Becker's Hospital Review

21 CFO / FINANCE CMS pitches 4 payment rules for 2022: 12 things to know By Ayla Ellison C MS in April released its annual proposed payment updates for skilled nursing facilities, hospices, inpatient psychiatric facili- ties and inpatient rehabilitation facilities. Twelve things to know about the proposed rules: Skilled nursing facilities 1. On April 8, CMS proposed increasing payments to skilled nursing facilities by 1.3 percent in fiscal year 2022. 2. CMS estimates that the payment update and other policies in the proposed rule would result in an increase of approximately $444 million in Medicare Part A payments to skilled nursing facil- ities in fiscal 2022. 3. CMS is seeking public comments on a potential methodology for recalibrating the Patient Driven Payment Model that would account for the potential effects of the COVID-19 public health emergency. The agency is also seeking comment on wheth- er any adjustments should be delayed or phased in to provide payment stability. Hospices 4. On April 8, CMS proposed raising hospice payments by 2.3 percent, or $530 million, in fiscal year 2022. 5. CMS proposed a new measure for the Hospice Quality Reporting Program called the Hospice Care Index. e single measure includes 10 indicators of quality that are calculated from claims data. 6. In response to the COVID-19 pandemic, CMS issued sever- al waivers, including one allowing the use of pseudo-patients for hospice aide competency testing. e agency proposed making this waiver permanent. Inpatient rehabilitation facilities 7. On April 7, CMS proposed increasing payments to inpatient reha- bilitation facilities by 2.2 percent in fiscal year 2022. 8. CMS estimates that the overall payment increase to inpatient rehab facilities would be $160 million in fiscal 2022. 9. CMS proposed adopting one new measure and updating the spec- ifications for another measure used for the Inpatient Rehabilitation Facility Quality Reporting Program, a pay-for-reporting program. Inpatient psychiatric facilities 10. On April 7, CMS proposed raising payments to inpatient psychiatric facilities by 2.3 percent in fiscal year 2022. 11. CMS estimates that total payments to inpatient psychiatric facili- ties would increase by $90 million in fiscal 2022. 12. CMS proposed changing the inpatient psychiatric facility teaching policy to ensure medical residents won't be displaced if their teach- ing hospital or program closes. is change would align the inpatient psychiatric facility teaching policy with changes finalized in the fiscal year 2021 Inpatient Prospective Payment System rule. n Lawsuit accuses BCBS of Massachusetts of systematically allowing overpayments By Morgan Haefner A laborers' fund in Massachusetts filed a lawsuit against its health insurance administrator, Blue Cross Blue Shield of Massachusetts, claiming its pricing led to millions in overpayments to providers. The Massachusetts Laborers' Health and Welfare Fund filed the lawsuit March 26 against BCBS of Massachusetts in the U.S. District Court of Massachusetts. According to the lawsuit, BCBS of Massachusetts was hired to adminis- ter the fund's health insurance services for its self-insured health plan and make benefit determinations on how much the fund should reimburse healthcare providers. In its lawsuit, the fund claims BCBS of Massachusetts vi- olated its fiduciary duties under the Employee Retire- ment Income Security Act by prioritizing "its relationships with healthcare providers and its own bottom line" when pricing health insurance claims. "BCBSMA allowed millions of dollars of billing [errors] to deplete the Fund's assets and obstructed the Fund's ef- forts in recovering overpayments," the lawsuit alleged. "BCBSMA failed to correct the systemic issues that gave rise to such costly errors in the first place." In a written statement emailed to Becker's, a BCBS of Mas- sachusetts spokesperson said the insurer rejects "the erro- neous claims made in this complaint, which misstates facts and mischaracterizes many events." The insurer continued: "The allegations in the complaint illustrate an incomplete and misguided understanding of BCBSMA's claims pricing systems. BCBSMA intends to take action against this vendor for the harm it has caused our business relationships." n

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