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Title
CMS-1607-F and other associated rules and notices
Type of File
Rules and Notices

1. CMS-1607-F

Date of Publication: August 22, 2014

Title: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2015 Rates; Quality Reporting Requirements for Specific Providers; Reasonable Compensation Equivalents for Physician Services in Excluded Hospitals and Certain Teaching Hospitals; Provider Administrative Appeals and Judicial Review; Enforcement Provisions for Organ Transplant Centers; and Electronic Health Record (EHR) Incentive Program

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 these 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), the Protecting Access to Medicare Act of 2014, and other legislation.  These changes are applicable to discharges occurring on or after October 1, 2014, 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 are effective for cost reporting periods beginning on or after October 1, 2014.

We also 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 to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.  In addition, we discuss our proposals on the interruption of stay policy for LTCHs and on retiring the “5 percent” payment adjustment for co-located LTCHs.  While many of the statutory mandates of the Pathway for SGR Reform Act apply to discharges occurring on or after October 1, 2014, others will not begin to apply until 2016 and beyond.

In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments.  We are establishing new requirements or revising requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare.

We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.  In addition, we are making technical corrections to the regulations governing provider administrative appeals and judicial review; updating the reasonable compensation equivalent (RCE) limits, and revising the methodology for determining such limits, for services furnished by physicians to certain teaching hospitals and hospitals excluded from the IPPS; making regulatory revisions to broaden the specified uses of Medicare Advantage (MA) risk adjustment data and to specify the conditions for release of such risk adjustment data to entities outside of CMS; and making changes to the enforcement procedures for organ transplant centers.

We are aligning the reporting and submission timelines for clinical quality measures for the Medicare EHR Incentive Program for eligible hospitals and critical access hospitals (CAHs) with the reporting and submission timelines for the Hospital IQR Program.  In addition, we provide guidance and clarification of certain policies for eligible hospitals and CAHs such as our policy for reporting zero denominators on clinical quality measures and our policy for case threshold exemptions.

In this document, we are finalizing two interim final rules with comment period relating to criteria for disproportionate share hospital uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program.

2. CMS-1607-CN

Date of Publication: October 3, 2014

Title: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2015 Rates; Quality Reporting Requirements for Specific Providers; Reasonable Compensation Equivalents for Physician Services in Excluded Hospitals and Certain Teaching Hospitals; Provider Administrative Appeals and Judicial Review; Enforcement Provisions for Organ Transplant Centers; and Electronic Health Record (EHR) Incentive Program; Correction

Description: This document corrects technical and typographical errors in the final rule that appeared in the August 22, 2014 Federal Register titled "Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2015 Rates; Quality Reporting Requirements for Specific Providers; Reasonable Compensation Equivalents for Physician Services in Excluded Hospitals and Certain Teaching Hospitals; Provider Administrative Appeals and Judicial Review; Enforcement Provisions for Organ Transplant Centers; and Electronic Health Record (EHR) Incentive Program."

3. CMS Manual System Change Request 9197

Date of Publication: originally issued May 22, 2015 (reissued June 5, 2015)

Subject: Inpatient Prospective Payment System (IPPS) Hospital Extensions per the Medicare Access and CHIP Reauthorization Act of 2015

Description: The Medicare Access and CHIP Reauthorization Act of 2015 enacted on April 16, 2015 provides for the extension of certain IPPS policies through September 30, 2017. CMS issued instructions (Change Request (CR) 9197; May 22, 2015, which was reissued June 5, 2015 as noted below) to implement the extension of increased payment adjustment for certain low-volume hospitals and the Medicare-Dependent Hospital (MDH) program through the remainder of FY 2015 (that is, for discharges occurring on or after April 1, 2015 through September 30, 2015). Prior to this legislation, these policies had expired on March 31, 2015. Generally, providers that were receiving these payment adjustments for FY 2015 as of the date of the expiration will have those payment adjustments restored effective April 1, 2015, as long as the hospital continued to meet the applicable qualifying criteria. Refer to CR 9197 for additional information. CMS intends to address the extension of these provisions beyond FY 2015 in the near future. (Note, CR 9197 was reissued June 5, 2015 to correct the extension through date of the MDH program in Attachment 3, draft Notification to Provider letter. All other information remains the same.)