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NABH Alert: CMS Announces 1.5-percent Increase for Inpatient Psychiatric Facilities for 2020 in Final Rule

The Centers for Medicare and Medicaid Services (CMS) announced a Medicare payment increase of 1.5 percent next year for inpatient psychiatric facilities in the final Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) rule the agency released today.

Compared with the 2019 payment rate, the increase reflects a total increase of $65 million for Medicare-participating inpatient psychiatric facilities in fiscal year 2020. The payment update aligns with the agency’s proposed rule earlier this year.

The rule also adds one new claims-based measured starting in fiscal year 2021 payment determination and continuing in subsequent years. The measure—Medication Continuing Following Inpatient Psychiatric Discharge (National Quality Forum #3205)—assesses whether patients admitted to IPFs with diagnoses of Major Depressive Disorder, schizophrenia, or bipolar disorder filled at least one evidence-based medication within two days before discharge or during the 30-day, post-discharge period.

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CMS Releases Emergency Medical Treatment and Labor Act (EMTALA) Memorandum

The Centers for Medicare & Medicaid Services (CMS) on July 2 released Frequently Asked Questions on the Emergency Medical Treatment and Labor Act (EMTALA) and Psychiatric Hospitals, a six-page memo addressing common concerns psychiatric hospitals and hospital emergency departments have regarding compliance with EMTALA.

EMTALA has been a top regulatory priority for NABH and our team has worked closely with CMS on this issue. In March, NABH released The High Cost of Compliance: Assessing the Regulatory Burden in Inpatient Psychiatric Facilities, a detailed report that quantifies the compliance costs related to EMTALA for inpatient psychiatric care providers. The analysis—which NABH commissioned Manatt Health to produce—also addresses ligature risk, a topic CMS addressed this past April in draft guidance.

Here are key excerpts from CMS’ July 2 FAQ Memo:

  • How do surveyors evaluate whether a staff person is qualified to perform a Medical Screening Exam?
    • The surveyor can review state scope of practice as well as hospital bylaws or rules and regulations to determine if the medical screening exams being performed are within a professional’s scope of practice.
  • What is the expectation of a psychiatric hospital when a medical emergency presents in terms of who can conduct a medical screening exam?
    • EMTALA requires hospitals to perform medical screening examinations within their capabilities. If the psych hospital doesn’t have the ability to perform a comprehensive medical screening exam (or provide stabilizing treatment), but the screening exam it performs indicates that the patient may have an emergency medical condition, the hospital is required to arrange an appropriate transfer to a facility for further evaluation and treatment. The hospital is expected to use its resources to perform the exam and provide care within its capabilities prior to transfer. This might be as simple as performing ongoing assessments with repeat vital signs and ensuring the patient is in a safe environment.
  • What is required in terms of stabilization and transfer for non-psychiatric emergencies?
    • There is no expectation that a psych hospital with basic clinical services would be expected to provide the same level of comprehensive medical assessments or treatment as an acute care hospital.
  • How does EMTALA intersect with admission?
    • If the hospital has the staff and facilities to stabilize the emergency medical condition, it is expected to do so. This includes inpatient admission, as appropriate. Having an empty inpatient bed does not always translate to having the capability or capacity to stabilize the emergency medical condition.
  • Can an ER physician in a facility that does not provide psychiatric care conduct the mental health screening?
    • It is within the scope of practice for ED physicians and practitioners to evaluate patients presenting with mental health conditions, same with any other medical, surgical, or psychiatric presentation. The ED practitioner may utilize hospital resources to assist with the examination and treatment or arrange appropriate transfers if additional resources are needed.

Read the full memo here.

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