On July 29, 2021, the Centers for Medicare and Medicaid Services (CMS) published their FY 2022 inpatient rehabilitation facilities (IRF) and skilled nursing facilities (SNF) Final Rules. 

The IRF final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2022. As required by statute, this final rule includes the classification and weighting factors for the IRF prospective payment system’s case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2022. This final rule also includes updates for the IRF Quality Reporting Program (QRP). In addition, CMS had previously exempted all CRT power wheelchair accessories from the same cuts, and Congress and the agency had instituted several temporary suspensions of the cuts for manual accessories. We advocated for the CRT issues with an AMA resolution, which was garnered support from the House of Medicine to assist in this win. The new permanent policy was issued as part of the Fiscal Year 2022 Inpatient Rehabilitation Facility Prospective Payment System final rule, which also included several DMEPOS policies. The final rule text can be found here, and the section dealing with CRT accessories begins on page 131. CMS’ fact sheet on the rule can be found here. View our full CRT resolution here.  

The SNF final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2022. In addition, the final rule includes a forecast error adjustment for FY 2022, updates the diagnosis code mappings used under the Patient Driven Payment Model (PDPM), rebases and revises the SNF market basket, implements a recently-enacted SNF consolidated billing exclusion along with the required proportional reduction in the SNF PPS base rates, and includes a discussion of a PDPM parity adjustment. In addition, the final rule includes updates for the SNF Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) Program, including a policy to suppress the use of the SNF readmission measure for scoring and payment adjustment purposes in the FY 2022 SNF VBP Program because CMS has determined that circumstances caused by the public health emergency for COVID-19 have significantly affected the validity and reliability of the measure and resulting performance scores. CMS is also finalizing a technical correction to the physical environment requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs.

On August 2, 2021, CMS finalized the Inpatient Prospective Payment System (IPPS) final rule.  The IPPS rule finalized payments effective October 1, 2021 for inpatient hospitals and long term care hospitals. This rule is being released in multiple parts and subsequent parts of the rule will address the CMS proposals related to direct graduate medical education and indirect medical education costs. This rule addresses key priorities to close health care equity gaps and support greater access to life-saving diagnostics and therapies during the COVID-19 public health emergency and beyond. Also included are new requirements and revisions to existing requirements for the Hospital Value-Based Purchasing Program, Hospital Readmissions Reduction Program, Hospital Inpatient Quality Reporting Program and LTCH Quality Reporting Program.

We are currently reviewing these proposed rules in detail. In the coming weeks, the Academy website may be expanded to include additional information about the rules. Comprehensive fact sheets for the IRF final rule, the SNF final rule and the IPPS final rule are available on CMS' website.