These forecasted numbers are subject to change when the final rule is issued by early August 2024.
Included in the proposed payment rule are various administrative changes, survey enforcement, SNF Quality Reporting Program (QRP) and new measures in the SNF Value-Based Purchasing (VBP).
Administrative Changes
- CMS proposes to update the SNF market basket base year from the current 2018 base year to a new base year of 2022 and to update the payment rates used under the SNF PPS based on the FY 2025 SNF market basket increase factor, as adjusted by the productivity adjustment and forecast error correction.
- CMS also proposes to update the SNF PPS wage index using the Core-Based Statistical Areas defined within the new Office of Management and Budget Bulletin 23-01 to improve the accuracy of wages and wage-related costs for the area in which the facility is located.
- CMS is proposing several changes to the PDPM ICD-10 code mappings for reporting during a Part A SNF stay.
- The proposed rule also includes a Request for Information seeking comments on potential future updates to the Non-Therapy Ancillary component of PDPM.
Nursing Facility Enforcement
Enforcement actions include increased use of civil monetary penalties (CMP), including combinations of both Per Diem and Per Instance application as below:
- CMS proposes to expand the penalties that can be enforced through regulatory revision to allow for more per instance (PI) and per day (PD) CMPs to be imposed, permitting both types of penalties to be imposed, not to exceed the statutory daily limits.
- CMS proposes to allow for both PD and PI CMPs to be imposed for noncompliance findings in the same survey, as well as ensure that the amount of a CMP does not depend solely on the date that the most recent standard survey is conducted or the date that a finding of noncompliance was identified by surveyors.
- CMS proposes that it or the state could impose a PI CMP to address noncompliance that occurred in the past or prior to the survey, and a PD CMP beginning at the start of the survey and continuing until the facility has corrected its noncompliance.
- CMS proposes if multiple instances of noncompliance occurred prior to the survey, CMS or the state could impose multiple PI CMPs, as well as a PD CMPs.
SNF QRP
The Skilled Nursing Facility QRP uses standardized measures applied to post-acute patients across post-acute provider settings, including skilled nursing. The QRP levies a 2% point reduction in the annual update for SNFs that do not comply, or meet, reporting requirements.
- CMS proposes adding four new social determinants of health (SDOH) items and modifying one SDOH assessment item for the SNF QRP.
- CMS proposes that SNFs included in the SNF QRP participate in a process to validate data submitted under the SNF QRP through the Minimum Data Set (MDS) beginning with the FY 2027 SNF QRP.
- CMS is also seeking feedback on future measure concepts for the SNF QRP with a Request for Information (RFI) on quality measure concepts under consideration for future SNF QRP years.
SNF VBP
The Skilled Nursing Facility VBP focuses on methods used to measure and demonstrate quality. For the FY25, VBP payment adjustments will be based only upon 30-day short stay readmissions rates using the Skilled Nursing Facility 30-Day All-Cause Readmission Measure, using FY19 as the baseline measure and FY23 as the performance period. While no new measures have been proposed for the VBP program at this time, CMS has proposed several policy changes. These changes and other details are spelled out in an AHCA-prepared summary.
In addition to the AHCA summary, you can also find more information from a CMS Fact Sheet and the Federal Register.
Webinar: AHCA will host a free webinar on Friday, April 5 at 10 a.m. ET covering what you need to know about the CMS proposal.
