Psychiatric facilities will get a 2.4% increase under the Centers for Medicare and Medicaid Services' proposed rule for the inpatient psychiatric facility prospective payment system for fiscal year 2026.
The 2.4% bump is equivalent to about $70 million, said CMS. The payment update reflects a proposed market-basket update of 3.2% minus a productivity adjustment of 0.8 percentage points.
CMS is proposing that if more recent data becomes available – for example, a more recent estimate of the market basket update or productivity adjustment – CMS would use this data, if appropriate, to determine the FY 2026 market basket update percentage increase and the productivity adjustment in the final rule.
CMS also proposes to update the outlier threshold so that estimated outlier payments remain at 2% of total payments. In addition, the agency would increase the adjustment factors for IPFs with teaching status and rural location, and recognize increases to IPF teaching caps as required by law.
Inpatient psychiatric facilities got a 2.7% bump in last year's proposed rule for 2025.
WHAT'S THE IMPACT
For the IPF Quality Reporting Program, CMS proposes to remove four structural measures and revise the reporting period for its emergency department visit following the IPF discharge measure. The rule also includes requests for information on a potential star rating system for IPFs, nutrition and well-being quality measures, and the use of Fast Healthcare Interoperability Resources (FHIR) standards for reporting patient assessment data.
CMS is also proposing to remove four measures: Facility Commitment to Health Equity, COVID-19 Vaccination Coverage among Health Care Personnel, Screening for Social Drivers of Health and Screen Positive Rate for Social Drivers of Health.
The agency will update the Program's Extraordinary Circumstances Exception policy to explicitly include extensions that can be granted if something affects the ability of an IPF to comply with reporting requirements. CMS is also proposing to codify the process for requesting or granting an ECE, which would remain the same as the current process, in regulation.
THE LARGER TREND
CMS is issuing three Requests for Information related to the IPFQR Program, seeking input on a potential future star rating system for the program for display on the Medicare.gov Care Compare tool.
The compare tool currently displays star ratings for many provider and facility types but does not include IPFs, CMS said. The RFI seeks feedback on the development of a five-star methodology for IPFs that can meaningfully describe their quality of care.
As well, the agency is seeking input on future measure concepts on the topics of well-being and nutrition, and requesting information on potentially using FHIR standards for IPFs reporting patient assessment data to CMS.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.