Therefore, we believe that it is appropriate to implement the new OMB delineations without delay. Commenters noted that the costs of these outcomes—both to the Medicare program and to individual patients—would more than offset any projected savings tied to the substitution of non-physician practitioners. We continue to believe that having as much pertinent information about the patient as possible prior to the IRF admission improves the quality of care the patient receives in the IRF. The IRF Web Pricer can be accessed by following this link, A federal government website managed and paid for by the U.S. Centers for Medicare & As such, any effects of this policy on the wage data of IPPS hospitals will be extended to the IRF setting, as this data will be used to establish the wage index for IRFs in the future. In the FY 2019 IRF PPS final rule (83 FR 38549 through 38553), we finalized several changes to the regulatory requirements that we believed were responsive to stakeholder feedback and helpful to providers in reducing administrative burden. 18-03, which superseded the August 15, 2017 OMB Bulletin No. of this final rule. Reimbursement opportunities may exist under individual state Medicaid In the FY 2006 IRF PPS final rule (70 FR 47880) and in correcting amendments to the FY 2006 IRF PPS final rule (70 FR 57166), we finalized a number of refinements to the IRF PPS case-mix classification system (the CMGs and the corresponding relative weights) and the case-level and facility-level adjustments. Under section 1861(e)(4) of the Act and § 482.12(c), every Medicare patient is generally required to be under the care of a physician. of this final rule. We apply weights to both of these averages using the IRFs' estimated costs, meaning that the CCRs of IRFs with higher total costs factor more heavily into the averages than the CCRs of IRFs with lower total costs. We believe that this balanced approach maintains the central role and judgment of the rehabilitation physician in the patient's plan of care, while also allowing for the expanded role of non-physician practitioners. Section 412.29 is amended by revising paragraph (e) to read as follows: (e) Except for care furnished to patients in a freestanding IRF hospital solely to relieve acute care hospital capacity in a state (or region, as applicable) that is experiencing a surge, as defined in § 412.622, during the Public Health Emergency, as defined in § 400.200 of this chapter, have in effect a procedure to ensure that patients receive close medical supervision, as evidenced by at least 3 face-to-face visits per week by a licensed physician with specialized training and experience in inpatient rehabilitation to assess the patient both medically and functionally, as well as to modify the course of treatment as needed to maximize the patient's capacity to benefit from the rehabilitation process except that during the Public Health Emergency, as defined in § 400.200 of this chapter, for the COVID-19 pandemic such visits may be conducted using telehealth services (as defined in section 1834(m)(4)(F) of the Act). As a result, we anticipate this final rule will have a positive impact on a substantial number of small entities. For the FY 2002 IRF PPS final rule, we analyzed various outlier policies using 3, 4, and 5 percent of the total estimated payments, and we concluded that an outlier policy set at 3 percent of total estimated payments would optimize the extent to which we could reduce the financial risk to IRFs of caring for high-cost patients, while still providing for adequate payments for all other (non-high cost outlier) cases. Generally, the software product includes patient classification programming called the Grouper software. For example, CBSA 19380 (Dayton, OH) will experience both a change to its number and its name, and become CBSA 19430 (Dayton-Kettering, OH), while all of its three constituent counties will remain the same. Table 14 provides our best estimate of the increase in Medicare payments under the IRF PPS as a result of the updates presented in this final rule based on the data for 1,118 IRFs in our database. Non-physician practitioners can add significant expertise to the patient care team, including recognizing emergent issues that, if left unaddressed, could lead to unplanned readmissions to the acute care hospitals. 15-01 are based on the application of the 2010 Standards for Delineating Metropolitan and Micropolitan Statistical Areas to Census Bureau population estimates for July 1, 2012 and July 1, 2013. This site displays a prototype of a “Web 2.0” version of the daily documents in the last year, 40 It is conducted by a licensed or certified clinician(s) designated by a rehabilitation physician described in § 412.622(a)(3)(iv) within the 48 hours immediately preceding the IRF admission. This final rule adopts more recent OMB statistical area delineations and applies a 5 percent cap on any wage index decreases compared to FY 2020 in a budget neutral manner. Response: We appreciate the commenters' support for the proposal. Register documents. We did not receive any comments on the proposed calculation of the standard payment conversion factor for FY 2021. To calculate the appropriate budget neutrality factor for use in updating the FY 2021 CMG relative weights, we use the following steps: Step 1. Such services are sometimes provided in inpatient rehabilitation facilities (IRFs).1 To qualify as an IRF, a facility must meet Medicare’s conditions of participation for acute care hospitals and must be primarily focused on treating conditions that typically require intensive rehabilitation, Part B also covers partial hospitalization (PHP), which is an outpatient treatment program provided through a hospital or a mental health center. For more information, see the “Medicare Program; Electronic Submission of Medicare Claims” final rule (70 FR 71008). Section 1886(j) of the Act confers broad statutory authority upon the Secretary to propose refinements to the IRF PPS. Therefore, properly managing a patient's medical complexities while developing an informative and, to the extent possible, an all-inclusive pre-admission screening is of utmost importance. Therefore, we do not believe that merely codifying these existing requirements in regulation will increase technical denials. Comment: The majority of commenters urged CMS not to finalize this proposal, expressing concerns that the change would have negative impacts on the health, quality of care, and recovery success rate of IRF patients. Codifying the current preadmission screening requirements into regulation text does not change the amount of documentation that is required. In accordance with past practice, we proposed to set the national CCR ceiling at 3 standard deviations above the mean CCR. Based on the more recent data available for this FY 2021 IRF final rule, the current estimate of the 10-year moving average growth of MFP for FY 2021 is -0.1 percentage point. This document has been published in the Federal Register. Therefore, we estimate $2.4 million in savings to the Medicare program and $600,000 in savings to beneficiaries. Standard Payment Conversion Factor for FY 2020, Market Basket Increase Factor for FY 2021 (2.4 percent), reduced by 0.0 percentage point for the productivity adjustment as required by section 1886(j)(3)(C)(ii)(I) of the Act, Budget Neutrality Factor for the Updates to the Wage Index and Labor-Related Share, Budget Neutrality Factor for the Revisions to the CMG Relative Weights, FY 2020 Standard Payment Conversion Factor, Market Basket Increase Factor for FY 2021 (2.4 percent), reduced by 0.0 percentage point for the productivity adjustment as required by section 1886(j)(3)(C)(ii)(I) of the Act, and further reduced by 2 percentage points for IRFs that failed to meet the quality reporting requirement, Adjusted FY 2021 Standard Payment Conversion Factor. We proposed that when calculating the area wage index, beginning with FY 2021, the wage data for hospitals located in these counties would be included in their new respective urban CBSAs. In contrast, IGI only produces forecasts of the more detailed price proxies used in the 2016-based IRF market basket on a quarterly basis. In column 7 of Table 13, we present the effects of the budget-neutral update of the CMG relative weights and average LOS values. The Public Inspection page However, as we discussed in the proposed rule, the purpose of the proposed transition policy, as well as those we have implemented in the past, is to help mitigate the significant negative impacts of certain wage index changes, not to curtail the positive impacts of such changes, and thus we do not believe it would be appropriate to apply the 5 percent cap on wage index increases as well. Among these, there are 93 urban IRFs and 21 rural IRFs. We estimate that on average each year physicians across all IRFs are billing $149 million for these services ($366.30 × 366 patients × 1,117 IRFs). Step 2. establishing the XML-based Federal Register as an ACFR-sanctioned The burden associated with this requirement is the time and effort put forth by the rehabilitation physician to document his or her concurrence with the pre-admission findings and the results of the pre-admission screening and retain the information in the patient's medical record. The comments we received on our proposal to allow non-physician practitioners to perform the IRF coverage requirements at § 412.622(a)(3), (4), and (5) that are currently required to be performed by a rehabilitation physician, provided that these duties are within the practitioner's scope of practice under applicable state law, are summarized below. Accordingly, Medicare pays only certain amounts of your stay at an IRF. For example, under § 412.622(a)(3)(iv), for an IRF claim to be considered reasonable and necessary under section 1862(a)(1) of the Act, there must be a reasonable expectation at the time of the patient's admission to the IRF that the patient requires physician supervision by a rehabilitation physician.
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