Medicare and Medicaid Programs and the Children's Health Insurance Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2025 Rates; Quality Programs Requirements; and Other Policy Changes

DEPARTMENT OF HEALTH AND HUMAN SERVICES <SUBAGY>Centers for Medicare & Medicaid Services</SUBAGY> <CFR>42 CFR Parts 412, 413, 431, 482, 485, 495, and 512</CFR> <DEPDOC>[CMS-1808-P]</DEPDOC> <RIN>RIN 0938-AV34</RIN> <SUBJECT>Medicare and Medicaid Programs and the Children's Health Insurance Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2025 Rates; Quality Programs Requirements; and Other Policy Changes</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 proposed rule would revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals; make changes relating to Medicare graduate medical education (GME) for teaching hospitals; update the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs); and make other policy-related changes. </SUM> <EFFDATE> <HD SOURCE="HED">DATES:</HD> To be assured consideration, comments must be received at one of the addresses provided in the <E T="02">ADDRESSES</E> section, no later than 5 p.m. EDT on June 10, 2024. </EFFDATE> <HD SOURCE="HED">ADDRESSES:</HD> In commenting, please refer to file code CMS-1808-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. 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 (and we encourage you to) submit electronic comments on this regulation to <E T="03">https://www.regulations.gov.</E> Follow the instructions under the “submit a comment” tab. 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-1808-P, P.O. Box 8013, Baltimore, MD 21244-8013. 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 via express or overnight mail to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1808-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. For information on viewing public comments, we refer readers to the beginning of the <E T="02">SUPPLEMENTARY INFORMATION</E> section. <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> Donald Thompson, and Michele Hudson, (410) 786-4487 or <E T="03">DAC@cms.hhs.gov,</E> Operating Prospective Payment, MS-DRG Relative Weights, Wage Index, Hospital Geographic Reclassifications, Graduate Medical Education, Capital Prospective Payment, Excluded Hospitals, Medicare Disproportionate Share Hospital (DSH) Payment Adjustment, Sole Community Hospitals (SCHs), Medicare-Dependent Small Rural Hospital (MDH) Program, Low-Volume Hospital Payment Adjustment, and Inpatient Critical Access Hospital (CAH) Issues. Emily Lipkin, and Jim Mildenberger, <E T="03">DAC@cms.hhs.gov,</E> Long-Term Care Hospital Prospective Payment System and MS-LTC-DRG Relative Weights Issues. Lily Yuan, <E T="03">NewTech@cms.hhs.gov,</E> New Technology Add-On Payments Issues. Mady Hue, <E T="03">marilu.hue@cms.hhs.gov,</E> and Andrea Hazeley, <E T="03">andrea.hazeley@cms.hhs.gov,</E> MS-DRG Classifications Issues. Siddhartha Mazumdar, <E T="03">siddhartha.mazumdar @cms.hhs.gov</E> , Rural Community Hospital Demonstration Program Issues. Jeris Smith, <E T="03">jeris.smith@cms.hhs.gov,</E> Frontier Community Health Integration Project (FCHIP) Demonstration Issues. Lang Le, <E T="03">lang.le@cms.hhs.gov,</E> Hospital Readmissions Reduction Program—Administration Issues. Ngozi Uzokwe, <E T="03">ngozi.uzokwe@cms.hhs.gov,</E> Hospital Readmissions Reduction Program—Measures Issues. Jennifer Tate, <E T="03">jennifer.tate@cms.hhs.gov,</E> Hospital-Acquired Condition Reduction Program—Administration Issues. Ngozi Uzokwe, <E T="03">ngozi.uzokwe@cms.hhs.gov,</E> Hospital-Acquired Condition Reduction Program—Measures Issues. Julia Venanzi, <E T="03">julia.venanzi@cms.hhs.gov,</E> Hospital Inpatient Quality Reporting Program and Hospital Value-Based Purchasing Program—Administration Issues. Melissa Hager, <E T="03">melissa.hager@cms.hhs.gov,</E> and Ngozi Uzokwe, <E T="03">ngozi.uzokwe@cms.hhs.gov</E> —Hospital Inpatient Quality Reporting Program and Hospital Value-Based Purchasing Program—Measures Issues Except Hospital Consumer Assessment of Healthcare Providers and Systems Issues. Elizabeth Goldstein, <E T="03">elizabeth.goldstein@cms.hhs.gov,</E> Hospital Inpatient Quality Reporting and Hospital Value-Based Purchasing—Hospital Consumer Assessment of Healthcare Providers and Systems Measures Issues. Ora Dawedeit, <E T="03">ora.dawedeit@cms.hhs.gov,</E> PPS-Exempt Cancer Hospital Quality Reporting—Administration Issues. Leah Domino, <E T="03">leah.domino@cms.hhs.gov,</E> PPS-Exempt Cancer Hospital Quality Reporting Program—Measure Issues. Lorraine Wickiser, <E T="03">lorraine.wickiser@cms.hhs.gov,</E> Long-Term Care Hospital Quality Reporting Program—Administration Issues. Jessica Warren, <E T="03">jessica.warren@cms.hhs.gov,</E> and Elizabeth Holland, <E T="03">elizabeth.holland@cms.hhs.gov,</E> Medicare Promoting Interoperability Program. Bridget Dickensheets, <E T="03">bridget.dickensheets@cms.hhs.gov</E> and Mollie Knight, <E T="03">mollie.knight@cms.hhs.gov,</E> LTCH Market Basket Rebasing. Benjamin Cohen, <E T="03">benjamin.cohen@cms.hhs.gov,</E> Provider Reimbursement Review Board. <E T="03">Nicholas.Bonomo@cms.hhs.gov</E> and <E T="03">tracy.smithtaylor@cms.hhs.gov,</E> Payment Error Rate Measurement Program. <E T="03">CMMI_TEAM@cms.hhs.gov,</E> Transforming Episode Accountability Model (TEAM). The Clinical Standards Group, <E T="03">HealthandSafetyInquiries@cms.hhs.gov,</E> Obstetrical Services Request for Information (RFI). </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">Tables Available on the CMS Website</HD> The IPPS tables for this fiscal year (FY) 2025 proposed rule are available on the CMS website at <E T="03">https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html.</E> Click on the link on the left side of the screen titled “FY 2025 IPPS Proposed rule Home Page” or “Acute Inpatient—Files for Download.” The LTCH PPS tables for this FY 2025 proposed rule are available on the CMS website at <E T="03">https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/index.html</E> under the list item for Regulation Number CMS-1808-P. For further details on the contents of the tables referenced in this proposed rule, we refer readers to section VI. of the Addendum to this FY 2025 IPPS/LTCH PPS proposed rule. Readers who experience any problems accessing any of the tables that are posted on the CMS websites, as previously identified, should contact Michael Treitel, <E T="03">DAC@cms.hhs.gov.</E> <HD SOURCE="HD1">I. Executive Summary and Background</HD> <HD SOURCE="HD2">A. Executive Summary</HD> <HD SOURCE="HD3">1. Purpose and Legal Authority</HD> This FY 2025 IPPS/LTCH PPS proposed rule would make payment and policy changes under the Medicare inpatient prospective payment system (IPPS) for operating and capital-related costs of acute care hospitals as well as for certain hospitals and hospital units excluded from the IPPS. In addition, it would make payment and policy changes for inpatient hospital services provided by long-term care hospitals (LTCHs) under the long-term care hospital prospective payment system (LTCH PPS). This proposed rule also would make policy changes to programs associated with Medicare IPPS hospitals, IPPS-excluded hospitals, and LTCHs. In this FY 2025 proposed rule, we are proposing to continue policies to address wage index disparities impacting low wage index hospitals. We are also proposing changes relating to Medicare graduate medical education (GME) for teaching hospitals and new technology add-on payments. We are proposing a separate IPPS payment for establishing and maintaining access to essential medicines. In the Hosp ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Preview showing 10k of 3862k characters. Full document text is stored and available for version comparison. ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━