PDPM Final Payment Rule FY 2022

CMS released the final payment rule for Medicare Part A SNF services under PDPM effective October 1, 2021 with an overall impact of a market basket increase of 1.2 percent. The rule does not include any payment recalibration as presented in the proposed rule earlier this year. CMS reviewed the “parity adjustment” based on feedback to the proposed rule and determined that data was inadequate to make the adjustment in the FY 2022 year. The adjustment will be reviewed again in the release of the FY 2023 rule. 

The final rule does not address the suspension of the 2% sequestration due to the pandemic but based on Congressional discussion, AHCA is expecting it to continue. If this changes AHCA/HCAM will provide a notice to members. Consolidated billing was changed to exclude blood clotting factors used in treating patients with hemophilia and similar disorders effective October 1, 2021. An adjustment to account for this exclusion was made to the PDPM rates.

SNF VBP program will continue the two percent withhold to SNF Part A payments and retain the ability of the facility to earned back these funds. The SNF VBP had proposed a changed performance period during the pandemic but CMS has determined that change is not feasible considering the circumstances in 2020.  As part of a special scoring policy for FY 2022, CMS will assign a performance score of zero to all participating SNFs. CMS will continue to suppress the SNF 30-Day All-Cause Readmission Measure (SNFRM) with plans to address the issue next year.

HCAM is updating a template that will calculate your PDPM rate utilizing the assessment scores from the appropriate MDS. The template will be shared with members once updated with the final payment data. To review the entire Federal Register for this payment rule and the related wage indexes click here. Link forthcoming should be out on August 4.