CMS proposes changes to skilled nursing facility prospective payment system

(Photo by Kathrin Ziegler/Getty Photographs) The Centers for Medicare and Medicaid Services has issued a

(Photo by Kathrin Ziegler/Getty Photographs)

The Centers for Medicare and Medicaid Services has issued a proposed rule that would update Medicare payment policies and prices for proficient nursing amenities under the Competent Nursing Facility future payment process for fiscal year 2022. 

The proposed rule also incorporates proposals for the SNF High-quality Reporting Application and the SNF Worth-Centered Application.

In accordance to CMS estimates, the affect of the payment policies in the proposed rule would end result in an boost of about $444 million in Medicare Aspect A payments to SNFs in FY22. 

This estimate reflects a $445 million boost from the update to the payment prices of one.3% – which is primarily based on a two.3% SNF market place basket update, minus a .eight proportion stage forecast error adjustment and a .two proportion stage multifactor productiveness adjustment – and a $one.two million lessen owing to the proposed reduction to the prices to account for the modern blood-clotting-things exclusion. 

That exclusion requires that selected specified blood-clotting things made use of for the remedy of sufferers with hemophilia and other bleeding ailments be excluded from the consolidated billing demands for goods and solutions furnished on or following October one.

As a end result, CMS is proposing a proportional reduction in the Medicare Aspect A SNF prices to account for this new exclusion. If finalized, this would end result in an believed lessen of about $one.two million in mixture Aspect A SNF expending. The reduction is intended to offset the boost in Aspect B expending that will arise owing to these goods and solutions currently being excluded from SNF consolidated billing.

The overall affect figures do not include the SNF VBP reductions, which are believed to be $184.25 million in FY22.

What is actually THE Influence?

The proficient nursing facility quality reporting plan is a spend-for-reporting plan. SNFs that do not satisfy reporting demands may well be subject matter to a two% reduction in their yearly update. CMS is proposing to adopt two new actions and update the requirements for one more evaluate, and is also proposing a modification to the community reporting of SNF quality actions.

In the meantime, the agency is proposing to suppress the SNF 30-Day All-Cause Readmission Evaluate mainly because conditions brought on by the COVID-19 community health and fitness unexpected emergency have significantly influenced the evaluate and the resulting general performance scores.

Precisely, to handle the achievable distortion of general performance scores and incentive payment multipliers, CMS is proposing to assign a general performance rating of zero to all participating SNFs, irrespective of how they complete applying the earlier finalized scoring methodology.

For every statute, the SNF VBP Application should withhold two% of SNF Medicare Aspect A price-for-services payment and redistribute 50-70% of the withhold in the variety of incentive payments.

To sustain compliance with the existing payback proportion coverage, CMS is proposing to cut down the usually applicable federal for every diem rate for every SNF by two% and award SNFs 60% of that withhold, resulting in a one.two% payback proportion to these SNFs, other than for SNFs that are subject matter to the very low volume adjustment coverage.

Extensive-expression treatment amenities should proceed to adhere to evidence-primarily based infection management techniques and CMS’ Demands for Participation, the agency reported.

THE Bigger Pattern

Compliance with the demands is significant, given that nursing home residents are far more inclined to critical infection from COVID-19 owing to their age, their fundamental health and fitness conditions and the congregate setting, CMS reported.

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