CMS proposes changes to skilled nursing facility prospective payment system

(Photo by Kathrin Ziegler/Getty Illustrations or photos)

The Centers for Medicare and Medicaid Providers has issued a proposed rule that would update Medicare payment guidelines and rates for qualified nursing services below the Competent Nursing Facility possible payment technique for fiscal year 2022. 

The proposed rule also incorporates proposals for the SNF Quality Reporting Plan and the SNF Price-Based Plan.

In accordance to CMS estimates, the impression of the payment guidelines in the proposed rule would consequence in an increase of about $444 million in Medicare Part A payments to SNFs in FY22. 

This estimate displays a $445 million increase from the update to the payment rates of one.three%, which is dependent on a 2.three% SNF marketplace basket update, minus a .8 share place forecast mistake adjustment and a .2 share place multifactor productivity adjustment, and a $one.2 million lessen due to the proposed reduction to the rates to account for the the latest blood-clotting things exclusion. 

That exclusion calls for that certain specified blood clotting things utilized for the procedure of people with hemophilia and other bleeding conditions be excluded from the consolidated billing specifications for items and services furnished on or right after October one.

As a consequence, CMS is proposing a proportional reduction in the Medicare Part A SNF rates to account for this new exclusion. If finalized, this would consequence in an estimated lessen of about $one.2 million in mixture Part A SNF paying. The reduction is meant to offset the increase in Part B paying that will manifest due to these items and services staying excluded from SNF consolidated billing.

The total impression figures do not integrate the SNF VBP reductions, which are estimated to be $184.twenty five million in FY22.

What is THE Impression

The qualified nursing facility high quality reporting plan is a spend-for-reporting plan. SNFs that do not fulfill reporting specifications could be issue to a 2% reduction in their once-a-year update. CMS is proposing to adopt two new actions and update the specifications for a further measure, and is also proposing a modification to the public reporting of SNF high quality actions.

In the meantime, the agency is proposing to suppress the SNF 30-Day All-Trigger Readmission Measure for the reason that instances brought about by the COVID-19 public wellness crisis have drastically affected the measure and the ensuing overall performance scores.

Particularly, to handle the possible distortion of overall performance scores and incentive payment multipliers, CMS is proposing to assign a overall performance score of zero to all collaborating SNFs, irrespective of how they execute using the formerly finalized scoring methodology.

Per statute, the SNF VBP Plan will have to withhold 2% of SNF Medicare Part A rate-for-company payment and redistribute 50-70% of the withhold in the sort of incentive payments.To retain compliance with the current payback share plan, CMS is proposing to lessen the normally applicable federal per diem charge for each individual SNF by 2% and award SNFs 60% of that withhold, ensuing in a one.2% payback share to those SNFs, apart from for SNFs that are issue to the reduced volume adjustment plan.

Lengthy-expression treatment services ought to continue on to adhere to evidence-dependent infection control procedures and CMS’ Specifications for Participation, the agency stated.

THE Greater Pattern

Compliance with the specifications is significant as nursing home citizens are much more susceptible to serious infection from COVID-19 due to their age, fundamental wellness circumstances, and congregated location, CMS stated.
 

Twitter: @JELagasse
Electronic mail the writer: [email protected]