Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the

585 Pages·2016·3.44 MB·English

56762 Federal Register/Vol. 81, No. 162/Monday, August 22, 2016/Rules and Regulations
DEPARTMENT OF HEALTH AND requirements or revising existing Mollie Knight (410) 786–7948, and
HUMAN SERVICES requirements for quality reporting by Bridget Dickensheets, (410) 786–8670,
specific Medicare providers (acute care Rebasing and Revising the LTCH Market
Centers for Medicare & Medicaid hospitals, PPS-exempt cancer hospitals, Basket Issues.
Services LTCHs, and inpatient psychiatric Siddhartha Mazumdar, (410) 786–
facilities), including related provisions 6673, Rural Community Hospital
42 CFR Parts 405, 412, 413, and 489 for eligible hospitals and critical access Demonstration Program Issues.
hospitals (CAHs) participating in the Jason Pteroski, (410) 786–4681, and
[CMS–1655–F; CMS–16644–F; CMS–1632–
Electronic Health Record Incentive Siddhartha Mazumdar, (410) 786–6673,
F2]
Program; updating policies relating to Frontier Community Health Integration
RIN 0938–AS77; 0938–AS88; 0938–AS41 the Hospital Value-Based Purchasing Project Demonstration Issues.
Program, the Hospital Readmissions Kathryn McCann Smith, (410) 786–
Medicare Program; Hospital Inpatient Reduction Program, and the Hospital- 7623, Hospital Notification Procedures
Prospective Payment Systems for Acquired Condition Reduction Program; for Beneficiaries Receiving Outpatient
Acute Care Hospitals and the Long- implementing statutory provisions that Observation Services Issues; or
Term Care Hospital Prospective require hospitals and CAHs to furnish Stephanie Simons, (206) 615–2420, only
Payment System and Policy Changes notification to Medicare beneficiaries, for Related Medicare Health Plans
and Fiscal Year 2017 Rates; Quality including Medicare Advantage Issues.
Reporting Requirements for Specific enrollees, when the beneficiaries receive Lein Han, (617) 879–0129, Hospital
Providers; Graduate Medical outpatient observation services for more Readmissions Reduction Program—
Education; Hospital Notification than 24 hours; announcing the Readmission Measures for Hospitals
Procedures Applicable to Beneficiaries implementation of the Frontier Issues.
Receiving Observation Services; Community Health Integration Project Delia Houseal, (410) 786–2724,
Technical Changes Relating to Costs Demonstration; and making technical Hospital-Acquired Condition Reduction
to Organizations and Medicare Cost corrections and changes to regulations Program and Hospital Readmissions
Reports; Finalization of Interim Final relating to costs to related organizations Reduction Program—Administration
Rules With Comment Period on LTCH and Medicare cost reports; we are Issues.
PPS Payments for Severe Wounds, providing notice of the closure of three Joseph Clift, (410) 786–4165,
Modifications of Limitations on teaching hospitals and the opportunity Hospital-Acquired Condition Reduction
Redesignation by the Medicare to apply for available GME resident slots Program—Measures Issues.
Geographic Classification Review James Poyer, (410) 786–2261, Hospital
under section 5506 of the Affordable
Board, and Extensions of Payments to Inpatient Quality Reporting and
Care Act.
MDHs and Low-Volume Hospitals We are finalizing the provisions of Hospital Value-Based Purchasing—
AGENCY: Centers for Medicare and itnhtaetr riemla ftien taol aru tleems pwoirtahr cyo emxcmeepntito pne froior d Panrodg Rraemco Ansdimdeirnaitsitorant iIossnu, eVsa. lidation,
Medicaid Services (CMS), HHS.
Cindy Tourison, (410) 786–1093,
certain wound care discharges from the
ACTION: Final rule. Hospital Inpatient Quality Reporting—
application of the site neutral payment
Measures Issues Except Hospital
SUMMARY: We are revising the Medicare rate under the LTCH PPS for certain
Consumer Assessment of Healthcare
hospital inpatient prospective payment LTCHs; application of two judicial
Providers and Systems Issues; and
systems (IPPS) for operating and capital- decisions relating to modifications of
Readmission Measures for Hospitals
related costs of acute care hospitals to limitations on redesignation by the
Issues.
implement changes arising from our Medicare Geographic Classification
Kim Spaulding Bush, (410) 786–3232,
continuing experience with these Review Board; and legislative
Hospital Value-Based Purchasing
systems for FY 2017. Some of these extensions of the Medicare-dependent,
Efficiency Measures Issues.
changes will implement certain small rural hospital program and Elizabeth Goldstein, (410) 786–6665,
statutory provisions contained in the changes to the payment adjustment for Hospital Inpatient Quality Reporting—
Pathway for Sustainable Growth Reform low-volume hospitals. Hospital Consumer Assessment of
Act of 2013, the Improving Medicare DATES: Effective Date: These final rules Healthcare Providers and Systems
Post-Acute Care Transformation Act of are effective on October 1, 2016. Measures Issues.
2014, the Notice of Observation FORFURTHERINFORMATIONCONTACT: Ing James Poyer, (410) 786–2261, PPS-
Treatment and Implications for Care Jye Cheng, (410) 786–4548, and Donald Exempt Cancer Hospital Quality
Eligibility Act of 2015, and other Thompson, (410) 786–44487, Operating Reporting Issues.
legislation. We also are providing the Prospective Payment, MS–DRGs, Wage Mary Pratt, (410) 786–6867, Long-
estimated market basket update to apply Index, New Medical Service and Term Care Hospital Quality Data
to the rate-of-increase limits for certain Technology Add-On Payments, Hospital Reporting Issues.
hospitals excluded from the IPPS that Geographic Reclassifications, Graduate Jeffrey Buck, (410) 786–0407 and
are paid on a reasonable cost basis Medical Education, Capital Prospective Cindy Tourison (410) 786–1093,
subject to these limits for FY 2017. Payment, Excluded Hospitals, Medicare Inpatient Psychiatric Facilities Quality
We are updating the payment policies Disproportionate Share Hospital (DSH) Data Reporting Issues.
and the annual payment rates for the Issues, Medicare-Dependent Small Rural Deborah Krauss, (410) 786–5264, and
S2 Medicare prospective payment system Hospital (MDH) Program, and Low- Lisa Marie Gomez, (410) 786–1175, EHR
ULE (PPS) for inpatient hospital services Volume Hospital Payment Adjustment Incentive Program Clinical Quality
D with R p(LrTovCiHdes)d f obry FloYn 2g0-t1e7rm. care hospitals IssMueics.h ele Hudson, (410) 786–4487, and MeEalsizuarbee Rthe lMateyder Iss,s (u4e1s0. ) 786–4751, EHR
RO In addition, we are making changes Emily Lipkin, (410) 786–3633, Long- Incentive Program Nonclinical Quality
P
G9T082 reedluatciantgio tno (dGirMecEt) garnadd uinadtei rmecetd miceadl ical TPaeyrmm eCnatr Se yHsotesmpi taanl dP rMosSp–eLcTtiCv–eD RG MeLaasuurreen R Welua,t e(2d0 I2ss) u6e9s0. –7151, Certified
K3 education payments; establishing new Relative Weights Issues. EHR Technology Related Issues.
S
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Federal Register/Vol. 81, No. 162/Monday, August 22, 2016/Rules and Regulations 56763
Kellie Shannon, (410) 786–0416, ALOS Average length of stay DPP Disproportionate patient percentage
Technical Changes Relating to Costs to ALTHA Acute Long-Term Hospital DRA Deficit Reduction Act of 2005, Public
Organizations and Medicare Cost Association Law 109–171
AMA American Medical Association DRG Diagnosis-related group
Reports Issues.
AMGA American Medical Group DSH Disproportionate share hospital
SUPPLEMENTARYINFORMATION: Association EBRT External beam radiotherapy
AMI Acute myocardial infarction ECE Extraordinary circumstances
Electronic Access
AOA American Osteopathic Association exemption
This Federal Register document is APR DRG All Patient Refined Diagnosis ECI Employment cost index
available from the Federal Register Related Group System eCQM Electronic clinical quality measure
online database through Federal Digital APRN Advanced practice registered nurse EDB [Medicare] Enrollment Database
System (FDsys), a service of the U.S. ARRA American Recovery and EHR Electronic health record
Reinvestment Act of 2009, Public Law EMR Electronic medical record
Government Printing Office. This
111–5 EMTALA Emergency Medical Treatment
database can be accessed via the
ASCA Administrative Simplification and Labor Act of 1986, Public Law 99–272
Internet at: http://www.gpo.gov/fdsys. Compliance Act of 2002, Public Law 107– EP Eligible professional
105 FAH Federation of American Hospitals
Tables Available Only Through the
ASITN American Society of Interventional FDA Food and Drug Administration
Internet on the CMS Web Site
and Therapeutic Neuroradiology FFY Federal fiscal year
In the past, a majority of the tables ASPE Assistant Secretary for Planning and FPL Federal poverty line
referred to throughout this preamble Evaluation (DHHS) FQHC Federally qualified health center
and in the Addendum to the proposed ATRA American Taxpayer Relief Act of FR Federal Register
2012, Public Law 112–240 FTE Full-time equivalent
rule and the final rule were published
BBA Balanced Budget Act of 1997, Public FY Fiscal year
in the Federal Register as part of the
Law 105–33 GAF Geographic Adjustment Factor
annual proposed and final rules. BBRA Medicare, Medicaid, and SCHIP GME Graduate medical education
However, beginning in FY 2012, some of [State Children’s Health Insurance HAC Hospital-acquired condition
the IPPS tables and LTCH PPS tables are Program] Balanced Budget Refinement Act HAI Healthcare-associated infection
no longer published in the Federal of 1999, Public Law 106–113 HCAHPS Hospital Consumer Assessment of
Register. Instead, these tables generally BIPA Medicare, Medicaid, and SCHIP [State Healthcare Providers and Systems
Children’s Health Insurance Program] HCFA Health Care Financing
will be available only through the
Benefits Improvement and Protection Act Administration
Internet. The IPPS tables for this final
of 2000, Public Law 106–554 HCO High-cost outlier
rule are available through the Internet BLS Bureau of Labor Statistics HCP Healthcare personnel
on the CMS Web site at: http:// CABG Coronary artery bypass graft HCRIS Hospital Cost Report Information
www.cms.hhs.gov/Medicare/Medicare- [surgery] System
Fee-for-Service-Payment/ CAH Critical access hospital HF Heart failure
AcuteInpatientPPS/index.html. Click on CARE [Medicare] Continuity Assessment HHA Home health agency
the link on the left side of the screen Record & Evaluation [Instrument] HHS Department of Health and Human
CART CMS Abstraction & Reporting Tool Services
titled, ‘‘FY 2017 IPPS Final Rule Home
CAUTI Catheter-associated urinary tract HICAN Health Insurance Claims Account
Page’’ or ‘‘Acute Inpatient—Files for
infection Number
Download’’. The LTCH PPS tables for CBSAs Core-based statistical areas HIPAA Health Insurance Portability and
this FY 2017 final rule are available CC Complication or comorbidity Accountability Act of 1996, Public Law
through the Internet on the CMS Web CCN CMS Certification Number 104–191
site at: http://www.cms.gov/Medicare/ CCR Cost-to-charge ratio HIPC Health Information Policy Council
Medicare-Fee-for-Service-Payment/ CDAC [Medicare] Clinical Data Abstraction HIS Health information system
LongTermCareHospitalPPS/index.html Center HIT Health information technology
CDAD Clostridium difficile-associated HMO Health maintenance organization
under the list item for Regulation
disease HPMP Hospital Payment Monitoring
Number CMS–1655–F. For further
CDC Centers for Disease Control and Program
details on the contents of the tables Prevention HSA Health savings account
referenced in this final rule, we refer CERT Comprehensive error rate testing HSCRC [Maryland] Health Services Cost
readers to section VI. of the Addendum CDI Clostridium difficile [C. difficile] Review Commission
to this final rule. infection HSRV Hospital-specific relative value
Readers who experience any problems CFR Code of Federal Regulations HSRVcc Hospital-specific relative value
accessing any of the tables that are CLABSI Central line-associated cost center
bloodstream infection HQA Hospital Quality Alliance
posted on the CMS Web sites identified
CIPI Capital input price index HQI Hospital Quality Initiative
above should contact Michael Treitel at
CMI Case-mix index HwH Hospital-within-hospital
(410) 786–4552.
CMS Centers for Medicare & Medicaid ICD–9–CM International Classification of
Acronyms Services Diseases, Ninth Revision, Clinical
CMSA Consolidated Metropolitan Modification
3M 3M Health Information System Statistical Area ICD–10–CM International Classification of
AAMC Association of American Medical COBRA Consolidated Omnibus Diseases, Tenth Revision, Clinical
Colleges Reconciliation Act of 1985, Public Law 99– Modification
ACGME Accreditation Council for Graduate 272 ICD–10–PCS International Classification of
Medical Education COLA Cost-of-living adjustment Diseases, Tenth Revision, Procedure
ACoS American College of Surgeons CoP [Hospital] condition of participation Coding System
ES2 AHA American Hospital Association COPD Chronic obstructive pulmonary ICR Information collection requirement
RUL AHIC American Health Information disease ICU Intensive care unit
with Community CPI Consumer price index IGI IHS Global Insight, Inc.
D AHIMA American Health Information CQL Clinical quality language IHS Indian Health Service
O
PR Management Association CQM Clinical quality measure IME Indirect medical education
T082 AHRQ Agency for Healthcare Research and CY Calendar year IMPACT Act Improving Medicare Post-
G9 Quality DACA Data Accuracy and Completeness Acute Care Transformation Act of 2014,
SK3 AJCC American Joint Committee on Cancer Acknowledgement Public Law 113–185
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56764 Federal Register/Vol. 81, No. 162/Monday, August 22, 2016/Rules and Regulations
I–O Input-Output NHSN National Healthcare Safety Network RRC Rural referral center
IOM Institute of Medicine NOP Notice of Participation RSMR Risk-standard mortality rate
IPF Inpatient psychiatric facility NOTICE Act Notice of Observation RSP Risk-standardized payment
IPFQR Inpatient Psychiatric Facility Treatment and Implication for Care RSSR Risk-standard readmission rate
Quality Reporting [Program] Eligibility Act, Public Law 114–42 RTI Research Triangle Institute,
IPPS [Acute care hospital] inpatient NQF National Quality Forum International
prospective payment system NQS National Quality Strategy RUCAs Rural-urban commuting area codes
IRF Inpatient rehabilitation facility NTIS National Technical Information RY Rate year
IQR [Hospital] Inpatient Quality Reporting Service SAF Standard Analytic File
LAMCs Large area metropolitan counties NTTAA National Technology Transfer and SCH Sole community hospital
LEP Limited English proficiency Advancement Act of 1991, Public Law SCHIP State Child Health Insurance
LOC Limitation on charges 104–113 Program
LOS Length of stay NUBC National Uniform Billing Code SCIP Surgical Care Improvement Project
LTC–DRG Long-term care diagnosis-related NVHRI National Voluntary Hospital SFY State fiscal year
group Reporting Initiative SGR Sustainable Growth Rate
LTCH Long-term care hospital OACT [CMS’] Office of the Actuary SIC Standard Industrial Classification
LTCH QRP Long-Term Care Hospital OBRA 86 Omnibus Budget Reconciliation SIR Standardized infection ratio
Quality Reporting Program Act of 1986, Public Law 99–509 SNF Skilled nursing facility
MA Medicare Advantage OES Occupational employment statistics SNF QRP Skilled Nursing Facility Quality
MAC Medicare Administrative Contractor OIG Office of the Inspector General Reporting Program
MACRA Medicare Access and CHIP OMB [Executive] Office of Management and SNF VBP Skilled Nursing Facility Value-
Reauthorization Act of 2015, Public Law Budget Based Purchasing
114–10 ONC Office of the National Coordinator for SOCs Standard occupational classifications
MAP Measure Application Partnership Health Information Technology SOM State Operations Manual
MCC Major complication or comorbidity OPM [U.S.] Office of Personnel SRR Standardized risk ratio
MCE Medicare Code Editor Management SSI Surgical site infection
MCO Managed care organization OQR [Hospital] Outpatient Quality SSI Supplemental Security Income
MDC Major diagnostic category SSO Short-stay outlier
Reporting
MDH Medicare-dependent, small rural SUD Substance use disorder
O.R. Operating room
hospital TEFRA Tax Equity and Fiscal
OSCAR Online Survey Certification and
MedPAC Medicare Payment Advisory Responsibility Act of 1982, Public Law 97–
Reporting [System]
Commission 248
PAC Post-acute care
MedPAR Medicare Provider Analysis and TEP Technical expert panel
PAMA Protecting Access to Medicare Act of
Review File THA/TKA Total hip arthroplasty/total knee
2014, Public Law 113–93
MEI Medicare Economic Index arthroplasty
PCH PPS-exempt cancer hospital
MGCRB Medicare Geographic Classification TMA TMA [Transitional Medical
PCHQR PPS-exempt cancer hospital quality
Review Board Assistance], Abstinence Education, and QI
reporting
MIEA–TRHCA Medicare Improvements and [Qualifying Individuals] Programs
PMSAs Primary metropolitan statistical
Extension Act, Division B of the Tax Relief Extension Act of 2007, Public Law 110–90
areas
and Health Care Act of 2006, Public Law TPS Total Performance Score
POA Present on admission
109–432 UHDDS Uniform hospital discharge data set
PPI Producer price index
MIPPA Medicare Improvements for Patients UR Utilization review
and Providers Act of 2008, Public Law PPR Potentially Preventable Readmissions VBP [Hospital] Value Based Purchasing
110–275 PPS Prospective payment system [Program]
MMA Medicare Prescription Drug, PRA Paperwork Reduction Act VTE Venous thromboembolism
PRM Provider Reimbursement Manual
Improvement, and Modernization Act of
ProPAC Prospective Payment Assessment Table of Contents
2003, Public Law 108–173
Commission
MMEA Medicare and Medicaid Extenders I. Executive Summary and Background
Act of 2010, Public Law 111–309 PRRB Provider Reimbursement Review A. Executive Summary
MMSEA Medicare, Medicaid, and SCHIP Board 1. Purpose and Legal Authority
Extension Act of 2007, Public Law 110–173 PRTFs Psychiatric residential treatment 2. Summary of the Major Provisions
MOON Medicare Outpatient Observation facilities 3. Summary of Costs and Benefits
Notice PSF Provider-Specific File B. Summary
MRHFP Medicare Rural Hospital Flexibility PSI Patient safety indicator 1. Acute Care Hospital Inpatient
Program PS&R Provider Statistical and Prospective Payment System (IPPS)
MRSA Methicillin-resistant Staphylococcus Reimbursement [System] 2. Hospitals and Hospital Units Excluded
aureus PQRS Physician Quality Reporting System From the IPPS
MSA Metropolitan Statistical Area PUF Public use file 3. Long-Term Care Hospital Prospective
MS–DRG Medicare severity diagnosis- QDM Quality data model Payment System (LTCH PPS)
related group QIES ASAP Quality Improvement 4. Critical Access Hospitals (CAHs)
MS–LTC–DRG Medicare severity long-term Evaluation System Assessment Submission 5. Payments for Graduate Medical
care diagnosis-related group and Processing Education (GME)
MU Meaningful Use [EHR Incentive QIG Quality Improvement Group [CMS] C. Summary of Provisions of Recent
Program] QIO Quality Improvement Organization Legislation Implemented in This Final
MUC Measure under consideration QM Quality measure Rule
NAICS North American Industrial QRDA Quality Reporting Document 1. American Taxpayer Relief Act of 2012
Classification System Architecture (ATRA) (Pub. L. 112–240)
NALTH National Association of Long Term RFA Regulatory Flexibility Act, Public Law 2. Pathway for SGR Reform Act of 2013
Hospitals 96–354 (Pub. L. 113–67)
ES2 NCD National coverage determination RHC Rural health clinic 3. Improving Medicare Post-Acute Care
RUL NCHS National Center for Health Statistics RHQDAPU Reporting hospital quality data Transformation Act of 2014 (IMPACT
with NCQA National Committee for Quality for annual payment update Act) (Pub. L. 113–185)
D Assurance RIM Reference information model 4. The Medicare Access and CHIP
O
PR NCVHS National Committee on Vital and RNHCI Religious nonmedical health care Reauthorization Act (MACRA) of 2015
T082 Health Statistics institution (Public Law 114–10)
G9 NECMA New England County Metropolitan RPL Rehabilitation psychiatric long-term 5. The Consolidated Appropriations Act,
SK3 Areas care (hospital) 2016 (Public Law 114–113)
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Federal Register/Vol. 81, No. 162/Monday, August 22, 2016/Rules and Regulations 56765
6. The Notice of Observation Treatment b. Pulmonary Embolism With tPA or Other a. Background of the CC List and the CC
and Implication for Care Eligibility Act Thrombolytic Therapy Exclusions List
(the NOTICE Act) of 2015 (Public Law 5. MDC 5 (Diseases and Disorders of the b. CC Exclusions List for FY 2017
114–42) Circulatory System) 16. Review of Procedure Codes in MS
D. Issuance of Notice of Proposed a. Implant of Loop Recorder DRGs 981 Through 983; 984 Through
Rulemaking b. Endovascular Thrombectomy of the 986; and 987 Through 989
E. Finalization of Interim Final Rule With Lower Limbs a. Moving Procedure Codes From MS–
Comment Period on the Temporary c. Pacemaker Procedures Code DRGs 981 Through 983 or MS–DRGs 987
Exception to the Site Neutral Payment Combinations Through 989 Into MDCs
Rate Under the LTCH PPS for Certain d. Transcatheter Mitral Valve Repair With b. Reassignment of Procedures Among MS–
Severe Wound Discharges From Certain Implant DRGs 981 Through 983, 984 Through
LTCHs as Required by the Consolidated e. MS–DRG 245 (AICD Generator 986, and 987 Through 989
Appropriations Act, 2016; and Procedures) c. Adding Diagnosis or Procedure Codes to
Modification of Limitation on 6. MDC 6 (Diseases and Disorders of the MDCs
Redesignation by the Medicare Digestive System): Excision of Ileum (1) Angioplasty of Extracranial Vessel
Geographic Classification Review Board 7. MDC 7 (Diseases and Disorders of the (2) Excision of Abdominal Arteries
G. Finalization of Interim Final Rule With Hepatobiliary System and Pancreas): (3) Excision of Retroperitoneal Tissue
Comment Period on Medicare Dependent Bypass Procedures of the Veins (4) Occlusion of Vessels: Esophageal
Small Rural Hospital Program and 8. MDC 8 (Diseases and Disorders of the Varices
Payment to Low-Volume Hospitals Musculoskeletal System and Connective (5) Excision of Vulva
II. Changes to Medicare Severity Diagnosis- Tissue) (6) Lymph Node Biopsy
Related Group (MS–DRG) Classifications a. Updates to MS–DRGs 469 and 470 (7) Obstetrical Laceration Repair
and Relative Weights (Major Joint Replacement or 17. Changes to the ICD–10–CM and ICD–
A. Background Reattachment of Lower Extremity With 10–PCS Coding Systems
B. MS–DRG Reclassifications and Without MCC, Respectively) a. ICD–10 Coordination and Maintenance
C. Adoption of the MS–DRGs in FY 2008 (1) Total Ankle Replacement (TAR) Committee
D. FY 2017 MS–DRG Documentation and Procedures b. Code Freeze
Coding Adjustment
(2) Hip Replacements Procedures With 18. Replaced Devices Offered Without Cost
1. Background on the Prospective MS–DRG
Principal Diagnosis of Hip Fracture or With a Credit
Documentation and Coding Adjustments
b. Revision of Total Ankle Replacement a. Background
for FY 2008 and FY 2009 Authorized by
Procedures b. Changes for FY 2017
Public Law 110–90
(1) Revision of Total Ankle Replacement 19. Other Policy Changes
2. Adjustment to the Average Standardized
Procedures a. MS–DRG GROUPER Logic
Amounts Required by Public Law 110–
(2) Combination Codes for Removal and (1) Operations on Products of Conception
90
Replacement of Knee Joints (2) Other Heart Revascularization
a. Prospective Adjustment Required by
c. Decompression Laminectomy (3) Procedures on Vascular Bodies:
Section 7(b)(1)(A) of Public Law 110–90
d. Lordosis Chemoreceptors
b. Recoupment or Repayment Adjustments
9. MDC 13 (Diseases and Disorders of the (4) Repair of the Intestine
in FYs 2010 Through 2012 Required by
Female Reproductive System): Pelvic (5) Insertion of Infusion Pump
Section 7(b)(1)(B) of Public Law 110–90
Evisceration (6) Procedures on the Bursa
3. Retrospective Evaluation of FY 2008 and
10. MDC 19 (Mental Diseases and (7) Procedures on the Breast
FY 2009 Claims Data
Disorders): Modification of Title of MS– (8) Excision of Subcutaneous Tissue and
4. Prospective Adjustments for FY 2008
DRG 884 (Organic Disturbances and Fascia
and FY 2009 Authorized by Section
Mental Retardation) (9) Shoulder Replacement
7(b)(1)(A) of Public Law 110–90
11. MDC 23 (Factors Influencing Health (10) Reposition
5. Recoupment or Repayment Adjustment
Status and Other Contacts With Health (11) Insertion of Infusion Device
Authorized by Section 7(b)(1)(B) of
Services): Logic of MS–DRGs 945 and (12) Bladder Neck Repair
Public Law 110–90
6. Recoupment or Repayment Adjustment 946 (Rehabilitation With and Without (13) Future Consideration
Authorized by Section 631 of the CC/MCC, Respectively) b. Issues Relating to MS–DRG 999
American Taxpayer Relief Act of 2012 12. Medicare Code Editor (MCE) Changes (Ungroupable)
(ATRA) a. Age Conflict Edit c. Other Operating Room (O.R.) and Non-
E. Refinement of the MS–DRG Relative (1) Newborn Diagnosis Category O.R. Issues
Weight Calculation (2) Pediatric Diagnosis Category (1) O.R. Procedures to Non-O.R. Procedures
1. Background b. Sex Conflict Edit (a) Endoscopic/Transorifice Insertion
2. Discussion of Policy for FY 2017 c. Non-Covered Procedure Edit (b) Endoscopic/Transorifice Removal
F. Changes to Specific MS–DRG (1) Endovascular Mechanical (c) Tracheostomy Device Removal
Classifications Thrombectomy (d) Endoscopic/Percutaneous Insertion
1. Discussion of Changes to Coding System (2) Radical Prostatectomy (e) Percutaneous Removal
and Basis for MS–DRG Updates d. Unacceptable Principal Diagnosis Edit (f) Percutaneous Drainage
a. Conversion of MS–DRGs to the (1) Liveborn Infant (g) Percutaneous Inspection
International Classification of Diseases, (2) Multiple Gestation (h) Inspection Without Incision
10th Revision (ICD–10) (3) Supervision of High Risk Pregnancy (i) Dilation of Stomach
b. Basis for FY 2017 MS–DRG Updates e. Other MCE Issues (j) Endoscopic/Percutaneous Occlusion
2. Pre-Major Diagnostic Category (Pre- (1) Procedure Inconsistent With Length of (k) Infusion Device
MDC): Total Artificial Heart Stay Edit (2) Non-O.R. Procedures to O.R. Procedures
Replacement (2) Maternity Diagnoses (a) Drainage of Pleural Cavity
3. MDC 1 (Diseases and Disorders of the (3) Manifestation Codes Not Allowed as (b) Drainage of Cerebral Ventricle
Nervous System) Principal Diagnosis Edit 20. Out of Scope Public Comments
ES2 a. Endovascular Embolization (Coiling) or (4) Questionable Admission Edit Received
RUL Occlusion of Head and Neck Procedures (5) Removal of Edits and Future G. Recalibration of the FY 2017 MS–DRG
with b. Mechanical Complication Codes Enhancement Relative Weights
D 4. MDC 4 (Diseases and Disorders of the 13. Changes to Surgical Hierarchies 1. Data Sources for Developing the Relative
O
PR Ear, Nose, Mouth and Throat) 14. Changes to the MS–DRG Diagnosis Weights
T082 a. Reassignment of Diagnosis Code R22.2 Codes for FY 2017 2. Methodology for Calculation of the
G9 (Localized Swelling, Mass and Lump, 15. Complications or Comorbidity (CC) Relative Weights
SK3 Trunk) Exclusions List 3. Development of National Average CCRs
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56766 Federal Register/Vol. 81, No. 162/Monday, August 22, 2016/Rules and Regulations
H. Add-On Payments for New Services and 4. Budget Neutrality 2. Other Policy Changes Affecting IME
Technologies H. Application of the Rural, Imputed, and F. Payment Adjustment for Medicare
1. Background Frontier Floors Disproportionate Share Hospitals (DSHs)
2. Public Input Before Publication of a 1. Rural Floor for FY 2017 and Subsequent Years
Notice of Proposed Rulemaking on Add- 2. Imputed Floor for FY 2017 (§412.106)
On Payments 3. State Frontier Floor for FY 2017 1. General Discussion
3. ICD–10–PCS Section ‘‘X’’ Codes for I. FY 2017 Wage Index Tables 2. Eligibility for Empirically Justified
Certain New Medical Services and J. Revisions to the Wage Index Based on Medicare DSH Payments and
Technologies Hospital Redesignations and Uncompensated Care Payments
4. FY 2017 Status of Technologies Reclassifications 3. Empirically Justified Medicare DSH
Approved for FY 2016 Add-On Payments 1. General Policies and Effects of Payments
a. KcentraTM Reclassification and Redesignation 4. Uncompensated Care Payments
b. Argus® II Retinal Prosthesis System 2. Finalization of Interim Final Rule With a. Calculation of Factor 1 for FY 2017
c. CardioMEMSTMHF (Heart Failure) Comment Period on Provisions Related b. Calculation of Factor 2 for FY 2017
Monitoring System to Modification on Limitations on c. Calculation of Factor 3 for FY 2017
d. MitraClip® System Redesignations by the Medicare d. Calculation of Factor 3 for FY 2018 and
e. Responsive Neurostimulator (RNS® ) Geographic Classification Review Board Subsequent Fiscal Years
System (MGCRB) (1) Background
f. Blinatumomab (BLINCYTOTMTrade a. Background (2) Proposed and Finalized Data Source
Brand) b. Criteria for an Individual Hospital and Time Period for FY 2018 and
g. Lutonix® Drug Coated Balloon PTA Seeking Redesignation to Another Area Subsequent Years, Including
Catheter and In.PACTTMAdmiralTM (§412.103)—Application of Policy Methodology for Incorporating
Pacliaxel Coated Percutaneous Provisions Worksheet S–10 Data
Transluminal Angioplasty (PTA) Balloon c. Final Rule Provisions (3) Definition of Uncompensated Care for
Catheter d. Impact FY 2018 and Subsequent Fiscal Years
5. FY 2017 Applications for New 3. Other MGCRB Reclassification and (4) Other Methodological Considerations
Technology Add-On Payments Redesignation Issues for FY 2017 for FY 2018 and Subsequent Fiscal Years
a. MAGEC® Spinal Bracing and Distraction
a. FY 2017 Reclassification Requirements G. Hospital Readmissions Reduction
System (MAGEC® Spine)
and Approvals Program: Updates and Changes
b. MIRODERM Biologic Wound Matrix
b. Requirements for FY 2018 Applications (§§412.150 Through 412.154)
(MIRODERM)
and Revisions Regarding Paper 1. Statutory Basis for the Hospital
c. Idarucizumab
d. Titan Spine (Titan Spine Endoskeleton® Application Requirements Readmissions Reduction Program
c. Other Policy Regarding Reclassifications 2. Regulatory Background
nanoLOCKTMInterbody Device)
for Terminated Hospitals 3. Policies for the FY 2017 Hospital
e. Defitelio® (Defibrotide)
4. Redesignation of Hospitals Under Readmissions Reduction Program
f. GORE® EXCLUDER® Iliac Branch
Section 1886(d)(8)(B) of the Act 4. Maintenance of Technical Specifications
Endoprosthesis (IBE)
5. Waiving Lugar Redesignation for the for Quality Measures
g VistogardTM(Uridine Triacetate)
Out-Migration Adjustment 5. Applicable Period for FY 2017
III. Changes to the Hospital Wage Index for
K. Out-Migration Adjustment Based on 6. Calculation of Aggregate Payments for
Acute Care Hospitals
Commuting Patterns of Hospital Excess Readmissions for FY 2017
A. Background
Employees for FY 2017 7. Extraordinary Circumstance Exception
1. Legislative Authority
L. Notification Regarding CMS ‘‘Lock-In’’ Policy
2. Core-Based Statistical Areas (CBSAs)
Date for Urban to Rural Reclassifications 8. Timeline for Public Reporting of Excess
Revisions for the FY 2017 Hospital Wage
Under §412.103 Readmission Ratios on Hospital
Index
M. Process for Requests for Wage Index Compare for the FY 2017 Payment
B. Worksheet S–3 Wage Data for the FY
Data Corrections Determination
2017 Wage Index
N. Labor Market Share for the FY 2017 H. Hospital Value-Based Purchasing (VBP)
1. Included Categories of Costs
2. Excluded Categories of Costs Wage Index Program: Policy Changes for the FY 2018
3. Use of Wage Index Data by Suppliers O. Public Comments on Treatment of Program Year and Subsequent Years
and Providers Other Than Acute Care Overhead and Home Office Costs in the 1. Background
Hospitals Under the IPPS Wage Index Calculation as a Result of a. Statutory Background and Overview of
C. Verification of Worksheet S–3 Wage Our Solicitation Past Program Years
Data IV. Other Decisions and Changes to the IPPS b. FY 2017 Program Year Payment Details
D. Method for Computing the FY 2017 for Operating Costs and Graduate 2. PSI 90 Measure in the FY 2018 Program
Unadjusted Wage Index Medical Education (GME) Costs and Future Program Years
E. Occupational Mix Adjustment to the FY A. Changes to Operating Payments for a. PSI 90 Measure Performance Period
2017 Wage Index Subsection (d) Puerto Rico Hospitals as Change for the FY 2018 Program Year
1. Use of 2013 Occupational Mix Survey a Result of Section 601 of Pub. L. 114– b. Intent To Propose in Future Rulemaking
for the FY 2017 Wage Index 113 To Adopt the Modified PSI 90 Measure
2. Development of the 2016 Medicare Wage B. Changes in the Inpatient Hospital 3. Retention Policy, Domain Name Change,
Index Occupational Mix Survey for the Updates for FY 2017 (§§412.64(d) and and Updating of Quality Measures for
FY 2019 Wage Index 412.211(c)) the FY 2019 Program Year
3. Calculation of the Occupational Mix 1. FY 2017 Inpatient Hospital Update a. Retention of Previously Adopted
Adjustment for FY 2017 2. FY 2017 Puerto Rico Hospital Update Hospital VBP Program Measures
F. Analysis and Implementation of the 3. Electronic Health Records (EHR) b. Domain Name Change
Occupational Mix Adjustment and the Adjustment to IPPS Market Basket c. Inclusion of Selected Ward Non-
FY 2017 Occupational Mix Adjusted C. Rural Referral Centers (RRCs): Annual Intensive Care Unit (ICU) Locations in
Wage Index Updates to Case-Mix Index (CMI) and Certain NHSN Measures Beginning With
ES2 G. Transitional Wage Indexes Discharge Criteria (§412.96) the FY 2019 Program Year
RUL 1. Background 1. Case-Mix Index (CMI) d. Summary of Previously Adopted
with 2. Transition for Hospitals in Urban Areas 2. Discharges Measures and Newly Finalized Measure
D That Became Rural D. Payment Adjustment for Low-Volume Refinements for the FY 2019 Program
O
PR 3. Transition for Hospitals Deemed Urban Hospitals (§412.101) Year
T082 Under Section 1886(d)(8)(B) of the Act E. Indirect Medical Education (IME) 4. Finalized Measures and Measure
G9 Where the Urban Area Became Rural Payment Adjustment (§412.105) Refinements for the FY 2021 Program
SK3 Under the New OMB Delineations 1. IME Adjustment Factor for FY 2017 Year and Subsequent Years
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a. Condition-Specific Hospital Level, Risk- c. Changes to the HAC Reduction Program 6. Technical Correction to 42 CFR
Standardized Payment Measures Scoring Methodology 413.200(c)(1)(i) Relating to Medicare
b. Finalized Update to an Existing Measure 4. Comments on Additional Measures for Cost Report Due Dates for Organ
for the FY 2021 Program Year: Hospital Potential Future Adoption Procurement Organizations and
30-Day, All-Cause, Risk-Standardized 5. Maintenance of Technical Specifications Histocompatibility Laboratories
Mortality Rate (RSMR) Following for Quality Measures N. Finalization of Interim Final Rule With
Pneumonia (PN) Hospitalization (NQF 6. Extraordinary Circumstance Exception Comment Period Implementing
#0468) (Updated Cohort) Policy for the HAC Reduction Program Legislative Extensions Relating to the
5. New Measure for the FY 2022 Program Beginning in FY 2016 and for Payment Adjustments for Low-Volume
Year: Hospital 30-Day, All-Cause, Risk- Subsequent Years Hospitals and the Medicare-Dependent,
Standardized Mortality Rate (RSMR) J. Payment for Graduate Medical Education Small Rural Hospital (MDH) Program
Following Coronary Artery Bypass Graft (GME) and Indirect Medical Education O. Clarification Regarding the Medicare
(CABG) Surgery (NQF #2558) (IME) Costs (§§412.105, 413.75 Through Utilization Requirement for Medicare-
6. Previously Adopted and Newly 413.83) Dependent, Small Rural Hospitals
Finalized Baseline and Performance 1. Background (MDHs) (§412.108)
Periods 2. Change in New Program Growth From 3 P. Adjustment to IPPS Rates Resulting
a. Background Years to 5 Years From 2-Midnight Policy
b. Patient- and Caregiver-Centered a. Urban and Rural Hospitals V. Changes to the IPPS for Capital-Related
Experience of Care/Care Coordination b. Policy Changes Relating to Rural Costs
Domain (Person and Community Training Tracks at Urban Hospitals A. Overview
Engagement Domain Beginning With the c. Effective Date B. Additional Provisions
FY 2019 Program Year) 3. Section 5506 Closed Hospitals 1. Exception Payments
c. Efficiency and Cost Reduction Domain K. Rural Community Hospital 2. New Hospitals
d. Safety Domain Demonstration Program 3. Changes in Payments for Hospitals
e. Clinical Care Domain 1. Background Located in Puerto Rico
f. Summary of Previously Adopted and 2. Budget Neutrality Offset Adjustments: C. Annual Update for FY 2017
Newly Finalized Baseline and Fiscal Years 2005 Through 2016 VI. Changes for Hospitals Excluded From the
Performance Periods for the FY 2018, FY a. Fiscal Years 2005 Through 2013 IPPS
2019, FY 2020, FY 2021, and FY 2022 b. Fiscal Years 2014 and 2015
A. Rate-of-Increase in Payments to
Program Years c. Fiscal Year 2016
Excluded Hospitals for FY 2017
7. Immediate Jeopardy Policy Changes 3. Budget Neutrality Methodology for FY
B. Report of Adjustment (Exceptions)
a. Background 2017 and Reconciliation for FYs 2011
Payments
b. Increase of Immediate Jeopardy Citations Through 2016
C. Critical Care Hospitals (CAHs)
From Two to Three Surveys a. Budget Neutrality Methodology for FY
1. Background
c. EMTALA-Related Immediate Jeopardy 2017
2. Frontier Community Health Integration
Citations b. Budget Neutrality Offset Reconciliation
Project (FCHIP) Demonstration
8. Performance Standards for the Hospital for FYs 2011 Through 2016
VII. Changes to the Long-Term Care Hospital
VBP Program L. Hospital and CAH Notification
Prospective Payment System (LTCH PPS)
a. Background Procedures for Outpatients Receiving
for FY 2017
b. Previously Adopted and Newly Observation Services
A. Background of the LTCH PPS
Finalized Performance Standards for the 1. Background
1. Legislative and Regulatory Authority
FY 2019 Program Year a. Statutory Authority
2. Criteria for Classification as a LTCH
c. Previously Adopted Performance b. Effective Date
a. Classification as a LTCH
Standards for Certain Measures for the 2. Implementation of the NOTICE Act
b. Hospitals Excluded From the LTCH PPS
FY 2020 Program Year Provisions
3. Limitation on Charges to Beneficiaries
d. Previously Adopted and Newly a. Notice Process
4. Administrative Simplification
Finalized Performance Standards for b. Notification Recipients
Compliance Act (ASCA) and Health
Certain Measures for the FY 2021 c. Timing of Notice Delivery
Program Year d. Requirements for Written Notice Insurance Portability and Accountability
e. Performance Standards for Certain e. Outpatient Observation Services and Act (HIPAA) Compliance
Measures for the FY 2022 Program Year Beneficiary Financial Liability B. Modifications to the Application of the
9. FY 2019 Program Year Scoring f. Delivering the Medicare Outpatient Site Neutral Payment Rate (§412.522)
Methodology Observation Notice 1. Background
a. Domain Weighting for the FY 2019 g. Oral Notice 2. Technical Correction of Definition of
Program Year for Hospitals That Receive h. Signature Requirements ‘‘Subsection (d) Hospital’’ for the Site
a Score on All Domains i. No Appeal Rights Under the NOTICE Act Neutral Payment Rate (§412.503)
b. Domain Weighting for the FY 2019 M. Technical Changes and Correction of 3. Finalization of Interim Final Rule With
Program Year for Hospitals Receiving Typographical Errors in Certain Comment Period: Temporary Exception
Scores on Fewer Than Four Domains Regulations Under 42 CFR Part 413 to the Site Neutral Payment Rate Under
I. Changes to the Hospital-Acquired Relating to Costs to Related the LTCH PPS for Certain Severe Wound
Condition (HAC) Reduction Program Organizations and Medicare Cost Reports Discharges From Certain LTCHs
1. Background 1. General Background C. Medicare Severity Long-Term Care
2. Implementation of the HAC Reduction 2. Technical Change to Regulations at 42 Diagnosis-Related Group (MS–LTC–
Program for FY 2017 CFR 413.17(d)(1) on Cost to Related DRG) Classifications and Relative
a. Clarification of Complete Data Organizations Weights for FY 2017
Requirements for Domain 1 3. Changes to 42 CFR 413.24(f)(4)(i) 1. Background
b. Clarification of NHSN CDC HAI Data Relating to Electronic Submission of Cost 2. Patient Classifications Into MS–LTC–
Submission Requirements for Newly Reports DRGs
Opened Hospitals 4. Technical Changes to 42 CFR a. Background
ES2 3. Implementation of the HAC Reduction 413.24(f)(4)(ii) Relating to Electronic b. Changes to the MS–LTC–DRGs for FY
RUL Program for FY 2018 Submission of Cost Reports and Due 2017
with a. Adoption of Modified PSI 90: Patient Dates 3. Development of the FY 2017 MS–LTC–
D Safety and Adverse Events Composite 5. Technical Changes to 42 CFR DRG Relative Weights
O
PR (NQF #0531) 413.24(f)(4)(iv) Relating to Reporting a. General Overview of the Development of
T082 b. Applicable Time Periods for the FY 2018 Entities, Cost Report Certification the MS–LTC–DRG Relative Weights
G9 HAC Reduction Program and the FY Statement, Electronic Submission and b. Development of the MS–LTC–DRG
SK3 2019 HAC Reduction Program Cost Reports Due Dates Relative Weights for FY 2017
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c. Data b. Market Basket Under the LTCH PPS for c. Clarification Regarding Data Submission
d. Hospital-Specific Relative Value (HSRV) FY 2017 for ED–1, ED–2, PC–01, STK–4, VTE–5,
Methodology c. Revision of Certain Market Basket and VTE–6
e. Treatment of Severity Levels in Updates as Required by the Affordable 9. Possible New Quality Measures and
Developing the MS–LTC–DRG Relative Care Act Measure Topics for Future Years
Weights d. Adjustment to the LTCH PPS Standard a. Potential Inclusion of the National
f. Low-Volume MS–LTC–DRGs Federal Payment Rate Under the Long- Institutes of Health (NIH) Stroke Scale
g. Steps for Determining the FY 2017 MS– Term Care Hospital Quality Reporting for the Hospital 30-Day Mortality
LTC–DRG Relative Weights Program (LTCH QRP) Following Acute Ischemic Stroke
D. Rebasing of the LTCH Market Basket e. Annual Market Basket Update Under the Hospitalization Measure Beginning as
1. Background LTCH PPS for FY 2017 Early as the FY 2022 Payment
2. Overview of the 2013-Based LTCH 3. Update Under the Payment Adjustment Determination
Market Basket for ‘‘Subclause (II)’’ LTCHs b. Potential Inclusion of National
3. Development of the 2013-Based LTCH F. Modifications to the ‘‘25-Percent Healthcare Safety Network (NHSN)
Market Basket Cost Categories and Threshold Policy’’ Payment Adjustments Antimicrobial Use Measure (NQF #2720)
Weights (§§412.534 and 412.536) c. Potential Measures for Behavioral Health
a. Use of Medicare Cost Report Data G. Refinement to the Payment Adjustment in the Hospital IQR Program
(1) Wages and Salaries Costs for ‘‘Subclause II’’ LTCHs d. Potential Public Reporting of Quality
(2) Employee Benefit Costs VIII. Quality Data Reporting Requirements for Measures Data Stratified by Race,
(3) Contract Labor Costs Specific Providers and Suppliers Ethnicity, Sex, and Disability and Future
(4) Pharmaceutical Costs A. Hospital Inpatient Quality Reporting Hospital Quality Measures That
(5) Professional Liability Insurance Costs (IQR) Program Incorporate Health Equity
(6) Capital Costs 1. Background 10. Form, Manner, and Timing of Quality
b. Final Major Cost Category Computation a. History of the Hospital IQR Program Data Submission
c. Derivation of the Detailed Operating Cost b. Maintenance of Technical Specifications a. Background
b. Procedural Requirements for the FY
Weights for Quality Measures
2019 Payment Determination and
d. Derivation of the Detailed Capital Cost c. Public Display of Quality Measures
Subsequent Years
Weights 2. Process for Retaining Previously
c. Data Submission Requirements for
e. 2013-Based LTCH Market Basket Cost Adopted Hospital IQR Program Measures
Chart-Abstracted Measures
Categories and Weights for Subsequent Payment Determinations
d. Alignment of the Hospital IQR Program
4. Selection of Price Proxies 3. Removal and Suspension of Hospital
With the Medicare and Medicaid EHR
a. Price Proxies for the Operating Portion IQR Program Measures
Incentive Programs for Eligible Hospitals
of the 2013-Based LTCH Market Basket a. Considerations in Removing Quality
and CAHs
(1) Wages and Salaries Measures From the Hospital IQR
e. Sampling and Case Thresholds for the
(2) Employee Benefits Program
FY 2019 Payment Determination and
(3) Electricity b. Removal of Hospital IQR Program
Subsequent Years
(4) Fuel, Oil, and Gasoline Measures for the FY 2019 Payment
f. HCAHPS Requirements for the FY 2019
(5) Water and Sewage Determination and Subsequent Years
Payment Determination and Subsequent
(6) Professional Liability Insurance 4. Previously Adopted Hospital IQR
Years
(7) Pharmaceuticals Program Measures for the FY 2018
g. Data Submission Requirements for
(8) Food: Direct Purchases Payment Determination and Subsequent
Structural Measures for the FY 2019
(9) Food: Contract Services Years
Payment Determination and Subsequent
(10) Chemicals 5. Expansion and Updating of Quality
Years
(11) Medical Instruments Measures
h. Data Submission and Reporting
(12) Rubber and Plastics 6. Refinements to Existing Measures in the Requirements for HAI Measures
(13) Paper and Printing Products Hospital IQR Program Reported via NHSN
(14) Miscellaneous Products a. Expansion of the Cohort for the PN 11. Modifications to the Existing Processes
(15) Professional Fees: Labor-Related Payment Measure: Hospital-Level, Risk- for Validation of Hospital IQR Program
(16) Administrative and Facilities Support Standardized Payment Associated With a Data
Services 30-Day Episode-of-Care for Pneumonia a. Background
(17) Installation, Maintenance, and Repair (NQF #2579) b. Modifications to the Existing Processes
Services b. Adoption of Modified PSI 90: Patient for Validation of Hospital IQR Program
(18) All Other: Labor-Related Services Safety and Adverse Events Composite Data
(19) Professional Fees: Nonlabor-Related Measure (NQF #0531) 12. Data Accuracy and Completeness
(20) Financial Services 7. Additional Hospital IQR Program Acknowledgement (DACA)
(21) Telephone Services Measures for the FY 2019 Payment Requirements for the FY 2019 Payment
(22) All Other: Nonlabor-Related Services Determinations and Subsequent Years Determination and Subsequent Years
b. Price Proxies for the Capital Portion of a. Adoption of Three Clinical Episode- 13. Public Display Requirements for the FY
the 2013-Based LTCH Market Basket Based Payment Measures 2019 Payment Determination and
(1) Capital Price Proxies Prior to Vintage b. Adoption of Excess Days in Acute Care Subsequent Years
Weighting After Hospitalization for Pneumonia (PN 14. Reconsideration and Appeal
(2) Vintage Weights for Price Proxies Excess Days) Measure Procedures for the FY 2019 Payment
c. Summary of Price Proxies of the 2013- c. Summary of Previously Adopted and Determination and Subsequent Years
Based LTCH Market Basket Newly Finalized Hospital IQR Program 15. Changes to the Hospital IQR Program
d. FY 2017 Market Basket Update for Measures for the FY 2019 Payment Extraordinary Circumstances Extensions
LTCHs Determination and Subsequent Years or Exemptions (ECE) Policy
e. FY 2017 Labor-Related Share 8. Changes to Policies on Reporting of a. Extension of the General ECE Request
E. Changes to the LTCH PPS Payment Rates eCQMs Deadline for Non-eCQM Circumstances
ES2 and Other Changes to the LTCH PPS for a. Requirement That Hospitals Report on b. Establishment of a Separate Submission
RUL FY 2017 an Increased Number of eCQMs in the Deadline for ECE Requests Related to
with 1. Overview of Development of the LTCH Hospital IQR Program Measure Set for eCQMs
D PPS Standard Federal Payment Rates the CY 2017 Reporting Period/FY 2019 B. PPS-Exempt Cancer Hospital Quality
O
PR 2. FY 2017 LTCH PPS Standard Federal Payment Determination and Subsequent Reporting (PCHQR) Program
T082 Payment Rate Annual Market Basket Years 1. Background
G9 Update b. Requirement That Hospitals Report a 2. Criteria for Removal and Retention of
SK3 a. Overview Full Year of eCQM Data PCHQR Program Measures
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Federal Register/Vol. 81, No. 162/Monday, August 22, 2016/Rules and Regulations 56769
3. Retention and Update to Previously Payment Determination and Subsequent 8. Form, Manner, and Timing of Quality
Finalized Quality Measures for PCHs Years Data Submission
Beginning With the FY 2019 Program a. Background a. Procedural and Submission
Year b. Timeline for Data Submission Under the Requirements
a. Background LTCH QRP for the FY 2018 Payment b. Change to the Reporting Periods and
b. Update of Oncology: Radiation Dose Determination and Subsequent Years Submission Timeframes
Limits to Normal Tissues (NQF #0382) c. Timeline and Data Submission c. Population and Sampling
Measure for FY 2019 Program Year and Mechanisms for the FY 2018 Payment d. Data Accuracy and Completeness
Subsequent Years Determination and Subsequent Years for Acknowledgement (DACA)
4. New Quality Measure Beginning With the LTCH QRP Resource Use and Other Requirements
the FY 2019 Program Year Measures—Claims-Based Measures 9. Reconsideration and Appeals Procedures
a. Considerations in the Selection of d. Revisions to the Previously Adopted 10. Exceptions to Quality Reporting
Quality Measures Data Collection Period and Submission Requirements
b. Adoption of the Admissions and Deadlines for Percent of Residents or E. Clinical Quality Measurement for
Emergency Department (ED) Visits for Patients Who Were Assessed and Eligible Hospitals and Critical Access
Patients Receiving Outpatient Appropriately Given the Seasonal Hospitals (CAHs) Participating in the
Chemotherapy Measure Influenza Vaccine (Short Stay) (NQF EHR Incentive Programs in 2017
5. Possible New Quality Measure Topics #0680) for the FY 2019 Payment
1. Background
for Future Years Determination and Subsequent Years
2. CQM Reporting for the Medicare and
6. Maintenance of Technical Specifications e. Timeline and Data Submission
Medicaid EHR Incentive Programs in
for Quality Measures Mechanisms for the Newly Finalized
2017
7. Public Display Requirements LTCH QRP Quality Measure for the FY
a. Background 2020 Payment Determination and a. Background
b. Additional Public Display Requirements Subsequent Years b. CQM Reporting Period for the Medicare
c. Public Display of Additional PCHQR 10. LTCH QRP Data Completion and Medicaid EHR Incentive Programs in
Thresholds for the FY 2016 Payment CY 2017
Measure
Determination and Subsequent Years c. CQM Reporting Form and Method for
d. Public Display of Updated Measure
11. LTCH QRP Data Validation Process for the Medicare EHR Incentive Program in
e. Postponement of Public Display of Two
the FY 2016 Payment Determination and 2017
Measures
Subsequent Years IX. MedPAC Recommendations
8. Form, Manner, and Timing of Data
12. Change to Previously Codified LTCH X. Other Required Information
Submission
QRP Submission Exception and A. Requests for Data From the Public
9. Exceptions From PCHQR Program
Extension Policies B. Collection of Information Requirements
Requirements
13. Previously Finalized LTCH QRP 1. Statutory Requirement for Solicitation of
C. Long-Term Care Hospital Quality
Reconsideration and Appeals Procedures Comments
Reporting Program (LTCH QRP)
14. Policies Regarding Public Display of 2. ICRs for Add-On Payments for New
1. Background and Statutory Authority
Measure Data for the LTCH QRP and Services and Technologies
2. General Considerations Used for
Procedures for the Opportunity To 3. ICRs for the Occupational Mix
Selection of Quality, Resource Use, and
Review and Correct Data and Adjustment to the FY 2017 Wage Index
Other Measures for the LTCH QRP
Information (Hospital Wage Index Occupational Mix
3. Policy for Retention of LTCH QRP
a. Public Display of Measures Survey)
Measures Adopted for Previous Payment
b. Procedures for the Opportunity To 4. Hospital Applications for Geographic
Determinations
Review and Correct Data and Reclassifications by the MGCRB
4. Policy for Adopting Changes to LTCH
Information 5. ICRs for Applications for GME Resident
QRP Measures
15. Mechanism for Providing Feedback Slots
5. Quality Measures Previously Finalized
Reports to LTCHs 6. ICRs for the Notice of Observation
for and Currently Used in the LTCH QRP D. Inpatient Psychiatric Facility Quality Treatment by Hospitals and CAHs
6. LTCH QRP Quality, Resource Use and Reporting (IPFQR) Program 7. ICRs for the Hospital Inpatient Quality
Other Measures for the FY 2018 Payment 1. Background Reporting (IQR) Program
Determination and Subsequent Years a. Statutory Authority 8. ICRs for PPS-Exempt Cancer Hospital
a. Measure To Address the IMPACT Act b. Covered Entities Quality Reporting (PCHQR) Program
Domain of Resource Use and Other c. Considerations in Selecting Quality 9. ICRs for Hospital Value-Based
Measures: Total Estimated MSPB—PAC Measures Purchasing (VBP) Program
LTCH QRP 2. Retention of IPFQR Program Measures 10. ICRs for the Long-Term Care Hospital
b. Measure To Address the IMPACT Act Adopted in Previous Payment Quality Reporting Program (LTCH QRP)
Domain of Resource Use and Other Determinations 11. ICRs for the Inpatient Psychiatric
Measures: Discharge to Community-Post 3. Update to Previously Finalized Measure: Facility Quality Reporting (IPFQR)
Acute Care (PAC) LTCH QRP Screening for Metabolic Disorders Program
c. Measure To Address the IMPACT Act 4. New Quality Measures for the FY 2019
12. ICRs for the Electronic Health Record
Domain of Resource Use and Other Payment Determination and Subsequent
(EHR) Incentive Programs and
Measures: Potentially Preventable 30- Years
Meaningful Use
Day Post-Discharge Readmission a. SUB–3—Alcohol and Other Drug Use
Measure for the LTCH QRP Disorder Treatment Provided or Offered Regulation Text
7. LTCH QRP Quality Measure Finalized at Discharge and the Subset Measure
Addendum—Schedule of Standardized
for the FY 2020 Payment Determination SUB–3a—Alcohol and Other Drug Use
Amounts, Update Factors, and Rate-of-
and Subsequent Years Disorder Treatment at Discharge (NQF
Increase Percentages Effective With Cost
a. Background #1664) (SUB–3 and SUB3a)
Reporting Periods Beginning on or after
b. Measure To Address the IMPACT Act b. Thirty-Day All-Cause Unplanned
October 1, 2016 and Payment Rates for
Domain of Medication Reconciliation: Readmission Following Psychiatric
ES2 Drug Regimen Review Conducted With Hospitalization in an IPF LTCHs Effective With Discharges Occurring
RUL Follow-Up for Identified Issues-Post 5. Summary of Measures for the FY 2019 on or After October 1, 2016
with Acute Care LTCH QRP Payment Determination and Subsequent I. Summary and Background
D 8. LTCH QRP Quality Measures and Years II. Changes to the Prospective Payment Rates
O
PR Measure Concepts Under Consideration 6. Possible IPFQR Program Measures and for Hospital Inpatient Operating Costs for
T082 for Future Years Topics for Future Consideration Acute Care Hospitals for FY 2017
G9 9. Form, Manner, and Timing of Quality 7. Public Display and Review A. Calculation of the Adjusted
SK3 Data Submission for the FY 2018 Requirements Standardized Amount
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B. Adjustments for Area Wage Levels and 4. Effects of Changes Under the FY 2017 III. Secretary’s Recommendation
Cost-of-Living Hospital Value-Based Purchasing (VBP) IV. MedPAC Recommendation for Assessing
C. Calculation of the Prospective Payment Program Payment Adequacy and Updating
Rates 5. Effects of the Changes to the HAC Payments in Traditional Medicare
III. Changes to Payment Rates for Acute Care Reduction Program for FY 2017
I. Executive Summary and Background
Hospital Inpatient Capital-Related Costs 6. Effects of Policy Changes Relating to
for FY 2017 Direct GME and IME Payments for Rural A. Executive Summary
A. Determination of Federal Hospital Training Tracks at Urban Hospitals
Inpatient Capital-Related Prospective 7. Effects of Implementation of Rural 1. Purpose and Legal Authority
Payment Rate Update Community Hospital Demonstration
This final rule makes payment and
B. Calculation of the Inpatient Capital- Program
policy changes under the Medicare
Related Prospective Payments for FY 8. Effects of Implementation of the Notice
inpatient prospective payment systems
2017 of Observation Treatment and
C. Capital Input Price Index Implications for Care Eligibility Act (IPPS) for operating and capital-related
IV. Changes to Payment Rates for Excluded (NOTICE Act) costs of acute care hospitals as well as
Hospitals: Rate-of-Increase Percentages 9. Effects of Technical Changes and for certain hospitals and hospital units
for FY 2017 Correction of Typographical Errors in excluded from the IPPS. In addition, it
V. Updates to the Payment Rates for the Certain Regulations Under 42 CFR part makes payment and policy changes for
LTCH PPS for FY 2017 413 Relating to Costs to Related inpatient hospital services provided by
A. LTCH PPS Standard Federal Payment Organizations and Medicare Cost Reports
long-term care hospitals (LTCHs) under
Rate for FY 2017 10. Effects of Implementation of the
the long-term care hospital prospective
B. Adjustment for Area Wage Levels Under Frontier Community Health Integration
payment system (LTCH PPS). It also
the LTCH PPS for FY 2017 Project (FCHIP) Demonstration
1. Background I. Effects of Changes in the Capital IPPS makes policy changes to programs
2. Geographic Classifications (Labor Market 1. General Considerations associated with Medicare IPPS
Areas) for the LTCH PPS Standard 2. Results hospitals, IPPS-excluded hospitals, and
Federal Payment Rate J. Effects of Payment Rate Changes and LTCHs.
3. Labor-Related Share for the LTCH PPS Policy Changes Under the LTCH PPS We are establishing new requirements
Standard Federal Payment Rate 1. Introduction and General Considerations or revising requirements for quality
4. Wage Index for FY 2017 for the LTCH 2. Impact on Rural Hospitals
reporting by specific providers (acute
PPS Standard Federal Payment Rate 3. Anticipated Effects of LTCH PPS
care hospitals, PPS-exempt cancer
5. Budget Neutrality Adjustment for Payment Rate Changes and Policy
hospitals, LTCHs, and inpatient
Changes to the LTCH PPS Standard Changes
Federal Payment Rate Area Wage Level 4. Effect on the Medicare Program psychiatric facilities) that are
Adjustment 5. Effect on Medicare Beneficiaries participating in Medicare, including
C. LTCH PPS Cost-of-Living Adjustment K. Effects of Requirements for Hospital related provisions for eligible hospitals
(COLA) for LTCHs Located in Alaska and Inpatient Quality Reporting (IQR) and critical access hospitals (CAHs)
Hawaii Program participating in the Electronic Health
D. Adjustment for LTCH PPS High-Cost L. Effects of Requirements for the PPS- Record (EHR) Incentive Program. We are
Outlier (HCO) Cases Exempt Cancer Hospital Quality
updating policies relating to the
E. Update to the IPPS Comparable/ Reporting (PCHQR) Program
Hospital Value-Based Purchasing (VBP)
Equivalent Amounts To Reflect the M. Effects of Requirements for the Long-
Program, the Hospital Readmissions
Statutory Changes to the IPPS DSH Term Care Hospital Quality Reporting
Payment Adjustment Methodology Program (LTCH QRP) for the FY 2018 Reduction Program, and the Hospital-
F. Computing the Adjusted LTCH PPS Payment Determination and Subsequent Acquired Condition (HAC) Reduction
Federal Prospective Payments for FY Years Program. We are implementing statutory
2017 N. Effects of Updates to the Inpatient provisions that require hospitals and
VI. Tables Referenced in This Final Rule and Psychiatric Facility Quality Reporting CAHs to furnish notification to
Available Through the Internet on the (IPFQR) Program Medicare beneficiaries, including
CMS Web site O. Effects of Requirements Regarding the
Medicare Advantage enrollees, when
Electronic Health Record (EHR)
Appendix A—Economic Analyses the beneficiaries receive outpatient
Incentive Programs and Meaningful Use
I. Regulatory Impact Analysis P. Alternatives Considered observation services for more than 24
A. Introduction Q. Overall Conclusion hours; announcing the implementation
B. Need 1. Acute Care Hospitals of the Frontier Community Health
C. Objectives of the IPPS 2. LTCHs Integration Project Demonstration; and
D. Limitations of Our Analysis II. Accounting Statements and Tables making technical corrections and
E. Hospitals Included in and Excluded A. Acute Care Hospitals changes to regulations relating to costs
From the IPPS B. LTCHs to organizations and Medicare cost
F. Effects on Hospitals and Hospital Units III. Regulatory Flexibility Act (RFA) Analysis
reports. In addition, in this final rule,
Excluded From the IPPS IV. Impact on Small Rural Hospitals
we are providing notice of the closure
G. Quantitative Effects of the Policy V. Unfunded Mandate Reform Act (UMRA)
Changes Under the IPPS for Operating Analysis of three teaching hospitals and the
Costs VI. Executive Order 12866 opportunity for hospitals to apply for
1. Basis and Methodology of Estimates available graduate medical education
Appendix B: Recommendation of Update
2. Analysis of Table I resident slots under section 5506 of the
Factors for Operating Cost Rates of Payment
3. Impact Analysis of Table II Affordable Care Act.
for Inpatient Hospital Services
H. Effects of Other Policy Changes Under various statutory authorities,
ES2 1. Effects of Policy Relating to New I. Background we are making changes to the Medicare
RUL Medical Service and Technology Add- II. Inpatient Hospital Update for FY 2017 IPPS, to the LTCH PPS, and to other
with On Payments A. FY 2017 Inpatient Hospital Update related payment methodologies and
D 2. Effect of Changes Relating to Payment B. Update for SCHs and MDHs for FY 2017
PRO Adjustment for Medicare C. FY 2017 Puerto Rico Hospital Update programs for FY 2017 and subsequent
G9T082 3. DEfifsepcrtosp oofr Rtieodnuatcet iSohna Uren Hdeors pthitea Hlso spital D. IUPPpSd ate for Hospitals Excluded From the fiinscclauld yee,a brus.t Tahree sneo st tlaimtuittoerdy taou, tthhoer ities
SK3 Readmissions Reduction Program E. Update for LTCHs for FY 2017 following:
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Federal Register/Vol. 81, No. 162/Monday, August 22, 2016/Rules and Regulations 56771
• Section 1886(d) of the Social form and manner, and at a time, establishment of site neutral payment
Security Act (the Act), which sets forth specified by the Secretary. rate criteria under the LTCH PPS with
a system of payment for the operating • Section 1886(o) of the Act, which implementation beginning in FY 2016.
costs of acute care hospital inpatient requires the Secretary to establish a • Section 1886(m)(5)(D)(iv) of the
stays under Medicare Part A (Hospital Hospital Value-Based Purchasing (VBP) Act, as added by section 1206 (c) of the
Insurance) based on prospectively set Program under which value-based Pathway for Sustainable Growth Rate
rates. Section 1886(g) of the Act requires incentive payments are made in a fiscal (SGR) Reform Act of 2013 (Pub. L. 113–
that, instead of paying for capital-related year to hospitals meeting performance 67), which provides for the
costs of inpatient hospital services on a standards established for a performance establishment of a functional status
reasonable cost basis, the Secretary use period for such fiscal year. quality measure under the LTCH QRP
a prospective payment system (PPS). • Section 1886(p) of the Act, as added for change in mobility among inpatients
• Section 1886(d)(1)(B) of the Act, by section 3008 of the Affordable Care requiring ventilator support.
which specifies that certain hospitals Act, which establishes a Hospital- • Section 1899B of the Act, as added
and hospital units are excluded from the Acquired Condition (HAC) Reduction by the Improving Medicare Post-Acute
IPPS. These hospitals and units are: Program, under which payments to Care Transformation Act of 2014 (the
Rehabilitation hospitals and units; applicable hospitals are adjusted to IMPACT Act, Pub. L. 113–185), which
LTCHs; psychiatric hospitals and units; provide an incentive to reduce hospital- imposes data reporting requirements for
children’s hospitals; cancer hospitals; acquired conditions. certain post-acute care providers,
and hospitals located outside the 50 • Section 1886(q) of the Act, as added including LTCHs.
States, the District of Columbia, and by section 3025 of the Affordable Care • Section 1886(d)(12) of the Act, as
Puerto Rico (that is, hospitals located in Act and amended by section 10309 of amended by section 204 of the Medicare
the U.S. Virgin Islands, Guam, the the Affordable Care Act, which Access and CHIP Reauthorization Act of
Northern Mariana Islands, and establishes the ‘‘Hospital Readmissions 2015, which extends, through FY 2017,
American Samoa). Religious Reduction Program’’ effective for changes to the inpatient hospital
nonmedical health care institutions discharges from an ‘‘applicable payment adjustment for certain low-
(RNHCIs) are also excluded from the hospital’’ beginning on or after October volume hospitals; and section
IPPS. 1, 2012, under which payments to those 1886(d)(5)(G) of the Act, as amended by
• Sections 123(a) and (c) of the BBRA hospitals under section 1886(d) of the
section 205 of the Medicare Access and
(Pub. L. 106–113) and section 307(b)(1) Act will be reduced to account for
CHIP Reauthorization Act of 2015,
of the BIPA (Pub. L. 106–554) (as certain excess readmissions.
codified under section 1886(m)(1) of the • Section 1886(r) of the Act, as added which extends, through FY 2017, the
Medicare-dependent, small rural
Act), which provide for the by section 3133 of the Affordable Care
hospital (MDH) program.
development and implementation of a Act, which provides for a reduction to • Section 1886(m)(6)(A)(i) and (E) of
prospective payment system for disproportionate share hospital (DSH)
the Act, as amended and added by
payment for inpatient hospital services payments under section 1886(d)(5)(F) of
section 231 of the Consolidated
of long-term care hospitals (LTCHs) the Act and for a new uncompensated
Appropriations Act, 2016 (Pub. L. 114–
described in section 1886(d)(1)(B)(iv) of care payment to eligible hospitals.
113), which established a temporary
the Act. Specifically, section 1886(r) of the Act
exception to the site neutral payment
• Sections 1814(l), 1820, and 1834(g) requires that, for fiscal year 2014 and
rate under the LTCH PPS for certain
of the Act, which specify that payments each subsequent fiscal year, subsection
severe wound discharges from certain
are made to critical access hospitals (d) hospitals that would otherwise
LTCHs occurring prior to January 1,
(CAHs) (that is, rural hospitals or receive a DSH payment made under
2017.
facilities that meet certain statutory section 1886(d)(5)(F) of the Act will
requirements) for inpatient and receive two separate payments: (1) 25 2. Summary of the Major Provisions
outpatient services and that these percent of the amount they previously
a. MS–DRG Documentation and Coding
payments are generally based on 101 would have received under section
Adjustment
percent of reasonable cost. 1886(d)(5)(F) of the Act for DSH (‘‘the
• Section 1866(k) of the Act, as added empirically justified amount’’), and (2) Section 631 of the American Taxpayer
by section 3005 of the Affordable Care an additional payment for the DSH Relief Act (ATRA, Pub. L. 112–240)
Act, which establishes a quality hospital’s proportion of uncompensated amended section 7(b)(1)(B) of Pub. L.
reporting program for hospitals care, determined as the product of three 110–90 to require the Secretary to make
described in section 1886(d)(1)(B)(v) of factors. These three factors are: (1) 75 a recoupment adjustment to the
the Act, referred to as ‘‘PPS-exempt percent of the payments that would standardized amount of Medicare
cancer hospitals.’’ otherwise be made under section payments to acute care hospitals to
• Section 1886(a)(4) of the Act, which 1886(d)(5)(F) of the Act; (2) 1 minus the account for changes in MS–DRG
specifies that costs of approved percent change in the percent of documentation and coding that do not
educational activities are excluded from individuals under the age of 65 who are reflect real changes in case-mix, totaling
the operating costs of inpatient hospital uninsured (minus 0.1 percentage points $11 billion over a 4-year period of FYs
services. Hospitals with approved for FY 2014, and minus 0.2 percentage 2014, 2015, 2016, and 2017. This
graduate medical education (GME) points for FY 2015 through FY 2017); adjustment represents the amount of the
programs are paid for the direct costs of and (3) a hospital’s uncompensated care increase in aggregate payments as a
S2 GME in accordance with section 1886(h) amount relative to the uncompensated result of not completing the prospective
with RULE oAfc •tth, Sew eAhcitccitoh. n r e1q8u8i6r(ebs) (t3h)e(B S)e(vcirieit)a oryf tthoe ceaxr•per Seasemsceotdiuo nanst 1 oa8f p 8a6elrl( mcDe)Sn(6Hta) ghoeof. sthpeit aAlsc t, as a72d(0bj1u)3(s1.t )Pm(Areio)n rot fta oPu tuthhbeo. rALiz.T e1Rd1A 0u–,n 9tdh0ei sru nsaemticlot iFuoYnn t
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RO reduce the applicable percentage added by section 1206(a)(1) of the could not have been recovered under
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K3 does not submit data on measures in a 67), which provided for the ¥9.3 percent adjustment to the
S
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