Market Areas, the FY 2025 Wage Index Based on CBSA Labor Market Areas for Rural Areas, and a county-level crosswalk of the FY 2024 CBSA Labor Market Areas to the FY 2025 CBSA Labor Market Areas are available exclusively through the internet, on the CMS website at <E T="03">https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/IPFPPS/WageIndex.html.</E> <HD SOURCE="HD1">I. Executive Summary</HD> <HD SOURCE="HD2">A. Purpose</HD> This proposed rule would update the prospective payment rates, the outlier threshold, and the wage index for Medicare inpatient hospital services provided by Inpatient Psychiatric Facilities (IPFs) for discharges occurring during fiscal year (FY) 2025, (beginning October 1, 2024 through September 30, 2025). We are proposing to adopt the Core-Based Statistical Area (CBSA) Labor Market Areas for the IPF PPS wage index as defined in the Office of Management and Budget (OMB) Bulletin 23-01. In addition, this rule includes a proposal to refine the patient-level adjustment factors and increase the payment amount for electroconvulsive therapy (ECT) treatments. We are not proposing changes to the facility-level adjustment factors for FY 2025; however, this proposed rule presents the results of our latest analysis and includes a request for information relating to those results. This rule also includes a clarification of the eligibility criteria for an IPF to be approved to file all-inclusive cost reports. In addition, this proposed rule includes a request for information regarding the creation of a patient assessment instrument (PAI) as mandated by Section 4125 of the Consolidated Appropriations Act (CAA), 2023 (hereafter referred to as CAA, 2023) (Pub. L. 117-328). Lastly, this proposed rule discusses quality measures and reporting requirements under the Inpatient Psychiatric Facilities Quality Reporting (IPFQR) Program. <HD SOURCE="HD2">B. Summary of the Major Provisions</HD> <HD SOURCE="HD3">1. Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS)</HD> For the IPF PPS, we are: • Proposing to revise the patient-level IPF PPS adjustment factors and increase the ECT per treatment payment amount. • Proposing to update the IPF PPS wage index to use the CBSAs defined within OMB Bulletin 23-01. • Clarifying the eligibility criteria for an IPF to be approved to file all-inclusive cost reports. Only a government-owned or tribally owned facility will be able to satisfy these criteria and will be eligible to file its cost report using an all-inclusive rate or no charge structure. • Soliciting comments to inform elements to be included in the IPF patient assessment instrument, which the CAA, 2023 requires the Centers for Medicare & Medicaid Services (CMS) to develop for FY 2028. • Soliciting comments to inform future refinements to the IPF PPS facility-level adjustment factors. • Making technical rate setting updates: The IPF PPS payment rates are adjusted annually for inflation, as well as statutory and other policy factors. This rule proposes to update: ++ The IPF PPS Federal per diem base rate from $895.63 to $874.93. ++ The IPF PPS Federal per diem base rate for providers who failed to report quality data to $857.89. ++ The ECT payment per treatment from $385.58 to $660.30. ++ The ECT payment per treatment for providers who failed to report quality data to $647.45. ++ The labor-related share from 78.7 percent to 78.8 percent. ++ The wage index budget neutrality factor to 0.9998. This proposed rule would apply a refinement standardization factor of 0.9514. ++ The fixed dollar loss threshold amount from $33,470 to $35,590, to maintain estimated outlier payments at 2 percent of total estimated aggregate IPF PPS payments. <HD SOURCE="HD3">2. Inpatient Psychiatric Facilities Quality Reporting (IPFQR) Program</HD> For the IPFQR Program, we are proposing to: • Adopt the 30-Day Risk-Standardized All-Cause Emergency Department (ED) Visit Following an IPF Discharge measure beginning with the FY 2027 payment determination; and • Modify reporting requirements to require IPFs to submit patient-level data on a quarterly basis. We also refer readers to our RFI in which we solicit comments to inform elements to be included in the IPF patient assessment instrument, which the CAA, 2023 requires the Centers for Medicare & Medicaid Services (CMS) to develop and implement for Rate Year (RY) 2028. <HD SOURCE="HD2">C. Summary of Impacts</HD> <GPH SPAN="3" DEEP="137"> <GID>EP03AP24.000</GID> </GPH> <HD SOURCE="HD1">II. B ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Preview showing 10k of 340k characters. 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