LegiStorm

Summary:
Highlights

GAO reviewed the Department of Health and Human Services, Centers for Medicare & Medicaid Services' (CMS) new rule entitled "Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2024 and Updates to the IRF Quality Reporting Program." GAO found that the final rule (1) updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year 2024; (2) rebases and revises the IRF market basket to reflect a 2021 base year; and (3) confirms when IRF units can become excluded and paid under the IRF PPS, and includes updates for the IRF Quality Reporting Program.

Enclosed is our assessment of CMS's compliance with the procedural steps required by section 801(a)(1)(B)(i) through (iv) of title 5 with respect to the rule. If you have any questions about this report or wish to contact GAO officials responsible for the evaluation work relating to the subject matter of the rule, please contact Shari Brewster, Assistant General Counsel, at (202) 512-6398.





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B-335498

August 14, 2023

The Honorable Ron Wyden
Chairman
The Honorable Mike Crapo
Ranking Member
Committee on Finance
United States Senate

The Honorable Cathy McMorris Rodgers
Chair
The Honorable Frank Pallone, Jr.
Ranking Member
Committee on Energy and Commerce
House of Representatives

The Honorable Jason Smith
Chairman
The Honorable Richard Neal
Ranking Member
Committee on Ways and Means
House of Representatives

Subject: Department of Health and Human Services: Centers for Medicare & Medicaid Services: Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2024 and Updates to the IRF Quality Reporting Program

Pursuant to section 801(a)(2)(A) of title 5, United States Code, this is our report on a major rule promulgated by the Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) entitled ?Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2024 and Updates to the IRF Quality Reporting Program? (RIN: 0938-AV04). We received the rule on July 26, 2023. It was published in the Federal Register as a final rule on August 2, 2023. 88 Fed. Reg. 50956. The effective date is October 1, 2023.

The final rule, according to CMS, updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year 2024. CMS stated that, as required by statute, the rule includes the classification and weighting factors for the IRF Prospective Payment System?s (PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for fiscal year 2024. Further, CMS stated the rule rebases and revises the IRF market basket to reflect a 2021 base year. Lastly, CMS noted the rule confirms when IRF units can become excluded and paid under the IRF PPS, and includes updates for the IRF Quality Reporting Program.

Enclosed is our assessment of CMS?s compliance with the procedural steps required by section 801(a)(1)(B)(i) through (iv) of title 5 with respect to the rule. If you have any questions about this report or wish to contact GAO officials responsible for the evaluation work relating to the subject matter of the rule, please contact Shari Brewster, Assistant General Counsel, at (202) 512-6398.


Shirley A. Jones
Managing Associate General Counsel

Enclosure

cc: Calvin E. Dukes II
Regulations Coordinator
Centers for Medicare & Medicaid Services
Department of Health and Human Services

ENCLOSURE

REPORT UNDER 5 U.S.C. § 801(a)(2)(A) ON A MAJOR RULE
ISSUED BY THE
DEPARTMENT OF HEALTH AND HUMAN SERVICES,
CENTERS FOR MEDICARE & MEDICAID SERVICES
ENTITLED
?MEDICARE PROGRAM; INPATIENT REHABILITATION FACILITY
PROSPECTIVE PAYMENT SYSTEM FOR FEDERAL FISCAL YEAR 2024
AND UPDATES TO THE IRF QUALITY REPORTING PROGRAM?
(RIN: 0938-AV04)

(i) Cost-benefit analysis

The Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) included an accounting statement, classifying the estimated expenditure of this final rule. Specifically, CMS stated that the change in estimated transfers from the federal government to inpatient rehabilitation facility (IRF) Medicare providers from the fiscal year 2023 IRF Prospective Payment System (PPS) to the fiscal year 2024 IRF PPS is $355 million. Further, CMS stated that the estimated costs associated with the fiscal year 2025 and fiscal year 2026 IRF Quality Reporting Program (QRP) due to new quality reporting program requirements is $31,412.56. Last, CMS noted that the estimated costs associated with regulatory review for the fiscal year 2024 IRF PPS is $16,613.10.

(ii) Agency actions relevant to the Regulatory Flexibility Act (RFA), 5 U.S.C. §§ 603?605, 607, and 609

CMS anticipates that this final rule will not have a significant impact on a substantial number of small entities.

(iii) Agency actions relevant to sections 202?205 of the Unfunded Mandates Reform Act of 1995, 2 U.S.C. §§ 1532?1535

CMS determined that this final rule does not mandate any requirements for state, local, or tribal governments, or for the private sector.

(iv) Other relevant information or requirements under acts and executive orders

Administrative Procedure Act, 5 U.S.C. §§ 551 et seq.

CMS published a proposed rule on April 7, 2023. 88 Fed. Reg. 20950. According to CMS, it received 45 timely responses from the public, many of which contained multiple comments on the proposed rule. CMS further stated it received comments from various trade associations, IRFs, individual physicians, therapists, clinicians, health care industry organizations, and health care consulting firms. CMS responded to comments in this final rule.

Paperwork Reduction Act (PRA), 44 U.S.C. §§ 3501?3520

CMS determined this final rule contains information collection requirements associated with Office of Management and Budget (OMB) Control Number 0938-0842 for the IRF QRP. CMS stated the changes to the IRF QRP will result in an estimated increase in programmatic burden for 1,133 IRFs, and the total burden increase is approximately $31,412.56 for all IRFs and $27.73 per IRF.

Statutory authorization for the rule

CMS promulgated this final rule pursuant to section 1886 of Public Law 74-271.

Executive Order No. 12866 as amended by Executive Order No. 14094 (Regulatory Planning and Review)

According to CMS, this final rule will have an effect on the economy of $200 million or more in any one year and is, therefore, significant under the Order. CMS stated the rule was reviewed by OMB.

Executive Order No. 13132 (Federalism)

CMS stated that this final rule will not have a substantial effect on state and local governments, preempt state law, or otherwise have a federalism implication.




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