CMS Releases FY 2024 IPF PPS Final Rule
The Centers for Medicare & Medicaid Services (CMS) on Thursday released its Fiscal Year (FY) 2024 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)
final rule.
NABH’s Position
While the final rule includes many NABH priorities, we remain concerned that it does not go far enough to account for the cost pressures IPFs face. The NABH team will meet with CMS to discuss the field’s health information technology and other obstacles that will greatly hinder compliance with the quality measures (QMs) to be added to the inpatient psychiatric facility quality reporting program (IPFQRP).
Final Payment Update
The rule finalizes a net increase in Medicare FY 2024 payments to IPFs of 2.3%, or $70 million, relative to FY 2023. While the agency’s final FY 2023 payment update is larger than the proposed rule’s 1.9% increase, NABH will continue to push policymakers to recognize fully the high costs that our members face. The FY 2024 update includes increases in the federal per-diem base rate to $895.63 from $865.63, and in the outlier threshold to $33,470 from $24,630, which will reduce the number of cases that qualify for an outlier payment.
Updated IPF Marketbasket:
The rule also finalizes CMS’ proposal to rebase and revise the IPF marketbasket using more recent cost report data from 2021 in place of 2016 data.
Streamlined Process for Opening New IPF Units:
The rule will allow new IPF units to open and begin billing Medicare at any time during its cost reporting year, following a 30-day advance notice.
Final Updates to IPFQRP
The final rule implements four new QMs and a data validation pilot, among other changes. The new QMs include these three QMs related to health equity and social drivers of health:
- A Facility Commitment to Health Equity measure, which providers will begin reporting in FY 2026 and will affect payments;
- A Screening for Social Drivers of Health (SDOH) measure, for which voluntary reporting will begin in FY 2025 and later will affect payments; and
- A Screen Positive Rate for SDOH measure beginning with voluntary reporting of CY 2024 data with impact on payment to begin in FY 2027.
The new data validation pilot program will begin data collection in FY 2025. While NABH supported the general concept of this pilot, we urged CMS to postpone it because the field is currently focused on its first year of submitting patient-level quality data. Because the agency is moving forward, we will continue to emphasize that the pilot is too much, too fast.
More information on these IPFQRP updates can be found in the NABH comment
letter on this rule, as well as the final rule text using the link above.
HHS, DOL and Treasury Release Proposed Rules to Strengthen MHPAEA
The U.S. Health and Human Services (HHS), Labor (DOL), and Treasury Departments on Tuesday released proposed
rules to bolster the
Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 and remove obstacles to behavioral healthcare access.
The rules propose several amendments to the 2013 MHPAEA final regulations, as well as provisions that would establish the content requirements of the Non-Qualitative Treatment Limitations, or NQTL, comparative analyses required under amendments to MHPAEA included in the
Consolidated Appropriations Act, 2021 (CAA, 2021).
“In evaluating their compliance with these proposed rules, plans and issuers would be required to consider whether an NQTL is inhibiting access to treatment for mental health conditions and substance use disorders by examining whether the NQTL that applies to mental health or substance use disorder benefits is more restrictive than the predominant NQTL that applies to substantially all medical/surgical benefits within a classification of benefits set forth under the regulations,” the guidance noted.
Meanwhile, the guidance said a plan or issuer would also be required to consider whether the processes, strategies, evidentiary standards, or other factors that it uses to design or apply an NQTL to mental health or substance use disorder benefits in a classification are comparable to, and applied no more stringently than, those used in designing and applying the NQTL to medical/surgical benefits in the same classification.
The three departments also released a
Technical Release on NQTLs that outlines principles and seeks public comment to inform future technical guidance about the application of proposed data collection and evaluation requirements to NQTLs related to network composition that the rule proposes.
Along with the proposed rules, the departments released the
2023 MHPAEA Comparative Analysis Report to Congress that the CAA, 2021 requires. The report includes information about the agencies’ enforcement efforts and identifies plans and issuers that received final determinations of non-compliance with MHPAEA.
The White House released a
fact sheet about the rule and DOL’s Employee Benefits Security Administration posted all the related documents
here.
NABH is a member of the CEO Alliance on Mental Health, which released a
statement about the guidance this week.
“The Biden Administration, along with bipartisan leadership in Congress, has made great progress in increasing access to comprehensive mental health and substance use care, including expanding the Certified Community Behavioral Health Clinic (CCBHC) model, improving crisis services and suicide prevention, and addressing youth mental health,” the Alliance statement said. “However, more work is needed to ensure everyone can access high quality care as early as possible, so we thank President Biden for this focus on improving parity.”
CMS will accept comments until 60 days after the rules are published in the
Federal Register. NABH will seek feedback from members and submit comments about the proposed rules and Technical Release.
CMS Releases Ligature Risk Guidance
CMS has released
guidance to state survey directors about ligature risk and assessment in hospitals.
The agency’s guidance centers around three main elements CMS said hospitals should consider when ensuring patient safety related to ligature risk: patient assessment, staffing/monitoring, and environmental risk.
“Based on their clinical evaluation, some patients may require both a more restrictive environment and an increased level of monitoring than other patients,” the guidance noted. “Therefore, it is not expected that hospitals have the same ligature risk configuration throughout their facility, but rather focus on the specific needs and risks of individual patients, based on their clinical or psychiatric assessment,” it continued. “Similarly, corrective actions implemented in response to deficiencies or adverse events should focus on appropriately addressing the findings or failures, rather than universal remedies.”
The changes are effective 30 days from when CMS released the memorandum on July 17. Please send any questions to
QSOG_Hospital@cms.hhs.gov.
Reminder: DEA Registration Training Requirement for Buprenorphine Prescribing
Early this year SAMSHA announced that clinicians no longer need a federal waiver to prescribe buprenorphine to treat opioid use disorder; however, clinicians must still register with the U.S. Drug Enforcement Agency (DEA) to prescribe controlled medications.
In late June, the DEA announced that both new and renewing applicants must complete a new, one-time, eight-hour training course. Exceptions for the training requirement are practitioners who are board-certified in addiction medicine or addiction psychiatry, and those who graduated from a medical, dental, physician assistant, or advanced practice nursing school in the United States within five years of June 27, 2023.
Click
here to learn more about the training.
2023 NABH Annual Meeting Photos Now Available
NABH is pleased to share
photos from last month’s 2023 Annual Meeting:
Security the Promise of Parity.
If you choose to download and use a photo, please credit photographer Chris Ferenzi. Thank you.
Reminder: Please Submit Data to Enhance NABH’s Managed-Care Advocacy Efforts
Thank you to all members who have submitted data to NABH’s denial-of-care portal!
We are still seeking data from additional members to support advocacy on health plan denials and prior-authorization timeliness. If you are a new participant, please e-mail NABH Administrative Coordinator
Emily Wilkins for support.
CEO Update During the Congressional August Recess
NABH will publish
CEO Update only on
Friday, Aug. 11 and
Friday, Aug. 28 during the congressional August recess.
Fact of the Week:
A new
study published in
Psychiatric Services reports disruptions in opioid use disorder outpatient and medications for opioid use disorder were marginal during the pandemic, possibly because of increased telehealth services.
For questions or comments about this CEO Update, please contact Jessica Zigmond.