2022 Hospital Inpatient Payment Proposal Adds New Codes for CAR-T Services; Seeks Stakeholder Input on Fully Digital Quality Measurement

April 28, 2021

On Tuesday, April 27, the Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Rates Proposed Rule. The proposed rule would update the Medicare fee-for-service payment rates and policies for inpatient hospitals and long-term care hospitals for FY 2022. It also aims to enhance the health care workforce in rural and underserved communities, in addition to addressing gaps in health equity.

In 2021 CMS established a Medicare Severity Diagnosis Related Group (MS-DRG) for chimeric antigen receptor T-cell (CAR-T) services (MS-DRG 018). Any cases reporting the existing CAR-T ICD- 10-PCS procedure codes (XW033C3 or XW043C3) are assigned to the new MS-DRG. CMS is proposing to add 16 new procedure codes to MS-DRG-018 for FY 2022 and subsequently renaming the MS-DRG “Chimeric Antigen Receptor (CAR) T-cell and Other Immunotherapies.”

The Consolidated Appropriations Act of 2021 requires the distribution of an additional 1,000 new Medicare-funded medical residency positions. To improve access to care, address workforce shortages, and encourage health professionals to work in rural hospitals and underserved areas, CMS is proposing to phase in the 1,000 additional physician residency slots to qualifying hospitals over the next five years, prioritizing applications from qualifying hospitals that serve geographic areas and underserved populations with the greatest need.

CMS aims to move fully to digital quality measurement in CMS quality reporting and value-based purchasing programs by 2025. A request for information included in the proposed rule seeks stakeholder comment on a four-stage plan to transition CMS’ quality measurement enterprise to a fully digital program by 2025.

The proposed rule would also extend the New COVID-19 Treatments Add-on Payment (NCTAP) for certain eligible technologies through the end of the fiscal year in which the Public Health Emergency ends. Furthermore, CMS is proposing to require hospitals to report COVID-19 vaccinations among workers in their facilities and to adopt the COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) quality measure.

Additional information can be found in CMS’ fact sheet.

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