May 19, 2021

Today’s article will conclude our look at the massive 2022 IPPS Proposed Rule (PR). So far, we’ve summarized how the PR treats topics such as payment rates, quality measures, negotiated payment disclosure, residency programs and efforts to reduce hospital readmissions. Based on a summary of the PR released by the Centers for Medicare and Medicaid Services (CMS), we will now provide some of the remaining highlights of the government’s proposed changes impacting hospitals in FY 2022.

Promoting Interoperability Program

In 2011, CMS established the Medicare and Medicaid EHR Incentive Programs (currently called “Promoting Interoperability”) to encourage meaningful use of certified EHR technology (CEHRT). In the 2022 PR, CMS recommends the following changes to the Medicare Promoting Interoperability Program:

Increase the EHR reporting period to a minimum of any continuous 180-day period for new and returning eligible hospitals and CAHs for CY 2024.

Increase the available bonus for the Electronic Prescribing Objective’s Query of PDMP measure from 5 points to 10 points.

Establish a data availability requirement to the Provide Patients Electronic Access to Their Health Information measure.

Add a new Health Information Exchange (HIE) Bi-Directional Exchange measure as a yes/no attestation, beginning in CY 2022.

Require reporting “yes” on four of the existing Public Health and Clinical Data Exchange Objective measures.

Attest to having completed an annual assessment of all nine guides in the SAFER Guides measure, under the Protect Patient Health Information objective.

Remove attestation statements 2 and 3 from the Promoting Interoperability Program’s prevention of information blocking attestation requirement.

Increase the minimum required score for the objectives and measures from 50 points to 60 points (out of 100 points) to be considered a meaningful EHR user.
Value-Based Purchasing Program

The Hospital Value-Based Purchasing (VBP) Program is a budget-neutral program funded by reducing participating hospitals’ base operating DRG payments each fiscal year by 2.0 percent and redistributing the entire amount back to the hospitals as value-based incentive payments. The PR recommends several “measure suppressions” for the FY 2022 program year. As a result of these suppressions, CMS believes that calculating a total performance score (TPS) for hospitals using only data from the remaining measures would result in an unfair national comparison. Accordingly, the agency is also proposing to refrain from calculating a TPS for any hospital based on one domain and to instead award to all hospitals a value-based payment amount for each discharge that is equal to the amount withheld.

Medicaid Enrollment of Medicare Providers

By way of background, the Medicare Savings Programs and certain Medicaid statutes require states to pay the Medicare cost sharing for dually eligible individuals. However, through what is commonly referred to as “lesser-of” policies, states are allowed to pay less than the full Medicare cost sharing or, in certain circumstances, make no payment at all. If states pay less than such cost-sharing amounts, certain Medicare providers may submit these unpaid cost-sharing amounts to Medicare for payment as reimbursement for “bad debt.” In order to claim Medicare bad debt, a provider must show it has tried to obtain payment for the debt.

Under the proposed rule, CMS would require Medicaid provider enrollment systems to allow valid enrollments from Medicare providers serving certain Medicare-Medicaid dually eligible individuals—even if a provider or supplier is of a type not recognized as eligible to enroll in the state Medicaid program. This recommended change is meant to lessen appeal and litigation costs.

Medicare Shared Savings Program

The PR recommends changes to policies for the Shared Savings Program that will allow eligible accountable care organizations (ACOs) participating in the BASIC track’s glide path option to elect to forgo automatic advancement along the glide path’s increasing levels of risk and potential reward for performance year (PY) 2022. Under this proposal, an eligible ACO may elect to remain in the same level of the BASIC track’s glide path in which it participated during PY 2021. For PY 2023, an ACO that elects this advancement deferral option would be automatically advanced to the level of the BASIC track’s glide path in which it would have participated during PY 2023—but only if it had advanced automatically to the required level for PY 2022 (unless the ACO elects to advance more quickly before the start of PY 2023).

Rural Designation

Along with the 2022 IPPS Proposed Rule, CMS is issuing an Interim Final Rule (IFR) to amend its current regulations at § 412.230 to allow hospitals with a rural redesignation to reclassify through the Medicare Geographic Classification Review Board using the rural reclassified area as the geographic area in which the hospital is located. These regulatory changes align CMS policy with the decision in Bates County Memorial Hospital v. Azar, 464 F. Supp. 3d (D.D.C. 2020).

For the full CMS summary of the 2022 IPPS Proposed Rule, you can click on the following link. Fiscal Year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) Rates Proposed Rule (CMS-1752-P) | CMS. It is important to remember that these provisions are only proposals and are subject to change. We will update you once the Final Rule for FY 2022 is published. Remember also that you can reach out to us at info@miramedgs.com if you have questions for us.