July 17, 2024

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CMS proposes changes to skilled nursing facility prospective payment system

(Photo by Kathrin Ziegler/Getty Images)(Image by Kathrin Ziegler/Getty Images)

The Centers for Medicare and Medicaid Expert services has issued a proposed rule that would update Medicare payment guidelines and fees for proficient nursing amenities underneath the Expert Nursing Facility possible payment method for fiscal year 2022. 

The proposed rule also incorporates proposals for the SNF Top quality Reporting System and the SNF Benefit-Dependent System.

According to CMS estimates, the influence of the payment guidelines in the proposed rule would consequence in an maximize of about $444 million in Medicare Aspect A payments to SNFs in FY22. 

This estimate reflects a $445 million maximize from the update to the payment fees of one.3{744e41c82c0a3fcc278dda80181a967fddc35ccb056a7a316bb3300c6fc50654}, which is dependent on a 2.3{744e41c82c0a3fcc278dda80181a967fddc35ccb056a7a316bb3300c6fc50654} SNF industry basket update, minus a .8 share level forecast mistake adjustment and a .2 share level multifactor efficiency adjustment, and a $one.2 million lower due to the proposed reduction to the fees to account for the modern blood-clotting things exclusion. 

That exclusion involves that sure specified blood clotting things applied for the therapy of sufferers with hemophilia and other bleeding conditions be excluded from the consolidated billing requirements for merchandise and products and services furnished on or after October one.

As a consequence, CMS is proposing a proportional reduction in the Medicare Aspect A SNF fees to account for this new exclusion. If finalized, this would consequence in an believed lower of about $one.2 million in mixture Aspect A SNF shelling out. The reduction is intended to offset the maximize in Aspect B shelling out that will happen due to these merchandise and products and services getting excluded from SNF consolidated billing.

The total influence figures do not incorporate the SNF VBP reductions, which are believed to be $184.25 million in FY22.

What is actually THE Impression

The proficient nursing facility quality reporting system is a pay-for-reporting system. SNFs that do not fulfill reporting requirements may be subject matter to a 2{744e41c82c0a3fcc278dda80181a967fddc35ccb056a7a316bb3300c6fc50654} reduction in their annual update. CMS is proposing to undertake two new measures and update the specifications for yet another measure, and is also proposing a modification to the community reporting of SNF quality measures.

Meanwhile, the agency is proposing to suppress the SNF thirty-Day All-Cause Readmission Measure because conditions prompted by the COVID-19 community overall health emergency have substantially influenced the measure and the ensuing performance scores.

Specially, to handle the achievable distortion of performance scores and incentive payment multipliers, CMS is proposing to assign a performance score of zero to all taking part SNFs, irrespective of how they accomplish working with the formerly finalized scoring methodology.

For every statute, the SNF VBP System have to withhold 2{744e41c82c0a3fcc278dda80181a967fddc35ccb056a7a316bb3300c6fc50654} of SNF Medicare Aspect A fee-for-assistance payment and redistribute fifty-70{744e41c82c0a3fcc278dda80181a967fddc35ccb056a7a316bb3300c6fc50654} of the withhold in the sort of incentive payments.To maintain compliance with the existing payback share coverage, CMS is proposing to lessen the in any other case relevant federal per diem price for every single SNF by 2{744e41c82c0a3fcc278dda80181a967fddc35ccb056a7a316bb3300c6fc50654} and award SNFs 60{744e41c82c0a3fcc278dda80181a967fddc35ccb056a7a316bb3300c6fc50654} of that withhold, ensuing in a one.2{744e41c82c0a3fcc278dda80181a967fddc35ccb056a7a316bb3300c6fc50654} payback share to all those SNFs, except for SNFs that are subject matter to the small volume adjustment coverage.

Very long-phrase treatment amenities really should continue on to adhere to evidence-dependent an infection command procedures and CMS’ Prerequisites for Participation, the agency stated.

THE Much larger Pattern

Compliance with the requirements is critical as nursing dwelling residents are additional susceptible to serious an infection from COVID-19 due to their age, underlying overall health circumstances, and congregated location, CMS stated.
 

Twitter: @JELagasse
Email the writer: [email protected]