CMS Releases FY 2018 Medicare Proposed Rule for Skilled Nursing Facilities

Posted on May 11, 2017

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule to update the Medicare fee-for-service (FFS) prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2018. Highlights of the proposed rule include:

  • A marketbasket increase of 1 percent as mandated by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.
  • Changes to the FY 2020 SNF quality reporting program to revise measures that address pressure ulcer changes and potentially preventable readmissions, adding four function outcome measures on resident functional status. The CMS would also require SNFs to collect certain standardized patient assessment data upon admission and discharge for all Medicare Part A patients, beginning with patients discharged between Oct. 1 and Dec. 31, 2018, to meet the requirements of the Improving Medicare Post-acute Care Transformation Act of 2014. Specifically, the CMS would require SNFs to collect data on functional status, cognitive function, and several types of special treatments and services, including cancer and respiratory treatments and transfusions.

In addition to the standard SNF PPS proposed rule, the CMS released an advance notice of proposed rulemaking to obtain input on potential future refinements to the SNF PPS, including the possibility of replacing the resource utilization group payment system. The rule indicates that the goal is to improve SNF PPS accuracy based on the CMS’s policy development work. The alternative methodology described in the advance notice would rely on service-based metrics to set payments based on patient characteristics. For example, under the alternative methodology, the model would use four components, rather than the current nursing and therapy components:

  • Physical and occupational therapy
  • Speech-language pathology
  • Nursing
  • Nontherapy ancillaries (NTA)

Under the new payment system, each per-diem payment would represent a compilation of the payments calculated for each of these four payment elements. In addition, the CMS is exploring the use of variable per-diem rates to account for the decline in physical and occupational therapy and NTA resources during the latter stages of a SNF stay. SNFs would also receive a payment add-on for the higher costs associated with treating patients with AIDS or HIV.

In the next few weeks, the MHA will distribute a facility-specific impact analysis to members with SNF operations. The association encourages members to contact Vickie Kunz by June 16 regarding issues or concerns identified in the proposed rule to include in the comments it submits to the CMS by the June 26 deadline. The CMS is expected to release a final rule by Aug. 1 for the Oct. 1 effective date. Members with questions should contact Vickie Kunz at the MHA. 

Tags: proposed rule, CMS, PPS, SNF

Posted in: Member News

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