Last week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed run for Fiscal Year 2020 that updates the Medicare payment rates and quality programs for skilled nursing facilities (SNFs).
Overall, the proposed SNF rule is mostly positive. SNFs could get an $887 million increase in aggregate payments under the proposed rule. Subtracting the productivity factor of .5% from the update, SNFs will see a rate increase of 2.5% starting on October 1. This new payment increase will be correlated under PDPM.
Under RUGs IV, the SNF rates would inflate by the applicable percentage, applied to each of the 66 groups. Under PDPM, the base rate corresponds to one of six case-mix categories (PT, OT, Speech, Nursing, Non-Therapy Ancillary and Non-Case Mix), multiplied by the applicable case-mix value in each category (excluding non-case mix which is a flat per diem). As a reminder, the proposed rule and PDPM will only impact traditional Medicare plans – not Medicare Advantage.
Other areas of interest under the 2020 SNF Rule include:
- Ensuring SNFs have access to the most up-to-date ICD-10 code information as soon as possible and in the clearest and most useful format;
- Proposing that group therapy consists of two to six patients doing the same or similar activities instead of exactly four patients;
- Updates to the name of the SNF Value-Based Purchasing Program (VBP) to the “Skilled Nursing Facility Potentially Preventable Readmissions after Hospital Discharge” measure;
- Updates public reporting requirements for SNFs with less than 25 eligible stays during the baseline period or performance period for a Program year and SNFs with zero eligible cases during the performance period for a Program year;
- A 30-day deadline for Phase One Review and Corrections requests; and;
- Adoption of two new quality measures to assess how health information is shared.
Comments can be made to CMS until June 18th.
Learn more on CMS’ Fact Sheet.