CMS has released the inpatient psychiatric facility proposed rule.
Approximately $75million is projected to be paid to inpatient psychiatric facilities (IPF), according to the Centers for Medicare & Medicaid Services (CMS) proposed 2020 inpatient prospective payment system (IPPS) released on April 19.
IPF-PPS applies to inpatient services for psychiatric hospitals and distinct psychiatric units of acute care and critical access hospitals.
The IPF market basket will be revised and rebased to reflect a 2016 base year. The current estimate of the market basket is 3.1 percent. The payment rates will be updated for inflation. The per diem rate will be updated from $782.78 to $803.48.
The Electroconvulsive Therapy (ECT) payment will increase from $337.00 to $345.91.  The ICD-10-PCS codes for ECTs are GZB0ZZZ, GZB2ZZZ, and GZB4ZZZ and must appear on the claim.  The wage index budget neutrality will increase from 1.0013 to 1.0078. The fixed dollar loss threshold will change from $12,865 to $14,590.
The cost to charge (CCR) upper threshold is proposed at 1.7321 for urban facilities and 2.0588 for rural facilities.   The median CCR threshold was reported at 0.4330 for urban facilities and 0.5810 for rural facilities. There were no changes made to the comorbidity, age, etc. adjustment values.
There were minor changes to the diagnoses for the comorbidities which include Developmental Disabilities; Coagulation Factor Deficits; Tracheostomy; Acute Renal Failure; Chronic Renal Failure; Oncology Treatment; Uncontrolled Diabetes Mellitus with or without Complications; Severe Protein-Calorie Malnutrition; Eating and Conduct Disorders; Infectious Disease; Drug and/or Alcohol-Induced Mental Disorders; Cardiac Conditions; Gangrene; Chronic Obstructive Pulmonary Disease; Artificial Openings – Digestive and Urinary; Severe Musculoskeletal and Connective Tissue Disorders; and Poisoning. There were four (4) ICD-10-CM codes added to Poisoning.   There were two (2) ICD-10-PCS codes added to Oncology Procedures (part of the Oncology Treatment comorbidity).  It should be noted that unspecified ICD-10-PCS codes have been deleted from the diagnosis comorbidity lists.
There are 17 Medicare Severity Diagnosis Related Groups (MS-DRGs) that have been assigned to IPF-PPS. There were no changes to those DRGs in the proposed rule. The diagnoses that are mapped to these MS-DRGs can be found in Addendum A. If a diagnosis is not mapped to one of the 17 MS-DRGs, then the case will receive per diem payment, but will not receive an MS-DRG adjustment.
There are 13 Inpatient Psychiatric Facility Quality Reporting (IPFQR) measures. No additions or deletions were made to these measures for FY20. The measures are the following:
| NQF# | Measure ID | Measure |
| 0640 | HBIPS-2 | Hours of Physical Restraint Use |
| 0641 | HBIPS-3 | Hours of Seclusion Use |
| 0560 | HBIPS-5 | Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification |
| 0576 | FUH | Follow-up After Hospitalization for Mental Illness |
| N/A* | SUB-2 and 2a | Alcohol Use Brief Intervention Provided or Offered//Alcohol Use Brief Intervention |
| N/A* | Sub-3 and 3a | Alcohol and Other Drug Use Disorder Treatment Provided or Offered at Discharge//Alcohol and Other Drug Use Disorder Treatment at Discharge |
| N/A* | TOB-2 and 2a | Tobacco Use Treatment Provided or Offered//Tobacco Use Treatment |
| N/A* | TOB-3 and 3a | Tobacco Use Treatment Provided or Offered at Discharge//Tobacco Use Treatment at Discharge |
| 1659 | IMM-2 | Influenza Immunization |
| N/A* | N/A | Transition Record with Specified Elements Received by Discharged Patients (Discharge from Inpatient Facility to Home/Self Care or Any Site of Care |
| N/A* | N/A | Timely Transmission of Transition Record (Discharge from an Inpatient Facility to Home/Self Care or Any Other Site of Care) |
| N/A | N/A | Screening for Metabolic Disorders |
| 2860 | N/A |
30-Day All-Cause Unplanned Readmission Following Psychiatric Hospitalization in an Inpatient Psychiatric Facility |
*Measure is no longer endorsed by the National Quality Forum (NQF).
A measure was proposed for fiscal year (FY)2021. NQF#3205 (Medication Continuation Following Inpatient Psychiatric Discharge) assesses whether the patient admitted to the IPF with a principal diagnosis of major depressive disorder (MDD), schizophrenia, or bipolar disorder has filled at least one evidence-based medication prior to discharge (within two days) or during the post-discharge period (30 days after discharge).  The performance time for this measure is two years. Exclusions to this measure are the following:
- The patient received ECT during the admission; the patient received transcranial magnetic stimulation (TMS) during the admission;
- The patient had a secondary diagnosis of delirium, or the patient has a principal diagnosis of schizophrenia with a secondary diagnosis of dementia. This measure will be claims based.
A future measure is about patient experience. The proposed rule mentioned that most organizations use the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to assess the patient experience. CMS is requesting comments regarding this proposal.
For More Information: https://www.icd10monitor.com/psychiatric-facilities-could-see-payments-of-75-million-in-2020
