IPPS Final Rule FY2015

On October 1, 2014, in Archives, by AQ-IQ LLC

According to CMS, some of the changes implement certain statutory provisions contained in the Affordable Care Act and other legislation.  These changes are applicable to discharges occurring on or after October 1, 2014, unless otherwise specified in this final rule.  There are updates to the rate of increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits.  The updated rate of increase limits are effective for cost reporting periods beginning on or after October 1, 2014.

There are changes to 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 implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.  In addition,  there is discussion for proposals on the interruption of stay policy for LTCHs and on retiring the “5 percent” payment adjustment for co-located LTCHs.  While many of the statutory mandates of the Pathway for SGR Reform Act apply to discharges occurring on or after October 1, 2014, others will not begin to apply until 2016 and beyond.

A number of changes relate to direct graduate medical education (GME) and indirect medical education (IME) payments. Look for new or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare.

There are policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.  In addition, technical corrections to the regulations governing provider administrative appeals and judicial review; updating the reasonable compensation equivalent (RCE) limits, and revising the methodology for determining such limits, for services furnished by physicians to certain teaching hospitals and hospitals excluded from the IPPS; making regulatory revisions to broaden the specified uses of Medicare Advantage (MA) risk adjustment data and to specify the conditions for release of such risk adjustment data to entities outside of CMS; and making changes to the enforcement procedures for organ transplant centers.

Also of note, is the aligning of reporting and submission timelines for clinical quality measures for the Medicare EHR Incentive Program for eligible hospitals and critical access hospitals (CAHs) with the reporting and submission timelines for the Hospital IQR Program.  Provide guidance and clarification of certain policies for eligible hospitals and CAHs such as the policy for reporting zero denominators on clinical quality measures and policy for case threshold exemptions.

Lastly, is the finalization of two interim final rules with comment period relating to criteria for disproportionate share hospital uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program.

 

Review the FY2015 Final Rule as it appears in the Federal Register for August 22, 2014

FY 2015 Final Rule Data Files Impact File and Data Files
FY 2015 Final Rule Tables Tables

 

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