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Medicare proposed rule for FY 2020 IPF payment and Quality Reporting updates


Inpatient Psychiatric Facilities (IPF) payment updates
IPF Quality Reporting updates

Release date: April 18, 2019
Federal Register publication date: April 23, 2019
Comments due: June 17, 2019
Effective date: October 1, 2019


Proposed update factors

Market basket update 3.10%
Economy wide productivity adjustment (0.50%)
ACA required adjustment     (0.75%)
  Net market basket update 1.85%
Impact of outlier threshold adjustment (0.15%)
    Proposed increase factor 1.70%

CMS estimates that FY 2020 total IPF payments will increase by $75 million in comparison to FY 2019. The PPS (Prospective Payment System) per diem base rate will increase from $782.78 to $803.48 from FY 2019 to FY 2020, respectively. The FY 2020 per diem base rate will be reduced by 2% ($787.80) for IPFs that failed to report quality data. 

Market basket rebasing
The FY 2020 proposed rule also proposes revising the IPF market basket to reflect a 2016 base year (from 2012) in order to be more reflective of current data on IPF cost structures. The base year was last adjusted in FY 2016 when a 2012-based IPF-specific market-basket was adopted.

Elimination of wage index lag
The proposed rule is seeking comment on this provision which would (a) eliminate the 1-year lag in wage index data and (b) align IPF wage index data with the concurrent IPPS wage data by removing the 1-year lag of the pre-floor, pre-reclassified IPPS hospital wage index upon which the IPF wage is based.

IPF Quality Reporting program
CMS is proposing for FY 2020 to adopt one new claims-based measure which would impact payment determinations beginning with FY 2021 and subsequent years. The proposed measure is Medication Continuation Following Inpatient Psychiatric Discharge (National Quality Forum #3205). This measure evaluates whether patients admitted to IPFs with certain diagnosis (Major Depressive Disorder, schizophrenia, bipolar disorder) filled at least one evidence-based medication either two days prior to discharge or during the 30-day post-discharge window. 

If you are interested in more information regarding the proposed FY 2020 changes to the IPF, please contact Connie Ouellette.

The full public inspection document is available here: 

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