CMS proposes changes to skilled nursing facility prospective payment system

(Photograph by Kathrin Ziegler/Getty Photographs)

The Centers for Medicare and Medicaid Companies has issued a proposed rule that would update Medicare payment insurance policies and prices for competent nursing facilities underneath the Proficient Nursing Facility prospective payment method for fiscal year 2022. 

The proposed rule also incorporates proposals for the SNF Good quality Reporting Program and the SNF Value-Based Program.

In accordance to CMS estimates, the effects of the payment insurance policies in the proposed rule would outcome in an raise of about $444 million in Medicare Element A payments to SNFs in FY22. 

This estimate demonstrates a $445 million raise from the update to the payment prices of 1.3% – which is primarily based on a 2.3% SNF marketplace basket update, minus a .eight percentage position forecast mistake adjustment and a .2 percentage position multifactor productivity adjustment – and a $1.2 million reduce because of to the proposed reduction to the prices to account for the modern blood-clotting-aspects exclusion. 

That exclusion necessitates that specific specified blood-clotting aspects made use of for the remedy of people with hemophilia and other bleeding diseases be excluded from the consolidated billing specifications for objects and expert services furnished on or just after October 1.

As a outcome, CMS is proposing a proportional reduction in the Medicare Element A SNF prices to account for this new exclusion. If finalized, this would outcome in an approximated reduce of about $1.2 million in combination Element A SNF expending. The reduction is meant to offset the raise in Element B expending that will happen because of to these objects and expert services currently being excluded from SNF consolidated billing.

The whole effects figures do not integrate the SNF VBP reductions, which are approximated to be $184.25 million in FY22.

What is THE Impression?

The competent nursing facility high quality reporting program is a spend-for-reporting program. SNFs that do not meet reporting specifications may possibly be subject to a 2% reduction in their yearly update. CMS is proposing to adopt two new measures and update the technical specs for a different evaluate, and is also proposing a modification to the public reporting of SNF high quality measures.

Meanwhile, the company is proposing to suppress the SNF 30-Day All-Bring about Readmission Measure for the reason that conditions induced by the COVID-19 public health and fitness emergency have appreciably afflicted the evaluate and the ensuing effectiveness scores.

Especially, to address the doable distortion of effectiveness scores and incentive payment multipliers, CMS is proposing to assign a effectiveness rating of zero to all taking part SNFs, irrespective of how they carry out making use of the beforehand finalized scoring methodology.

Per statute, the SNF VBP Program need to withhold 2% of SNF Medicare Element A cost-for-services payment and redistribute fifty-70% of the withhold in the form of incentive payments.

To manage compliance with the current payback percentage policy, CMS is proposing to lower the otherwise relevant federal for each diem amount for just about every SNF by 2% and award SNFs 60% of that withhold, ensuing in a 1.2% payback percentage to all those SNFs, other than for SNFs that are subject to the lower volume adjustment policy.

Prolonged-time period treatment facilities should continue on to adhere to proof-primarily based an infection handle procedures and CMS’ Demands for Participation, the company reported.

THE More substantial Development

Compliance with the specifications is vital, considering that nursing home citizens are more inclined to serious an infection from COVID-19 because of to their age, their fundamental health and fitness conditions and the congregate setting, CMS reported.
 

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