On April 4, 2023, CMS released the fiscal year (FY) 2024 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Proposed Rule. Included is a net increase of 3.7%, or approximately $1.2 billion, in Medicare payments. This rate increase results from a 6.1% net market basket update to the payment rates. The second phase of the Patient-Driven Payment Model (PDPM) parity adjustment recalibration resulted in a 2.7% SNF market basket increase plus a 3.6% market basket forecast error adjustment and minus 0.2% productivity adjustment and a negative 2.3%, or approximately $745 million, decrease in the 2024 SNF PPS rates.
Minimum staffing requirements had been proposed in the FY 2023 proposed rule with CMS soliciting comments from providers and stakeholders. In addition, CMS launched a new mixed-methods study in 2022 collecting quantitative and qualitative evidence on staffing levels in nursing homes. At this time, CMS is continuing to review the feedback from providers and stakeholders along with the data from the mixed-methods study. CMS plans to use this information for rulemaking changes, possibly this spring.
Proposed changes to PDPM ICD-10 Code mappings are included in the proposed rule. This includes changing of clinical categories for five ICD-10 codes that were effective October 2022:
- D75.84 Other Platelet activating antiplatelet factor 4 will now map to Medical Management instead of Return to Provider.
- F43.81 Prolonged Grief Disorder and F43.89 Other reactions to severe stress will now map to Return to Provider instead of Medical Management.
- G90.A Postural orthostatic tachycardia syndrome will now map to Medical Management instead of Acute Neurologic.
- K72.82 Hepatic Encephalopathy will now map to Medical Management instead of Return to Provider.
In addition to these changes, there were six unspecified substance use disorders (SUDs) added to Medical Management in 2022. These will all now map to Return to Provider and 162 additional unspecified SUD codes will move from Medical Management to Return to Provider. There also are proposed changes for S42.2 and M84.5 fracture codes. Lastly, there are an additional 95 codes that were reassigned to Return to Provider. It is always important for providers to use the most current version of the CMS Mapping tool for ICD-10 codes.
SNF Quality Reporting Program (SNF QRP) is a pay-for-reporting program. SNFs that do not meet reporting requirements are subject to a two-percentage point reduction in their Annual Payment Update (APU). CMS has proposed to adopt three new measures, remove three current measures, and modify one current measure. This also would make policy changes to the SNF QRP and begin publicly reporting four measures.
- FY 2025: Modify the COVID-19 vaccination coverage among healthcare personnel (HCP) measure. Adopt the Discharge Functional Score measure; remove application of percentage of long-term care hospital patients with an admission and discharge functional assessment and care plan that addresses function and change in self-care score and change in mobility score.
- FY 2026: Adoption of percentage of patients who are up to date with COVID-19 vaccines; add short stay discharge measure by administering the CoreQ: Short Stay Discharge (CoreQ:SS DC) measure. Increase percentage of compliance from 80% to 90%.
CMS is proposing to begin the public reporting of the Transfer of Health Information to the Provider – Post Acute Care (PAC) measure and the Transfer of Health Information to the Patient – PAC measure beginning with the October 2025 Care Compare refresh or as soon as technically feasible. This measure reports the percentage of patient stays with a discharge assessment indicating that a current reconciled medication list was provided to the subsequent provider and/or patient/family/caregiver upon discharge or transfer.
Proposed changes to the SNF Value-Based Purchasing (VBP) Program include adoption of new measures, replacement of one measure, and several policy changes in the program. See the table for measures, first program year, and first performance period:1
Source: Federal Register
In addition, CMS has proposed to increase the payback percentage policy under the SNF VBP program from the current 60% to 66% in the FY 2027 program year.
The proposed rule also addresses streamlining a procedure for facilities facing a civil money penalty (CMP) to actively waive their right to a hearing in writing in order to receive a penalty reduction. Nearly 95% of facilities facing CMPs follow this process and subsequentially receive a 35% penalty reduction. This would create a system in which a failure to submit a timely request for a hearing would be treated as a constructive waiver and the 35% penalty reduction would remain.
The proposed rule can be downloaded from the Federal Register.
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