Federal Register, Volume 75, Number 226, November 24, 2010, Pages 71519-72652 Page: 71,994
viii, 72651, iv p. ; 28 cm.View a full description of this periodical.
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71994 Federal Register/Vol. 75, No. 226/Wednesday, November 24, 2010/Rules and Regulations
Response: We appreciate the
commenters' request to make CMHC
data available through the HCRIS and
starting in early 2011, CMHC cost report
information will begin to be available in
the HCRIS. The hospital-based PHP data
are based on cost report information
currently in and accessible through the
HCRIS.
Comment: A few commenters
expressed their concern as to why CMS
continues to state that a day of partial
hospitalization should not equal the
cost of the separate services provided in
a non-PHP setting. They stated that, for
example, four individual group
psychotherapy services (APC 0325) add
up to more than a proposed Level II day
of PHP for CMHCs.
Response: We do not believe that it is
appropriate to compare the partial
hospitalization services to separate
mental health services. The payment
rates for individual APC services cited
by the commenter (APC 0325) are not
computed from PHP bills. As stated
earlier, we used data from PHPs to
determine the median cost of a day ofPHP service. A PHP is a program of
services where savings can be realized
by hospitals and CMHCs over delivering
individual psychotherapy services.
We structured the PHP APCs (APCs
0172, 0173, 0175, and 0176) as a per
diem methodology in which the day of
care is the unit that reflects the structure
and scheduling of PHPs and the
composition of the PHP APCs consist of
the cost of all services provided each
day. Although we require that each PHP
day include a psychotherapy service, we
do not specify the specific mix of other
services provided, and our payment
methodology reflects the cost per day
rather than the cost of each service
furnished within the day. We believe
the data used for setting the PHP
payment appropriately reflect the
typical PHP day and its costs should not
be compared to the costs of providing
separate services. A PHP is a complete
program of services with efficiencies
and economies of scale provided in
contrast to individual psychotherapy
services.In summary, after consideration of the
public comments we received, we are
finalizing our CY 2011 proposal, with
modification, to establish four separate
PHP APC per diem payment rates, two
for CMHC PHPs and two for hospital-
based PHPs, based on each provider's
own unique cost data. As discussed
above, we are instituting a 2-year
transition to CMHC rates based solely
on CMHC data for the two CMHC PHP
APC per diem payments, which will
help mitigate the rate reduction.
Specifically, for CY 2011, we are
calculating the CMHC PHP APC Level I
and Level II rates by taking 50 percent
of the difference between the CY 2010
final hospital-based medians and the CY
2011 final CMHC medians and adding
that number to the CY 2011 final CMHC
medians. The two hospital-based PHP
APCs per diem payments are finalized
as proposed.
The updated PHP APCs median per
diem costs that we are finalizing for CY
2011 are shown in Tables 44 and 45
below:TABLE 44-CY 2011 MEDIAN PER DIEM COSTS FOR CMHC PHP SERVICES PLUS TRANSITION
Median per diem
APC Group title costs plus
transition
0172 ........................................ Level I Partial Hospitalization (3 services) for CMHCs ......... .......... ......... $128.25
0173 ........................ ................. Level II Partial Hospitalization (4 or more services) for CMHCs ......................... 162.67
TABLE 45-CY 2011 MEDIAN PER DIEM COSTS FOR HOSPITAL-BASED PHP SERVICES
APC Group title Median per diem
costs
0175 ........................ ................. Level I Partial Hospitalization (3 services) for hospital-based PHPs ...................... $202.71
0176 ........................ ................. Level II Partial Hospitalization (4 or more services) for hospital-based PHPs ....... 235.79C. Changes to Regulations to
Incorporate Provisions of HCERA 2010
As stated in section X.A. of this final
rule with comment period, section 1301
of HCERA 2010 made a change to the
statutory definition of a CMHC and a
change to the description of what
constitutes a PHP. Specifically, section
1301(a) of HCERA 2010 revised the
definition of a CMHC set forth at section
1861(ff)(3)(B) of the Act by adding to the
existing provisions a new requirement
under which a CMHC must provide at
least 40 percent of its services to
individuals who are not eligible for
benefits under Title XVIII of the Act
(Medicare), effective on the first day of
the first calendar quarter that begins at
least 12 months after the date of
enactment (that is, April 1, 2011).
Section 1301(b) of HCERA 2010
amended the description of a PHP tospecify that the program must be a
distinct and organized intensive
ambulatory treatment service offering
less than 24-hour daily care "other than
in an individual's home or in an
inpatient or residential setting." This
revised description applies to both
CMHC and hospital-based PHPs.
Our existing regulations at 42 CFR
410.2 incorporate the statutory
definitions of "Community mental
health center (CMHC)" and "Partial
hospitalization services." We proposed
to revise the definition of a CMHC in
410.2 to include the additional
requirement provided for under the
amendment made by section 1301(a) of
HCERA 2010. Under existing 410.2,
we define "partial hospitalization
services" to mean "a distinct and
organized intensive ambulatory
treatment program that offers less than24-hour daily care and furnishes the
services described in 410.43." We
proposed to revise this definition to
incorporate the amendment made by
section 1301(b) of HCERA 2010 to
describe partial hospitalization services
as a distinct and organized intensive
ambulatory treatment program that
offers less than 24-hour daily care "other
than in an individual's home or in an
inpatient or residential setting" and
furnishes the services described in
410.43.
Comment: Several of the commenters
requested that CMS delay or transition
the implementation of the provisions of
section 1301(a) of HCERA2010, which
amended the current definition for
Community Mental Health Centers to
require that at least 40 percent of its
services be provided to individuals who
are not eligible for benefits under this
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United States. Office of the Federal Register. Federal Register, Volume 75, Number 226, November 24, 2010, Pages 71519-72652, periodical, November 24, 2010; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc52807/m1/483/: accessed April 18, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.