The policy, which dated from FY05, established a wage index floor (i.e., a requirement for urban hospitals in each state to have higher wage indexes than the state’s rural area wage index) for states with no rural hospitals. CMS Prior Authorization Proposed Rule Faces Backlash, Support, EHR Vendor Resolves Kickback Allegations, Settling for $18.25 Million, Guidehouse Analyzes Data for Compliance with Price Transparency Rule, CMS Audits Hospitals for Compliance with Transparency Measures. When deciding to make modifications to the MS-DRGs, CMS considers whether the resource consumption and clinical characteristics of patients with a given set of conditions are significantly different than the remaining patients represented in the MS-DRG. The CMS “wage index” remains a vital (and controversial) component of how hospitals receive payment for services to Medicare beneficiaries. The labor-related share is the national average portion of costs related to, influenced by, or varying with the local labor market, and is determined by summing the relative importance of labor-related cost categories included in the 2016-based market basket. index beginning on January 1, 2021. CMS typically uses the wage index to adjust Medicare rates to reflect wages in a specific geographic area. Please see our Privacy Policy for details. Key Takeaway: CMS finalized new MS-DRG 018 (Chimeric Antigen Receptor (CAR) T-cell Immunotherapy). CMS Extends Inpatient Prospective Payment System (IPPS) Wage Index Occupational Mix Survey Submission. 6. The Act further requires that we update the wage index annually, based on a survey of wages and wage-related costs of short-term, acute care hospitals. CMS declines to propose updates to the Overall Hospital Quality Star Rating on Hospital Compare despite previous indications it would. The federal agency said last week that it published the Medicare wage index reclassification data early since the 60-day delay in the effective date of final rule was delayed in the proposed Inpatient Prospective Payment System (IPPS) … With the intent to support and improve beneficiary access to new technology, CMS finalized for FY 2021 several policies streamlining and facilitating access to add-on payments for certain antimicrobial products. On May 11, 2020, CMS released the 2021 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”). Continuation of the Low Wage Index Hospital Policy In the 2020 IPPS final rule, CMS finalized policies to reduce the disparity between high and low wage index hospitals. 500 North Capitol Street, N.W. Key insights. CMS recognizes that labor costs vary from one area to the next. Completed 2019 Occupational Mix Surveys, Hospital Reporting Form CMS-10079, for the Wage Index Beginning FY 2022, are due to the Medicare Administrative Contractors (MACs) on the Excel hospital reporting form by July… In assessing whether a new technology qualifies for add-on payment, one criterion is whether the charges for the new technology meet or exceed certain threshold amounts. Changes to Wage Index. The agency indicated that this policy will be effective for at least four years. Significant Vulnerabilities Exist in the Hospital Wage Index System for Medicare Payments (A-01-17-00500) 2 Inpatient Prospective Payment System Base Payments and Wage Data CMS sets two IPPS base payment rates annually, one for operating costs and one for capital costs. Currently, NTAP payments are equal to 65% of the estimated costs of the inpatient case in excess of the full diagnosis-related group payment, up to a maximum of 65% of the costs of the technology. 1. CMS will cap the negative adjustment at 5% for fiscal year 2020 on any decrease in a hospital’s wage index from its final wage index for FY 2019. CMS discontinued the NTAPs for two CAR-T products, Yescarta and Kymriah. Expanded Alternative Pathway and Conditional Approval for Certain Antimicrobial Products. Additionally, as CAR-T cases will no longer be assigned to MS-DRG 016, CMS finalized its proposal to revise the title for MS-DRG 016 from “Autologous Bone Marrow Transplant with CC/MCC or T-cell Immunotherapy” to “Autologous Bone Marrow Transplant with CC/MCC.”, MS-DRG Reclassification Request Submission Deadline.
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