CMS Proposed & Finalized Rules, Drug Price Updates

On July 25, 2016 CMS released the Advancing Care Coordination proposed rule. Looking to the aim of CMMI to test innovative payment and service-delivery models to reduce expenditures while preserving or enhancing the quality of care, the proposed rule targets the Medicare Program introducing three new episode payment models (EPMs), a Cardiac Rehabilitation (CR) Incentive Payment Model, and a set of changes to the Comprehensive Care for Joint Replacement (CJR) model.

  • The three new EPMs are scheduled for July 1, 2017 – December 31, 2021. Those for acute myocardial infarction (AMI) and coronary bypass graft (CABG) will be mandatory in 98 MSAs still to be selected. The third EPM for surgical hip/femur fracture treatment excluding lower extremity joint replacement (SHFFT) will be an expansion of CJR and include the same 67 MSAs.
  • The CR Incentive Model will provide direct financial incentives based on the number of CR services provided by hospitals treating AMI or CABG beneficiaries to encourage greater utilization of such services in the 90 days post-discharge.
  • The updates to CJR create a pathway to Advanced APM status and well as a set of technical changes to the quality scoring effect on reconciliation payments.

We will be presenting a webinar outlining the proposed rule in increased detail as well as providing an opportunity for you to pose any questions you have around the proposal. Thursday, August 4th at 12pm EST. Details forthcoming.

On July 29, 2016 CMS issued a final rule outlining FY 2017 Medicare payment policies and rates for the Skilled Nursing Facility Prospective Payment System (SNF PPS), the SNF Quality Reporting Program (SNF QRP), and the SNF Value-Based Purchasing (SNF VBP) Program. CMS projects a 2.4% increase from 2016 aggregate payments for SNFs, for a $920 million SNF PPS increase. Both the SNF QRP and the SNF VBP added new measures that focus on readmission among other SNF PAC concerns.Updates to the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP) for FY 2017 were also released.

On July 28, 2016 CMS issued the updates for the Final FY 2017 Medicare Payment and Policy Changes for Inpatient Psychiatric Facilities (IPF). CMS estimates IPF payments will increase by 2.2%, or $100 million, in FY 2017. The IPF wage index will also be updated for FY 2016 to reflect the OMB area delineations with rural adjustment first finalized in the 2016 final rule.