CMS Final Rule on Hospital Inpatient Rates and More

On Friday, August 3, 2018, the Centers for Medicare & Medicaid Services (CMS) released its final rule entitled, “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2019 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (Promoting Interoperability Programs) Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Medicare Cost Reporting Requirements; and Physician Certification and Recertification of Claims.”

CMS estimates the final rule will result in an increase in payments of $4.8 billion in 2019.

The final rule revises the Medicare hospital inpatient prospective payment systems (IPPS) for acute care hospitals, modifies Medicare graduate medical education affiliation agreements for new urban teaching hospitals, establishes the market basket update for certain hospitals excluded from the IPPS, updates payments and policies for long-term care hospitals, modifies quality reporting for certain hospitals, modifies the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, and modifies hospital quality programs addressing value-based purchasing, readmissions and hospital acquired conditions, among other provisions.

CMS Administrator Seema Verma emphasized that the final rule addresses key priorities, including “improving the quality and safety of care, advancing health information exchange and usability, and removing outdated or redundant regulations on healthcare providers to make way for innovation and greater value.”

CMS outlined multiple changes to the Medicare and Medicaid EHR Incentive Programs, including:

(1) creating a “reporting period of a minimum of any continuous 90-day period in each of calendar years 2019 and 2020 for new and returning participants attesting to CMS or their State Medicaid agency;”

(2) establishing a new performance-based scoring methodology in Medicare;

(3) finalizing two new electronic prescribing measures for opioids; and

(4) making changes to measures and removing certain measures that “do not emphasize interoperability and the electronic exchange of health information.”  CMS will consider comments on enhanced transparency measures in future rule making.

The final rule is effective October 1, 2018. 

Additional information can be found here: Fact Sheet Hospital Inpatient     Press Release Hospital Inpatient