|
FY 2015 LTACH-PPS Final Rule
The official version of the FY 2015 LTACH-PPS Final Rule was published today, August 22, 2014 in the Federal Register, Murer provides the following synopsis regarding final changes for FY 2015 which will be effective for discharges on or after October 1, 2014.
Changes to Payment Rates for LTACH PPS
CMS adjusted its proposal to increase payments by 1.1% in FY 2015 from FY 2014 rates (approximately $62 million) from its previous proposal of +0.8%.
LTCHs are subject to a 2.0% percentage point reduction for failure to submit required quality data, including other statutorily-mandated reductions. The update also accounts for the FY 2015 market basket estimate for the LTCH PPS of 2.9 percent (referring to the change in the index price of LTACH-specific goods and services from the previous period of 2014).
Interrupted Stay - No Change
CMS did not finalize nor implement its proposed changes to the fixed-day threshold under the "greater than 3-day interrupted stay policy", whereby it proposed to modify the fixed-day thresholds for discharge and readmission from an LTACH to an IPPS, IRF, or SNF facility to a blanket, 30-day fixed threshold.
The interrupted stay policy provides a bundled payment to LTACHs if a patient is discharged from an LTACH, admitted to an inpatient PPS hospital, inpatient rehab facility (IRF), or a skilled nursing facility (SNF), and then re-admitted to the LTACH directly. In the example of an intervening IPPS stay, commenters complained that the change in the fixed-day threshold from 9 to 30 days was "drastic" and that, if finalized, a multi-year transition period would be needed to account for the impact of this policy. CMS agreed this move was premature.
Moratorium on New LTACHs and New Beds
CMS finalized the new LTACH moratorium, implementing the Protecting Access to Medicare Act of 2014, which amended the Pathway for SGR Reform Act of 2013. The moratorium on new LTACHs, LTACH satellites, and an increase in beds for existing LTACHs is effective April 1, 2014 to September 30, 2017.
"The moratorium ... shall not apply to a long term care hospital that -
(a) Began its qualifying period for payment as a long term care hospital under section 412.23(e) of title 42, Code of Federal Regulations, on or before the date of enactment of this paragraph;
(b) Has a binding written agreement as of the date of the enactment of this paragraph with an outside, unrelated party for the actual construction, renovation, lease, or demolition for a long-term care hospital, and has expended, before such date of enactment, at least 10 percent of the estimated cost of the project (or, if less, $2,500,000); or
(c) Has obtained an approved certificate of need in a State where one is required on or before such date of enactment."
Reinstatement of the Moratorium on Full Implementation of the 25% Threshold
The FY 2015 final rule implemented the proposed changes to LTACH PPS payments regarding a statutorily-required retroactive 9-year moratorium on full implementation of the "25% patient threshold" rule requiring application of inpatient PPS payments for LTACHs that admit more than 25% of its patients from a single acute care hospital.
The final rule implemented Section 1206(b)(1) of the Pathway for SGR Reform Act of 2013, which modified the American Recovery and Reinvestment Act of 2009 (ARRA) and the Affordable Care Act in 2010 (ACA), which initially expanded the cost reporting period range to October 1, 2013 prior to its shift to October 1, 2016.
Site Neutral Payment
The final rule also reviewed FY 2016 changes required by the Bipartisan Budget Act (BiBA) of 2013 and Protecting Access to Medicare Act (PAMA) of 2014 and accepted comments on the impending imposition of a two-tier system with site-neutral payments.
BiBA requires CMS to implement "site neutral" Inpatient Prospective Payment System (IPPS)-equivalent payment rates for LTACHs starting in FY 2016. The multi-year phase-in plan mandates that, unless newly-specified criteria are met, then LTACHs are not to be paid at the LTCH PPS rate, but at the site neutral, IPPS-equivalent rate. The criteria can generally be summarized as follows:
"The statutory requirements to be paid in the 'standard LTCH PPS payment amount' are that the LTCH discharge does not have a principal diagnosis relating to a psychiatric diagnosis or to rehabilitation, and:
- The stay in the LTCH was immediately preceded by a discharge from an acute care hospital that included at least 3 days in an [ICU]; or
- The stay in the LTCH was immediately preceded by a discharge from an acute care hospital in the patient's LTCH stay is assigned to an MS-LTC-DRG based on the receipt of ventilator services of at least 96 hours"
CMS is not putting forward proposals until "the FY 2016 rulemaking cycle".
Termination of 5% Readmissions Policy for Co-Located Providers
The proposed rule recommending termination of the policy which requires a singular LTACH payment (rather than two) where readmissions from co-located providers exceed 5% was finalized. CMS found that the 5% rule had "limited impact on provider behavior" and therefore terminated the policy.
Quality Reporting Program
The final rule retains seven previously finalized quality measures, revises two finalized measures, and adds three additional measures for inclusion into the LTCHQR program. The three new measures affecting the FY 2018 (and subsequent years) payment determination are listed as follows:
- Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function
- Functional Outcome Measure: Change in Mobility among Long-Term Care Hospital Patients Requiring Ventilator Support
- National Healthcare Safety Network (NHSN) Ventilator-Associated Event (VAE) Outcome Measure
We hope that this brief summary provides an overview of the complex regulations applicable to Long-Term Acute Care Hospitals. For more information or to specifically discuss issues impacting your hospital, please contact Murer Consultants at 708-478-7030.
- MURER CONSULTANTS -
| 
