Acute Inpatient PPS

Title
CMS-1588-F
Type of File
Final Rule

1. CMS-1588-F

Title: Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and FY 2013 Rates and to the Long Term Care Hospital PPS and FY 2013 Rates.

Description: We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems.  Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation.  These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule.  We also are updating 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 will be effective for cost reporting periods beginning on or after October 1, 2012.

We are updating 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 made by the Affordable Care Act.  Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule.

In addition, we are implementing changes relating to determining a hospital’s full‑time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments.  We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare.  We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers (ASCs) that are participating in Medicare.

We are establishing requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program.