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IPPS Proposed Rule – FFY2020

CMS-1716-P drafted on 4/23/2019; Published in the Federal Register on 5/3/2019. On April 23, 2019, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that focuses the agency’s efforts on a singular objective:  transforming the healthcare delivery system through competition and innovation to provide patients with better value and results.  The proposed rule updates Medicare payment policies and rates for hospitals under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS), effective for discharges on or after October 1, 2019. The policies in the IPPS and LTCH PPS proposed rule would represent historic changes to the way rural hospitals are paid and help ensure access to a world-class healthcare system with access to potentially life-saving diagnostics and therapies by unleashing innovation in medical technology and removing barriers to competition. Overall, the proposed rule is projected to result in an estimated increase of $4.7B (or 3.7%) in payments to providers, ranging from 1.7% increases for urban hospitals in the New England Region up to 4.9% increases for smaller, rural hospitals. Comments must be sent to CMS no later than 5pm EDT on June 24, 2019 at the applicable address provided in each section of the Proposed Rule or submitted electronically at  When commenting, please refer to file code CMS-1716-P.
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Other Rules, Transmittals, and Articles Recently Published

Inpatient Psych Facility PPS Proposed Rule [CMS-1712-P]
(Display Copy available here 4/18/2019; FR Publish Date 4/23/2019)
Fact Sheet LinkFederal Register Link
* Per diem base rate increase from $782.78 to $803.48.
* Elimination of 1-year lag in WIF, aligning it with concurrent IPPS WIF.

Inpatient Rehab Facility PPS Proposed Rule [CMS-1710-P]
(Display Copy available here 4/17/2019; FR Publish Date 4/24/2019)
Fact Sheet Link
Federal Register Link
* Standard payment conversion factor increase from $16,021 to $16,573.
* Elimination of 1-year lag in WIF, aligning it with concurrent IPPS WIF.

Long-Term Care Hospital PPS Proposed Rule [CMS-1716-P]
(Display Copy available here 4/23/2019; FR Publish Date 5/3/2019) – Published as part of the IPPS Acute Care Hospital Proposed Rule
Fact Sheet Link
Federal Register Link
* LTCH-PPS payments expected to increase by 0.9% or $37M.
* Proposal to modify the “Discharge to Community” measure to exclude nursing home residents who already reside in the nursing home.

Skilled Nursing Facility PPS Proposed Rule [CMS-1718-P]
(Display Copy available here 4/19/2019; FR Publish Date 4/25/2019)
Fact Sheet Link
Federal Register Link
* Increase in unadjusted Federal per diem rates of 2.5%.  

Supplemental Security Income (SSI) Data for FFY2017 (Trans 2271, CR 11187)
(Publish Date 3/29/2019) 

CMS Change in Policy for Accounting of Medicare Crossover Bad Debts (MLN Connects)
(Notice Date 4/4/2019) Click here  for a copy of the MLN Connects article from CMS.
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EHR Incentive Program Changes

CMS is proposing to allow eligible hospitals that are not yet meaningful users to have all of CY2019 to complete their respective 90-day EHR reporting period for FY2020. Similarly, CMS is proposing that the EHR reporting period be a minimum of any continuous 90-day period in CY2021 for both new and returning participants. CMS is also proposing to remove the Verify Opioid Treatment Agreement “bonus” measure beginning in CY2020 from the program due to implementation challenges and the burden on providers. Click here for a table of the proposed updated scoring methodology.
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