CMS Proposes New Quality Measures, Reporting, Other Changes For FY 2016 Psych Facilities Prospective Payment SYstem Updates

May 2, 2015

June 23, 2015 is the deadline for submitting comments on proposed updates to the Medicare Psychiatric Facilities Prospective Payment System Regulations (PFPPS Rule) that the Centers for Medicare & Medicaid Services (CMS) wants to implement beginning October 1, 2015 published on May 1, 2015 in the proposed “Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System—Update for FiscalYear Beginning October 1, 2015 (FY 2016) available for review here (Proposed PFPPS Rule).  All inpatient facilities and other affected providers and patients should review the potential implications of these proposed changes and act quickly to comment on any concerns on or before this June 23, 2015 deadline. The Proposed PFPPS Rule, if implemented as proposed, will update the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs) (which are freestanding IPFs and psychiatric units of an acute care hospital or critical access hospital) for IPF discharges occurring during the fiscal year (FY) beginning October 1, 2015 through September 30, 2016 (FY 2016). The Proposed PFPPS Rule also proposes:

  • A new IPF-specific market basket;
  • To update the IPF labor-related share; a transition to new Core Based Statistical Area (CBSA) designations in the FY 2016 IPF Prospective Payment System (PPS) wage index;
  • To phase out the rural adjustment for IPF providers whose status changes from rural to urban as a result of the proposed wage index CBSA changes; and
  • New quality measures and reporting requirements under the IPF quality reporting program.

For More Information Or Assistance

If you need assistance reviewing or responding to these or other health care related risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer, may be able to help. A practicing attorney with extensive health industry experience, also recognized as a knowledgeable and highly popular health industry thought and policy leader, who writes and publishes extensively  on health industry concerns, Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, Board Certified in Labor & Employment Law, and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 27 years experience advising health industry clients about these and other matters. Her experience includes advising and defending hospitals, nursing home, home health, physicians and other health care professionals, rehabilitation and other health care providers and health industry clients to establish and administer compliance and risk management policies and programs in response under CMS, OCR, HHS, FDA, IRS, DOJ, DEA, NIH, licensing, and other regulations; prevent, conduct and investigate, and respond to Board of Medicine, OIG, DOJ, DEA, DOD, DOL, Department of Health, Department of Aging & Disability, IRS, Department of Insurance, and other federal and state regulators; ERISA and private insurance, prompt pay and other reimbursement and contracting; peer review and other quality concerns; and other health care industry investigation, and enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. The scribe for the American Bar Association (ABA) Joint Committee on Employee Benefits annual agency meeting with the Department of Health & Human Services Office of Civil Rights,  Ms. Stamer has worked extensively with health care providers, health plans, health care clearinghouses, their business associates, employers, banks and other financial institutions, and others on risk management and compliance with HIPAA and other information privacy and data security rules, investigating and responding to known or suspected breaches, defending investigations or other actions by plaintiffs, OCR and other federal or state agencies, reporting known or suspected violations, business associate and other contracting, commenting or obtaining other clarification of guidance, training and enforcement, and a host of other related concerns.  Her clients include public and private health care providers, health insurers, health plans, technology and other vendors, and others.  In addition to representing and advising these organizations, she also has conducted training on Privacy & The Pandemic for the Association of State & Territorial Health Plans,  as well as  HIPAA, FACTA, PCI, medical confidentiality, insurance confidentiality and other privacy and data security compliance and risk management for  Los Angeles County Health Department, ISSA, HIMMS, the ABA, SHRM, schools, medical societies, government and private health care and health plan organizations, their business associates, trade associations and others. Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  You can get more information about her health industry experience here. If you need assistance responding to concerns about the matters discussed in this publication or other health care concerns, wish to obtain information about arranging for training or presentations by Ms. Stamer, wish to suggest a topic for a future program or update, or wish to request other information or materials, please contact Ms. Stamer via telephone at (214) 452-8297 or via e-mail here.

About Solutions Law Press

Solutions Law Press™ provides business risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, compensation, data security and privacy, health care, insurance, and other key compliance, risk management, internal controls and other key operational concerns. If you or someone else you know would like to receive future updates about developments on these and other concerns from Ms. Stamer, see here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile here. For important information concerning this communication click here.THE FOLLOWING DISCLAIMER IS INCLUDED TO COMPLY WITH AND IN RESPONSE TO U.S. TREASURY DEPARTMENT CIRCULAR 230 REGULATIONS.  ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, OR (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN. ©2015 Cynthia Marcotte Stamer.  Non-exclusive right to republish granted to Solutions Law Press, Inc.  All other rights reserved.

9/21 NTHCPA Meeting To Focus On Quality Measures & Reimbursement

September 16, 2011


Invites Members and Guests to Our Next Study Group & Brown Bag Luncheon

“Quality Measures and Reimbursement: New Programs, New Compliance Challenges”


Timothy D. Martin, J.D., LL.M, CCP, MCP

Wednesday, September 21, 2011
Noon-2:00 p.m.
Dallas Ft Worth Hospital Council

250 Decker Drive, Irving, TX 75062-2706 

North Texas Healthcare Compliance Professional Association (NTHCPA) invites members and other interested health care compliance professionals to join other NTHCPA members and guests on Wednesday, September 21, 2011 from Noon to 2:00 p.m. as Timothy D. Martin, J.D., LL.M, CCP, MCP, leads a program on “Quality Measures and Reimbursement: New Programs, New Compliance Challenges.”  

The expanding use of payment incentives for meeting quality benchmarks by private and public payers create new opportunities and new compliance challenges.  The Affordable Care Act created a number of new quality incentive programs that build on earlier ones. Texas has also created new quality incentive programs with the passage of its healthcare collaborative initiative. While most health quality incentives continue to rely on structure, process, and outcome measures that the healthcare industry has experimented with for many years, new compliance requirements require providers to change their data-gathering and data-communication procedures. Further, these programs may force providers to deal with clinical guidelines that lag behind the standard of care and data-transmission protocols that lag behind reporting requirements. Newer bundled-payment methodologies may require healthcare organizations to create a complex contractual web to allocate a single payment among multiple providers. This discussion will focus on these issues and their possible solutions.

The meeting will be held at the offices of the Dallas Ft Worth Hospital Council, 250 Decker Drive, Irving, TX 75062-2706.  Under the new brown bag luncheon format, members and guests are encouraged to bring along a lunch of their choosing and participate in this compliance knowledge and skill-building and networking event.

Timothy D. Martin, J.D., LL.M, CCP, MCP was a founder and Chief System Architect for Innovative Managed Care Systems, LLC (now MedAssets, Inc.). He has more than 30 years’ experience in information technology—the last 20 years in healthcare information technology. He holds a degree in Mathematics and Computer Information Systems from West Texas State University and two law degrees from Southern Methodist University Dedman School of Law.

NTHCPA meetings are open to all NTHCPA members and other interested health care compliance professionals. Participation in the meeting is complimentary. Participants are responsible for any parking charges incurred. 

RSVP & Register For Invites & Updates

To help us to notify you about upcoming meetings and to arrange for adequate space for this and other meetings, interested persons are encouraged to forward their current contact information including e-mail to Vice-President Cynthia Marcotte Stamer at (469) 767-8872 or by e-mail here.  Stay on top of information about upcoming meetings and share and dialogue with other NTHCPA members about health care compliance challenges and developments by joining our Linked In Group here.  Please feel free to share this invitation with others who may be interested. 

About the NTHCPA & Involvement

NTHCPA exists to champion ethical practice and compliance standards and to provide the necessary resources for ethics and compliance Professionals and others in North Texas who share these principles.  The vision of NTHCPA is to be a pre-eminent compliance and ethics group promoting lasting success and integrity of organizations within North Texas.  To register or update your registration or to receive notice of future meetings, e-mail here.

Would you like to get more involved?  We encourage persons interested in serving on the steering committee, sponsoring refreshments for an upcoming meeting, wish to suggesting topics or speakers, or seeking more information about membership or involvement with the NTHCPA to contact:

NTHCPA President Erma Lee at (817) 927-1232 or by e-mail here or

Vice-President Cynthia Marcotte Stamer at (469) 767-8872 or by e-mail here

This communication may be considered a marketing communication for certain purposes.  If you wish to update your e-mail for purposes of receiving future e-mail concerning meetings or other activities of the North Texas Healthcare Compliance Professionals Association , please send an email here.

Please share this invitation with others who might be interested in this topic or other NTHCPA events!

%d bloggers like this: