CMS Releases Proposed FY 2023 Medicare Inpatient Prospective Payment Systems for Long-Term Care Hospitals

The Centers for Medicare and Medicaid Services (CMS) released a proposed rule on Monday that would update Medicare payment policies for hospitals under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year (FY) 2023. The proposed rule is scheduled for publication in the Federal Register on May 10.

The rule includes a proposed $1.6 billion (3.2%) increase in operating payment rates paid under the IPPS for general acute care hospitals that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are electronic health record (EHR) users. At the same time, the agency projects that combined Medicare disproportionate share hospital (DSH) payments and Medicare uncompensated care payments will decrease by approximately $0.8 billion in FY 2023.

The proposed rule includes several provisions related to the COVID-19 pandemic. One provision in the proposed rule includes a proposed return to the agency’s historical practice of using the most recent available data, including the FY 2021 MedPAR claims and the FY 2020 cost reports, for the FY 2023 rate setting. The rule includes certain proposed modifications to the agency’s usual rate-setting methodologies to account for the anticipated decline in COVID-19 hospitalizations of Medicare beneficiaries at IPPS hospitals and LTCHs compared with FY 2021. Additional provisions would require hospitals to continue to complete COVID-19 and seasonal influenza reporting after the conclusion of the current public health emergency. The rule would also establish new reporting requirements for future public health emergencies related to a specific infectious disease or pathogen.

The proposed rule also builds upon the previously established HHS Maternal Health Action Plan to improve maternal mortality and morbidity and address health disparities, a priority of the Biden administration. Of note to the AABB community, the proposed rule introduces two additional electronic clinical quality measures (eCQMs) intended to drive improvements in maternal health for the Hospital Quality Reporting Program: a measure of low-risk Cesarean deliveries and a measure of severe obstetric complications. CMS specifically recognizes that blood transfusions were considered with respect to the severe obstetric complications eCQM, as blood transfusions “may be necessary for a number of reasons and for less severe complications,” Thus, the measure “reports two outcomes, one that includes all patients that meet the numerator criteria, and one that excludes patients whose only qualification for the numerator is a transfusion.”

CMS released a fact sheet that summarizes key provisions of the proposed rule. CMS is accepting comments on the proposed rule through June 17.

AABB is analyzing the proposed rule for provisions that may be of interest to the blood and biotherapies community.