CMS Releases Proposed 2022 IPPS and LTCH Rule

On April 27, the Centers for Medicare & Medicaid Services (CMS) released its Proposed 2022 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital rule. Comments on the proposed changes may be submitted by June 28, 2021. 

Key insights

The proposed rule increases payments to acute care hospitals, adopts wage index policy changes, provides details on distributing 1,000 new graduate medical education (GME) residency slots, and proposes various changes to the Promoting Interoperability Program. In addition, CMS proposes to delete a requirement that hospitals report median negotiated rates from third-party payers such as Medicare Advantage. 

Inpatient Prospective Payment System

Payment and policy updates 

• Market-basket update — CMS proposes a 2.5% update. Combined with a 0.2% multifactor productivity adjustment and a statutorily required increase of 0.5%, this results in a 2022 update of 2.8%. 
• Labor related shares — For discharges occurring on or after October 1, 2021, CMS proposes a labor-related share of 67.6%.
• National capital federal rate — CMS proposes a capital rate of $471.89 for fiscal year (FY) 2022. 
• Indirect medical education (IME) adjustment — For discharges occurring during FY 2022, CMS proposes a formula multiplier of 1.35. CMS estimates that the application of the formula multiplier will result in an increase in IPPS payment of 5.5% for every approximately 10% increase in the hospital’s resident-to-bed ratio.
• Chimeric antigen receptor (CAR) T-cell immunotherapy — CMS proposes adding more immunotherapies to the CAR-T Medicare Severity Diagnosis Related Group, MS-DRG 018. MS-DRG 018 will also be updated to “Chimeric Antigen Receptor (CAR) T-cell and Other Immunotherapies” to account for non-CAR T-cell therapies to be grouped into the MS-DRG for FY 2022. 
• New technology add-on payments (NTAP) — CMS proposes to continue nine new technology add-on payments for FY 2022 for those technologies that were approved for NTAP for FY 2021 and which would still be considered “new” for those purposes. In addition, due to the pandemic, CMS proposes to extend for another year the NTAP for 14 technologies that would have expired in 2022. CMS also discussed 22 new applications through the normal pathway and 16 through the alternative pathway. 
• New COVID-19 treatment add-on payments — CMS proposes extending these payments for eligible COVID-19 products through the end of the fiscal year in which the public health emergency (PHE) ends. 
• Medicare Disproportionate Share Hospital (DSH) payments — There are three factors that go into determining these payments to DSH hospitals. For 2022, CMS calculates the factors as follows:
  • Factor 1 — DSH pool of $10,573,368,841.28, which is equal to 75% of the total amount of estimated Medicare DSH payments for FY 2021 ($14,097,825,121.71 minus $3,524,456,280.43).  
  • Factor 2 — CMS calculated Factor 2 for the FY 2022 proposed rule to be 0.7214 (72.14%). The uncompensated care amount would be $10.573 billion multiplied by 0.7214, or $7.628 billion. CMS indicates this is roughly $662 million below the 2021 uncompensated care amount of $8.290 billion and equates to a decrease of 7.99%.
  • Factor 3 — proposes to use a hospital’s FY 2018 Worksheet S–10 data.
• Medicaid fraction in DSH calculation — Due to several court cases finding that CMS is required to consider certain days in the numerator of the Medicaid fraction, CMS is proposing modifications to its policy on counting patient days. CMS would explicitly state that a patient is deemed eligible for Medicaid for the purposes of the DSH calculation on a given day, and the corresponding patient day is included in the numerator of the Medicaid fraction, only if the patient is eligible for inpatient hospital services under an approved state Medicaid plan that includes coverage for inpatient hospital care on that day, or the patient directly receives inpatient hospital insurance coverage on that day under an approved 1115 waiver.
• Operating room (OR) and non-operating room codes — CMS continues its ongoing work related to its review of OR and non-OR codes, including when a procedure should be considered one or the other and moving current codes from one to the other.
• Medicare Severity Diagnosis Related Groups (MS-DRGs) — Due to the pandemic, CMS is proposing to use claims data from the March 2020 update of the FY 2019 MedPAR file in its analysis of proposed MS-DRG classification changes for FY 2022.
  
  CMS continues its review of MS-DRGs, including analyzing multiple change requests related to MS-DRGs. CMS also continues its ongoing work on MS-DRG severity levels: complication/comorbidity (CC), major complication/comorbidity (MCC) or non-CC. In particular, CMS is focused on 3,490 “unspecified” codes with CC or MCCs that can be mapped back to other codes that further specify the anatomic site. CMS is considering whether to change all these codes to non-CCs and seeks comment.
• Medicare Advantage (MA) median payer-specific negotiated charge — CMS is proposing to repeal the requirement it put in place under last year’s rule that requires a hospital to report on its Medicare cost report the median payer-specific negotiated charge that the hospital has negotiated with all of its MA organization payers, by MS-DRG, for cost reporting periods ending on or after January 1, 2021. CMS was going to use this in establishing a new market-based MS-DRG relative weight methodology effective for FY 2024. However, CMS also repeals that methodology and will continue using the existing cost-based methodology for calculating the MS-DRG relative weights for FY 2024 and subsequent fiscal years.
• Organ procurement — CMS proposes to codify various longstanding Medicare organ acquisition payment policies, with clarifications where necessary, and proposes to codify several new organ acquisition payment policies. 
• Medicaid enrollment of dually eligible — Under the proposed rule, CMS proposes that for purposes of determining Medicare cost-sharing obligations, the state Medicaid programs must accept enrollment of all Medicare-enrolled providers and suppliers (even if a provider or supplier is of a type not recognized as eligible to enroll in the state Medicaid program) if the provider or supplier otherwise meets all federal Medicaid enrollment requirements.

Wage index changes

• Imputed rural floor — As required under the American Rescue Plan Act of 2021 (Pub. L. 117–2) enacted on March 11, 2021, CMS is re-establishing the minimum area wage index for hospitals in all-urban states beginning with discharges occurring on or after October 1, 2021. CMS indicates that, based on data available at the release of this proposed rule, the change would apply to New Jersey, Rhode Island, Delaware, Connecticut, and Washington, DC.
• Low wage index hospitals — To help mitigate wage index disparities, CMS had previously finalized policies to reduce the disparity between high and low wage index hospitals by increasing the wage index values for certain hospitals with low wage index values, and doing so in a budget-neutral manner. The wage index for hospitals with a wage index value below the 25th percentile wage index value for a fiscal year was increased by half the difference between the otherwise applicable final wage index value for a year for that hospital and the 25th percentile wage index value for that year across all hospitals. For purposes of the low wage index hospital policy, based on the data for this proposed rule, the FY 2022 25th percentile wage index value is 0.8418. CMS continues this wage-index transition, including the 5% cap phase-in of new Office of Management and Budget (OMB) delineations. However, in light of the pandemic, CMS seeks comments on whether an additional year phase-in should be considered for this transition.
• Urban to rural wage index reclassifications — To address what it references as “gaming” of the rural wage index, CMS proposes that requests to cancel rural reclassifications must be submitted to the CMS regional office not earlier than one calendar year after the reclassification effective date. In addition, CMS proposes to eliminate the current rule that cancelation must be requested 120 days prior to the end of the fiscal year and is effective beginning with the next fiscal year, and replace it with a policy that ensures that a hospital approved for rural reclassification (and does not receive an additional reclassification) would have its data included in the calculation of the rural wage index for at least one federal fiscal year before the rural reclassification status could be canceled. Therefore, CMS proposes to make cancellation requests effective for the federal fiscal year that begins in the calendar year after the calendar year in which the cancelation request is submitted. 

Graduate medical education

New residency slots

CMS proposes numerous changes to implement statutory requirements enacted under the Consolidated Appropriations Act of 2021 (CAA 2021), including the addition of 1,000 residency slots over five years. CMS may not distribute more than 200 of those slots per year. As such, CMS proposes to make 200 residency positions available for FY 2023 and each subsequent year under the requirements below. Applications for new slots are due by January 31 of the preceding fiscal year.

The statute requires a demonstrated likelihood the slots will be used. CMS is, therefore, proposing to consider as Demonstrated Likelihood Criterion 1 (New Residency Program) and Demonstrated Likelihood Criterion 2 (Expansion of an Existing Program).

Further, CAA 2021 requires CMS to distribute not less than 40% of the slots to four priority categories of hospitals:

• Category 1 hospitals — Not less than 10% of available slots must go to rural hospitals. CMS proposes to define “rural” as any hospital with its main campus located in an area outside of an urban core-based statistical area. A hospital that is treated as rural is also eligible.
• Category 2 hospitals — Not less than 10% must go to hospitals training residents above their cap. Generally, CMS refers to the ‘‘reference resident level’’ as a hospital’s allopathic and osteopathic FTE resident count for the recent period and the “otherwise applicable resident limit” as the hospital’s 1996 cap during its reference year, adjusted by several items.
• Category 3 hospitals — Not less than 10% must go to hospitals located in states with new medical schools, or additional locations and branch campuses. CMS proposes hospitals located in the following states qualify for this category: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Mississippi, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Puerto Rico, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, and Wisconsin.
• Category 4 hospitals — Not less than 10% of slots must go to hospitals serving underserved areas. For this category, CMS proposes to consider health professional shortage areas (HPSAs).  Qualifying hospitals would have their main campus or a provider-based facility physically located in a primary care or mental health geographic HPSA. Additionally, at least 50% of the residents’ training time over the duration of the program must occur at those locations in the HPSA. 

CAA 2021 caps the number of slots a hospital can receive at 25; however, CMS proposes to limit slots to no more than 1.0 FTE each year per hospital. Hospitals may only submit one application a year. 

Further CMS proposes to prioritize applications of qualifying hospitals for residency programs that serve underserved populations in geographic HPSAs or population HPSAs. CMS will prioritize applications from the highest HPSA scores (i.e., need). Alternatively, CMS is considering distributing the additional residency positions for FY 2023 among hospitals that qualify under the four categories, with higher priority given to applications from hospitals that qualify in more categories.
CMS proposes to require all applicant hospitals to attest they meet the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards can be found HERE.)

CMS would pay for these additional positions using the same primary care and nonprimary per resident amounts (PRAs) for which payment is made for FTE residents subject to the 1996 FTE cap. CMS expects to revise Worksheet E–4 to add a line on which hospitals would report the number of FTEs by which the hospital’s FTE caps were increased for direct GME positions received under this change. 

Hospitals would need to attest that they will increase their residency positions in accordance with these new slots.

Rural training tracks (RTT)

Over the years, stakeholders and advocates of residency training in rural areas have raised concerns about inequities and unintended consequences of the past laws governing residency positions. CAA 2021 included statutory language on these issues, to which CMS proposes to implement the following changes:

• Cap adjustments for urban and rural hospitals in RTTs — CMS proposes that each time an urban hospital and rural hospital establish an RTT program for the first time, even if the RTT program does not meet the newness criteria for Medicare payment purposes, both the urban and rural hospitals may receive a rural track FTE limitation. 
• Cap adjustment for urban hospitals that add additional RTTs — CMS proposes to prospectively allow increases for both the participating urban and rural hospitals that expand a qualifying RTT. CMS proposes that if, in a cost reporting period beginning on or after October 1, 2022, an urban hospital with an existing RTT (“hub”) adds an additional RTT (“spoke”) to the existing urban core program of the same specialty, the urban and rural hospitals may receive adjustments to their rural track FTE limitation. 
• Remove the requirement that the RTT must be separately accredited — CMS proposes that, effective for cost reporting periods beginning on or after October 1, 2022, so long as the program in its entirety is accredited by the Accreditation Council for Graduate Medical Education, regardless of the specialty, it may qualify as an RTT as long as 50% of the training is in a rural area. In addition, CMS proposes that a rural hospital partnered with the urban hospital in the RTT would similarly include in its FTE count, not to exceed its rural track FTE limitation, the time residents train in the rural hospital only if the residents rotate to a rural area for greater than 50% of the duration of the particular program.
• Exemption from the three-year rolling average — Residents in new programs are exempt from the three-year rolling average until the cost reporting period that coincides with or follows the start of the sixth program year. Similarly, effective for RTTs started in cost reporting periods beginning on or after October 1, 2022, for each rural track started, full-time equivalent residents at an urban hospital or rural hospital in an RTT are excluded from the rolling average calculation during the cost reporting periods prior to the beginning of the applicable hospital’s cost reporting period that coincides with or follows the start of the sixth program year of each rural track.

Hospitals qualifying to reset PRAs, FTEs

CAA 2021 addresses situations where hospitals have low or zero PRAs and FTE resident caps due to hospitals hosting or rotating small numbers of residents for short periods and inadvertently setting those caps. CMS addresses two situations: Category A and Category B hospitals.

• Category A hospitals — Typically, a Category A hospital is one that trained less than 1.0 FTE in its most recent cost reporting period ending on or before December 31, 1996, and received a very low or $0 PRA.
• Category B hospital — A Category B hospital is one that, as of the date of enactment (December 27, 2020), has a PRA that was established based on training of no more than 3.0 FTEs in any cost reporting period beginning on or after October 1, 1997, and before the date of enactment (December 27, 2020). 

CMS will establish a new PRA for each hospital in either category. The recalculation period begins on December 27, 2020, and ends five years later. For redetermining the PRA, CMS proposes that the training at either a Category A hospital or a Category B hospital does not necessarily need to be under a new program. As the PRA base period, CMS proposes to use the first cost reporting period in which either the Category A hospital or Category B hospital trains their requisite threshold FTEs; that is, the cost report beginning on or after December 27, 2020, in which at least 1.0 FTE is trained at the Category A hospital, or the cost reporting period beginning on or after December 27, 2020, in which more than 3.0 FTEs are trained at the Category B hospital. 

Unlike PRAs, CMS proposes that the FTE resident cap would only be reset when a Category A hospital or Category B hospital “begins training” FTE residents in a new residency program(s). CMS proposes the relevant factor in determining the timing of resetting an FTE resident cap is if the hospital first begins training the requisite amount of FTE residents at some point in a cost reporting period beginning on or after December 27, 2020 (date of enactment), and five years after (December 26, 2025).

Intern and Resident Information System (IRIS)

CMS proposes effective for cost reporting periods on or after October 1, 2021, IRIS data must contain the same total counts of direct GME FTE residents (unweighted and weighted) and of IME FTE residents as the total counts of direct GME FTE and IME FTE residents reported in the hospital’s cost report, or the cost report will be rejected for lack of supporting documentation.

Medicare Shared Savings Program (MSSP)

Due to the pandemic, CMS proposes that accountable care organizations (ACOs) participating in Medicare’s BASIC track’s glide path may elect to maintain their current level of risk under the BASIC track for performance year (PY) 2022. As such, an applicable 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 then be automatically advanced to the level of the BASIC track’s glide path in which it would have participated during PY 2023 if it had advanced automatically.

Medicare Promoting Interoperability Program

CMS proposes a variety of changes as discussed below.

• A proposed continuation of the 90-day reporting period for FY 2022 and FY 2023 but moving to a 180-day continuous reporting period for FY 2024.
• For calendar year (CY) 2022 and subsequent years, the minimum scoring threshold is increased from 50 points to 60 points.
• The Maintain the Electronic Prescribing Objective’s Query of PDMP measure will continue to be optional for the electronic health record (EHR) reporting period in CY 2022, while increasing its associated bonus points from 5 points to 10 points.
• For CY 2022, CMS would modify the Provide Patients Electronic Access to Their Health Information measure to require eligible hospitals and CAHs to make patient health information available indefinitely, using any application of the patient’s choice configured to meet the technical specifications of the API in the eligible hospital or CAH’s CEHRT. This would include all patient health information from encounters on or after January 1, 2016.
• Under the Health Information Exchange objective, CMS would add the Health Information Exchange (HIE) Bi-Directional Exchange measure. This measure would be an optional alternative to the two existing measures — the Support Electronic Referral Loops by Sending Health Information measure and the Support Electronic Referral Loops by Receiving and Reconciling Health Information measure. CMS proposes that eligible hospitals and CAHs may either report the two existing measures and associated exclusions OR may choose to report the new measure. CMS proposes the new measure would be worth 40 points. It would be reported by attestation and a “yes/no” response.
• Beginning with the EHR reporting period in CY 2022, CMS proposes to require an eligible hospital or CAH to report under the Public Health and Clinical Data Exchange objective on the following:
  • - Syndromic surveillance reporting
  • - Immunization registry reporting
  • - Electronic case reporting
  • - Electronic reportable laboratory result reporting
• If reporting ‘‘yes’’ for each of the four required measures, a hospital would receive 10 points. Some exclusions exists, but if those do not apply — and the eligible hospital or CAH fails to report on any one of the four measures required for this objective or reports a “no” response for one or more of these measures — CMS proposes it would receive a score of zero for the this objective and a total score of zero for the Medicare Promoting Interoperability Program.
• CMS proposes retaining the Public Health Registry Reporting and Clinical Data Registry Reporting measures, but to make them optional and available for bonus points beginning with the EHR reporting period in CY 2022.
• CMS proposes to add a Safety Assurance Factors for EHR Resilience (SAFER) guides measure to the Protect Patient Health Information objective beginning with the CY 2022 EHR reporting period. For this measure, CMS would have an eligible hospital or CAH attest to having conducted an annual self-assessment of all nine SAFER guides at any point during the calendar year in which the EHR reporting period occurs, with one “yes/no” attestation statement accounting for a complete self-assessment using all nine guides. CMS proposes that the measure would be required in CY 2022 but not scored.
• To maintain alignment between the Hospital Inpatient Quality Reporting (IQR) Program and Medicare Promoting Interoperability Program, CMS also proposes to remove multiple eCQMs: STK-03, STK-06, PC-05, and ED-2, beginning with the reporting period in CY 2024.
• To maintain alignment with other programs and support hospitals’ ability to choose among a consistent pool of CQMs, CMS proposes to adopt the Severe Hypoglycemia and Severe Hyperglycemia CQMs for the Medicare Promoting Interoperability Program, beginning with the reporting period in CY 2023.
• CMS proposes to require eligible hospitals and CAHs to use only certified technology updated consistently with the 2015 Edition Cures Update — as finalized by the Office of the National Coordinator 21st Century Cures Act — to submit data for eCQMs, beginning with the reporting period in CY 2023.
• CMS proposes to remove several attestation statements (statements 2 and 3) from the program’s prevention of information block requirement as unnecessary.

CMS also seeks comments on multiple topics:

• Further aligning the Medicare Promoting Interoperability Program measures with approaches utilizing HL7® FHIR® (Fast Healthcare Interoperability Resources) standard Release 4-based API (Application Program Interface) functionality with the Health Information Exchange as well as the Public Health and Clinical Data Exchange objectives.
• Changing the Medicare Promoting Interoperability Program and related efforts to better target patient access outcomes related to use of patient portals or third-party application(s).
• Development of a required and independently scored measure for the Medicare Promoting Interoperability Program to allocate points for the use of “clinical note” types supported by certified health IT and the types of clinical notes that are commonly sought, but not easily accessible to patients.
• Feedback on the development of, or support and adoption of, designating high-performing hospitals in the context of EHR excellence.

Quality programs

Measure suppression criterion

Due to the COVID-19 pandemic, CMS proposes a measure suppression policy for various programs:

• Hospital Readmissions Reduction Program (HRRP)
• Hospital-Acquired Condition (HAC) Reduction Program
• Hospital Value-Based Purchasing Program
• Skilled Nursing Facility Value-Based Purchasing Program
• End-Stage Renal Disease Quality Incentive Program

The policy will use various factors to assess whether to suppress measures or not.

HAC reduction program

CMS proposes suppression of Q3 and Q4 2020 Hospital-Acquired Infections (HAI) and CMS Patient Safety Indicators (PSI) 90 measures data.

Hospital Inpatient Quality Reporting (IQR) program

CMS proposes to adopt five new measures to the program:

1. Maternal Morbidity Structural measure — beginning with a shortened reporting period from October 1, 2021, through December 31, 2021, affecting the CY 2021 reporting period/FY 2023 payment determination
2. Hybrid Hospital-Wide All-Cause Risk Standardized Mortality (Hybrid HWM) measure — beginning with a voluntary submission period that would run from July 1, 2022, through June 30, 2023, and followed by mandatory reporting beginning with the reporting period that runs July 1, 2023, through June 30, 2024, affecting the FY 2026 payment determination
3. COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) measure — beginning with a shortened reporting period from October 1, 2021, through December 31, 2021, affecting the CY 2021 reporting period/FY 2023 payment determination
4. Hospital Harm-Severe Hypoglycemia eCQM — beginning with the CY 2023 reporting period/FY 2025 payment determination
5. Hospital Harm-Severe Hyperglycemia eCQM — beginning with the CY 2023 reporting period/FY 2025 payment determination

CMS proposes removing the following five measures between FY 2023 and FY 2026 payment determinations:

1. Death Among Surgical Inpatients with Serious Treatable Complications (CMS PSI-04)
2. Exclusive Breast Milk Feeding (PC-05) (NQF #0480)
3. Admit Decision Time to ED Departure Time for Admitted Patients (ED-2)
4. Anticoagulation Therapy for Atrial Fibrillation/Flutter (STK-03)
5. Discharged on Statin Medication (STK-06)

CMS also discusses other measures it is considering for the future:

1. 30-Day, All-Cause Mortality Measure for Patients Admitted With COVID-19 Infection
2. Hospital-Level, Risk Standardized Patient Reported Outcomes Measure Following Elective Primary Total Hip and/or Total Knee Arthroplasty
3. Ways to leverage or develop new measures to address the gap in existing health inequities

Finally, CMS proposes that Hospital IQR Program participants must use technology certified to the 2015 Edition Cures Update and it must support the reporting requirements for all available eCQMs beginning in 2023 reporting years.

Hospital Readmissions Reduction Program (HRRP)

CMS proposes to suppress the CMS 30-Day Pneumonia Readmission measure (NQF #0506) in the 2023 program year and modify the five other measures to exclude COVID-19 patients.

CMS proposes to calculate the measure’s rate for the relevant program year but then suppress the use of that rate to make hospital payment changes by weighting the suppressed measure at 0% in the HRRP scoring methodology. Hospitals would receive confidential reports of their rates as calculated without suppression.

Hospital Value-Based Purchasing Program

CMS proposes to suppress all measures in the Person and Community Engagement Domain, the Safety Domain, and the Efficiency and Cost Reduction Domain for the FY 2022 program year. Those include:

• Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) (NQF #0166)
• Medicare Spending Per Beneficiary — Hospital (NQF #2158)
• National Healthcare Safety Network (NHSN) Catheter-Associated Urinary Tract Infection (CAUTI) Outcome measure (NQF #0138)
• National Healthcare Safety Network (NHSN) Central Line-Associated Bloodstream Infection (CLABSI) Outcome measure (NQF #0139)
• American College of Surgeons — Centers for Disease Control and Prevention Harmonized Procedure Specific Surgical Site Infection (SSI) Outcome measure (NQF #0753)
• National Healthcare Safety Network (NHSN) Facility-wide Inpatient Hospital-onset Methicillin-resistant Staphylococcus aureus (MRSA) Bacteremia Outcomes measure (NQF #1716)
• National Healthcare Safety Network (NHSN) Facility-wide Inpatient Hospital-onset Clostridium difficile Infection (CDI) Outcome measure (NQF #1717)

As such, CMS also indicates it would not determine total performance score for any hospital.

For FY 2023, CMS proposes removal of the CMS PSI 90 measure and would suppress the MORT 30-PN measure due to the impact of COVID-19.  

PPS-exempt Cancer Hospital Quality Reporting Program

CMS proposes removal of one measure, Oncology: Plan of Care for Pain — Medical Oncology and Radiation Oncology (NQF #0383) (PCH-15), in FY 2024 program year. CMS would adopt one measure, COVID-19 Vaccination Coverage Among Healthcare Personnel, beginning with the FY 2023 program year and for subsequent years.

Additional requests for information (RFI)

CMS seeks comments on digital quality measures (dQMs) and use of FHIR in order to advance to dQMs by 2025. Specifically, CMS seeks comments on:

1. Leveraging and Advancing Standards for Digital Data and Obtaining all EHR Data Required for Quality measures via Provider FHIR-based APIs
2. Redesigning Quality measures to be Self-Contained Tools
3. Building a Pathway to Data Aggregation in Support of Quality Measurement
4. Potential Future Alignment of measures Across Reporting Programs, Federal and State Agencies, and the Private Sector

A second RFI is focused on closing the health equity gap in CMS quality programs. This includes many topics for comments, such as:

1. The possibility of expanding CMS current disparities methods to include reporting by race and ethnicity using indirect estimation
2. The possibility of hospital collection of standardized demographic information for the purposes of potentially incorporating into measure specifications to permit more robust equity measurement
3. The design of a hospital equity score for calculating results across multiple social risk factors and measures, including race and ethnicity and dual eligibility
4. Future potential stratification of quality measure results by race and ethnicity

Long-Term Care Hospitals (LTCH)

Payment updates

CMS proposes a 2.4% market basket update for FY 2022. When the required MFP adjustment of 0.2% is included, the result is a proposed FY 2022 update of 2.2%.

CMS indicates the standard LTCH PPS payment rates for FY 2022 would be $44,827.87 (reporting of quality data) or $43,950.62 (not reporting quality data).

CMS proposes to continue using current methodology to determine the MS-LTC-DRG relative weights for FY 2022. In doing so, it will propose to apply a normalization factor of 1.25811 and a budget neutrality factor of 1.000275.

Long-Term Care Hospital Quality Reporting Program (LTCH QRP)

CMS proposes to adopt one new measure, COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) 1352, beginning with FY 2023. CMS proposes to update the denominator for another measure, Transfer of Health (TOH) Information to the Patient — Post-Acute Care (PAC), to exclude patients discharged under the care of an organized home health service or hospice. CMS also seeks comments on dQMs in the future for LTCH QRP and for FHIR, along with how to close the health equity gap.

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