Proposed IPPS Rule Includes Criteria for Newness  

New substances and devices are cited in technology proposals.

The Inpatient Prospective Payment System (IPPS) Proposed Rule for the 2022 fiscal year (FY), which was released on April 27, includes numerous applications for New Technology Add-On Payments (NTAPs). The proposals will be finalized in the IPPS Final Rule, which should be published in early August 2021.

There is an unprecedented proposal to continue 15 items from FY 2021 that were due to be discontinued, based on the “newness” criteria. This proposal can be attributed to the COVID-19 pandemic. The items proposed to be continued include the following:

• ZEMDRI
• AndexXa
• AZEDRA
• Cablivi
• ELZONRIS
• SPRAVATO
• T2 Bacterial Panel
• ContaCT
• Eluvia Drug Eluting Vascular Stent System
• NUZYRA
• Hemospray Endoscopy Hemostat
• IMFINZI/TECENTRIQ
• Spine Jack System Expansion Kit
• XOSPATA

There are two items that are continued from FY 2020; they are JAKAFI, which treats graft versus host disease, and Balversa, which treats locally advanced or metastatic urothelial carcinoma. There are seven items that were continued from FY 2021; these items include the following:

• BAROSTIM NEO System
• Optimizer System
• Cefiderocol
• Soliris
• RECARBRIO
• XENLETA
• ZERBAXA

There were several new proposals outlined in the proposed rule. The following items are among the new proposals – to be considered if they meet the “newness” criteria, the MS-DRG payment does not cover the cost, and they significantly impact patient outcomes.

The proposed rule also cites the New COVID-19 Treatment Add-On Payment (NC-TAP), which was implemented on Nov. 2, 2020. This provides for additional payment for items that do not qualify for NTAP, but treat COVID-19. An item cannot receive both NC-TAP and NTAP payment; if the item is approved for NTAP, then it will not receive NC-TAP. This additional payment will remain in effect until the end of the fiscal year, when the end of the pandemic is declared. For example, if the pandemic is declared over in July 2021, then the NC-TAP will end Sept. 30, 2021. If the pandemic was declared over in November 2021, then the NC-TAP would remain in effect until Sept. 30, 2022.

There are 12 items that are proposed for the New Technology Add-On Payment Alternative Pathway. These items include the following:

There is one last item that has been proposed under the Qualified Infectious Disease Products (QIDP). CONTEPO is used to treat complicated urinary tract infections. 

It is important to note these New Technology Add-On Payment items, as the reimbursement is paid in addition to the MS-DRG payment. These payments are triggered by the ICD-10-PCS code, unless otherwise noted in the regulations. The increased number of proposals has impacted the activity in the Coordination and Maintenance Committee meeting, as many of the new proposals have ICD-10-PCS codes requested. As you identify the items that are used by your facility, you should also identify which documentation can be used to identify the items. The items and documentation should be part of your education for IPPS FY 2022.

Programming Note: Listen to Laurie Johnson’s live coding report every Tuesday during Talk Ten Tuesdays, 10-10:30 a.m. Eastern.