The Centers for Medicare & Medicaid Services (CMS) released on April 23 proposed policy changes and rates for the 2020 Inpatient Prospective Payment System (IPPS) and Long-term Care Hospital Prospective Payment System (LTCH PPS).

The proposed payment updates for 2020 are:

• 2.7% for hospitals that submit quality data and are meaningful EHR users
• 0.3% for hospitals that submit quality data and are not meaningful EHRs users
• 1.9% for hospitals that do not submit quality data and are not meaningful EHR users
• -0.5% for hospitals that do not submit quality data and are not meaningful EHR users

CMS proposes a LTCH PPS standard federal payment rate full update of 2.7 percent and a reduced update of 0.7 percent for LTCHs that fail to submit quality reporting data for 2020.

Stakeholder Gives Preliminary View

The American Hospital Association (AHA) reports, “Under the proposed rule, payments would increase by $37 million as compared to fiscal year 2019. CMS also estimates that site-neutral cases will continue to decrease as a proportion of total cases and will account for 29 percent of all LTCH cases in FY 2020.”

CMS is also proposing a payment cut for LTCHs that have fewer than 50 percent of cases qualifying for the traditional rate, and to modify its quality measures to include seven more data elements related to social determinants of health, according to the AHA.

Code Changes Proposed

Tables 6P.1a-e show the proposed ICD-10-CM and ICD-10-PCS codes for proposed MS-DRG changes.

Tables 6A-6K show the new, revised, and invalid ICD-10-CM and ICD-10-PCS codes CMS is proposing for 2020, as well as the codes CMS is proposing to delete from the CC and/or MCC lists.

Comments must be received no later than 5 p.m. EDT on June 24, 2019. See the proposed rule for more information and commenting instructions.