Federal Register/Vol. 85, No. 154/Monday, August 10, 2020
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48424 Federal Register / Vol. 85, No. 154 / Monday, August 10, 2020 / Rules and Regulations DEPARTMENT OF HEALTH AND Catie Cooksey, (410) 786–0179, for determined by the IRF to have HUMAN SERVICES information about the IRF payment specialized training and experience in policies and payment rates. inpatient rehabilitation to conduct 1 of Centers for Medicare & Medicaid Kadie Derby, (410) 786–0468, for the 3 required face-to-face visits with Services information about the IRF coverage the patient per week, provided that such policies. duties are within the non-physician 42 CFR Part 412 SUPPLEMENTARY INFORMATION: practitioner’s scope of practice under [CMS–1729–F] applicable state law. There are no Availability of Certain Information updates in this final rule to the IRF RIN 0938–AU05 Through the Internet on the CMS Quality Reporting Program (QRP). Website Medicare Program; Inpatient The IRF PPS Addenda along with B. Waiver of the 60-Day Delayed Rehabilitation Facility Prospective other supporting documents and tables Effective Date for the Final Rule Payment System for Federal Fiscal referenced in this final rule are available Year 2021 The United States is responding to an through the internet on the CMS website outbreak of respiratory disease caused at https://www.cms.gov/Medicare/ AGENCY: Centers for Medicare & by a novel (new) coronavirus that has Medicare-Fee-for-Service-Payment/ Medicaid Services (CMS), HHS. now been detected in more than 190 ACTION: Final rule. InpatientRehabFacPPS. We note that in previous years, each locations internationally, including in SUMMARY: This final rule updates the rule or notice issued under the IRF PPS all 50 States and the District of prospective payment rates for inpatient has included a detailed reiteration of the Columbia. The virus has been named rehabilitation facilities (IRFs) for various regulatory provisions that have ‘‘SARS-CoV–2’’ and the disease it Federal fiscal year (FY) 2021. As affected the IRF PPS over the years. That causes has been named ‘‘coronavirus required by statute, this final rule discussion, along with detailed disease 2019’’ (abbreviated ‘‘COVID– includes the classification and background information for various 19’’). weighting factors for the IRF prospective other aspects of the IRF PPS, is now Due to CMS prioritizing efforts in payment system’s case-mix groups and available on the CMS website at https:// support of containing and combatting a description of the methodologies and www.cms.gov/Medicare/Medicare-Fee- the COVID–19 PHE, and devoting data used in computing the prospective for-Service-Payment/InpatientRehab significant resources to that end, as payment rates for FY 2021. This final FacPPS. discussed and for the reasons discussed rule adopts more recent Office of I. Executive Summary in section XIII. of this final rule, we are Management and Budget statistical area hereby waiving the 60-day requirement delineations and applies a 5 percent cap A. Purpose and determining that the IRF PPS final on any wage index decreases compared This final rule updates the rule will take effect 55 days after to FY 2020 in a budget neutral manner. prospective payment rates for IRFs for issuance. This final rule also amends the IRF FY 2021 (that is, for discharges C. Summary of Major Provisions coverage requirements to remove the occurring on or after October 1, 2020, post-admission physician evaluation and on or before September 30, 2021) as In this final rule, we use the methods requirement and codifies existing required under section 1886(j)(3)(C) of described in the FY 2020 IRF PPS final documentation instructions and the Social Security Act (the Act). As rule (84 FR 39054) to update the guidance. In addition, this final rule required by section 1886(j)(5) of the Act, prospective payment rates for FY 2021 amends the IRF coverage requirements this final rule includes the classification using updated FY 2019 IRF claims and to allow, beginning with the second and weighting factors for the IRF PPS’s the most recent available IRF cost report week of admission to the IRF, a non- case-mix groups (CMGs) and a data, which is FY 2018 IRF cost report physician practitioner who is description of the methodologies and data. This final rule adopts more recent determined by the IRF to have data used in computing the prospective OMB statistical area delineations and specialized training and experience in payment rates for FY 2021. This final applies a 5 percent cap on any wage inpatient rehabilitation to conduct 1 of rule adopts more recent Office of index decreases compared to FY 2020 in the 3 required face-to-face visits with Management and Budget (OMB) a budget neutral manner. This final rule the patient per week, provided that such statistical area delineations and applies also amends the IRF coverage duties are within the non-physician a 5 percent cap on any wage index requirements to remove the post- practitioner’s scope of practice under decreases compared to FY 2020 in a applicable state law. admission physician evaluation budget neutral manner. This final rule requirement and codifies existing DATES: These regulations are effective also amends the IRF coverage documentation instructions and on October 1, 2020. requirements to remove the post- guidance. In addition, this final rule Applicability dates: The updated IRF admission physician evaluation amends the IRF coverage requirements prospective payment rates are requirement and codifies existing to allow non-physician practitioners to applicable for IRF discharges occurring documentation instructions and perform some of the weekly visits, on or after October 1, 2020, and on or guidance. In addition, this final rule provided that such duties are within the before September 30, 2021 (FY 2021). amends the IRF coverage requirements non-physician practitioner’s scope of FOR FURTHER INFORMATION CONTACT: to allow, beginning with the second practice under applicable state law. Gwendolyn Johnson, (410) 786–6954, week of admission to the IRF, a non- for general information. physician practitioner who is D. Summary of Impact VerDate Sep<11>2014 22:13 Aug 07, 2020 Jkt 250001 PO 00000 Frm 00002 Fmt 4701 Sfmt 4700 E:\FR\FM\10AUR3.SGM 10AUR3 jbell on DSKJLSW7X2PROD with RULES3 Federal Register / Vol. 85, No. 154 / Monday, August 10, 2020 / Rules and Regulations 48425 TABLE 1—COST AND BENEFIT Provision description Transfers FY 2021 IRF PPS payment rate up- The overall economic impact of this final rule is an estimated $260 million in increased payments from date. the Federal Government to IRFs during FY 2021. II. Background determining the standard payment percentage (LIP), and high-cost outlier conversion factor. adjustments. Beginning with the FY A. Statutory Basis and Scope We applied the relative weighting 2006 IRF PPS final rule (70 FR 47908 Section 1886(j) of the Act provides for factors to the standard payment through 47917), the market basket index the implementation of a per-discharge conversion factor to compute the used to update IRF payments was a PPS for inpatient rehabilitation unadjusted prospective payment rates market basket reflecting the operating hospitals and inpatient rehabilitation under the IRF PPS from FYs 2002 and capital cost structures for units of a hospital (collectively, through 2005. Within the structure of freestanding IRFs, freestanding inpatient hereinafter referred to as IRFs). the payment system, we then made psychiatric facilities (IPFs), and long- Payments under the IRF PPS encompass adjustments to account for interrupted term care hospitals (LTCHs) (hereinafter inpatient operating and capital costs of stays, transfers, short stays, and deaths. referred to as the rehabilitation, furnishing covered rehabilitation Finally, we applied the applicable psychiatric, and long-term care (RPL) services (that is, routine, ancillary, and adjustments to account for geographic market basket). Any reference to the FY capital costs), but not direct graduate variations in wages (wage index), the 2006 IRF PPS final rule in this final rule medical education costs, costs of percentage of low-income patients, also includes the provisions effective in approved nursing and allied health location in a rural area (if applicable), the correcting amendments. For a education activities, bad debts, and and outlier payments (if applicable) to detailed discussion of the final key other services or items outside the scope the IRFs’ unadjusted prospective policy changes for FY 2006, please refer of the IRF PPS. A complete discussion payment rates. to the FY 2006 IRF PPS final rule. of the IRF PPS provisions appears in the For cost reporting periods that began The regulatory history previously original FY 2002 IRF PPS final rule (66 on or after January 1, 2002, and before included in each rule or notice issued FR 41316) and the FY 2006 IRF PPS October 1, 2002, we determined the under the IRF PPS is available on the final rule (70 FR 47880), and we final prospective payment amounts CMS website at https://www.cms.gov/ provided a general description of the using the transition methodology Medicare/Medicare-Fee-for-Service- IRF PPS for FYs 2007 through 2019 in prescribed in section 1886(j)(1) of the Payment/InpatientRehabFacPPS/ the FY 2020 IRF PPS final rule (84 FR Act. Under this provision, IRFs index?redirect=/InpatientRehabFacPPS/ 39055 through 39057). transitioning into the PPS were paid a . Under the IRF PPS from FY 2002 blend of the Federal IRF PPS rate and through FY 2005, the prospective the payment that the IRFs would have B. Provisions of the PPACA Affecting payment rates were computed across received had the IRF PPS not been the IRF PPS in FY 2012 and Beyond 100 distinct CMGs, as described in the implemented. This provision also FY 2002 IRF PPS final rule (66 FR allowed IRFs to elect to bypass this The Patient Protection and Affordable 41316). We constructed 95 CMGs using blended payment and immediately be Care Act (PPACA) (Pub.