The Centers for Medicare & Medicaid Services (CMS) has issued the federal fiscal year (FFY) 2020 final rule for the skilled-nursing facility prospective payment system (SNF PPS). The provisions in the proposed rules will be effective Oct. 1, 2020.
Highlights of the final rule include:
CMS projects that payments to SNFs will increase by 2.4 percent, or $851 million, as compared to FFY 2019, the result of a 2.8 percent market-basket update, offset by statutorily mandated 0.5% cut for productivity.
Patient Driven Payment Model Implementation
As provided in the FFY 2019 final rule, CMS will implement a revised case-mix methodology and replace the current resource use group methodology with the patient driven payment model on Oct. 1, 2019. CMS finalizes a sub-regulatory process to make non-substantive changes to the list of ICD-10 codes for the purposes of patient classification.
Definition of Group Therapy
CMS finalizes a change to the definition of group therapy to align with the definition used in the inpatient rehabilitation facility PPS: therapy that consists of two to six patients doing the same or similar activities. CMS believes that aligning the group therapy definition supports consistency in payment policies across post-acute care settings and creates opportunities for site-neutral payments.
CMS finalizes several proposals relating to the SNF Quality Reporting Program (QRP), including the addition of several standardized patient assessment data elements, several of which address social determinants of health. CMS also finalizes two new measures addressing “Transfer of Health Information,” as well as a change to the existing “Discharge to Community” measure to exclude baseline nursing home residents. In response to comments, CMS is not finalizing its proposal to collect SNF QRP data on all patients, regardless of payer source.
CMS finalizes several updates to the SNF Value-Based Purchasing Program (VBP), including the adoption of a new name for the VBP’s potentially preventable readmission measure.