What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its proposed payment policies for inpatient rehabilitation facilities (IRFs), skilled-nursing facilities (SNFs), and hospices for federal fiscal year (FFY) 2025.
What else to know: Comments on the proposed rules are due to CMS by 2 p.m. (PT) on May 28.
The proposed rules provide payment updates, continued refinement of quality reporting programs (QRPs), and other policy changes for IRFs, SNFs, and hospices.
- Update the IRF prospective payment system (PPS) payment rates by 2.8% based on the proposed IRF market basket update of 3.2%, less a proposed 0.4% point productivity adjustment.
- Adopt four new items in the IRF-PAI (patient assessment instrument) as social determinants of health (SDOH) standardized patient assessment data elements.
- Modify the transportation item under the SDOH category in IRF quality reporting program (QRP).
- Remove the “Admission Class” assessment item from the IRF-PAI item set.
- Requests feedback on potential measurement concepts and the creation of a star rating system for the IRF QRP.
- Update the SNF PPS rates by 4.1% based on the proposed SNF market basket of 2.8%, plus a 1.7% market basket forecast error adjustment, and a negative 0.4% productivity adjustment.
- Several changes to Patient-Driven Payment Model (PDPM) ICD-10 code mappings.
- Revise CMS’ existing nursing home enforcement authority, including expanding its ability to impose financial penalties.
- Add four new SDOH items and modify one SDOH assessment item for the SNF QRP.
- Modify the transportation item under the SDOH category in the SNF QRP.
- Require SNFs participating in the SNF QRP to participate in a minimum data set validation process.
- Adopt a measure retention and removal policy to the SNF value-based purchasing program, update the case-mix methodology for the total nurse staffing measure and a review and correction policy update.
- Payment increase of 2.6% (an estimated increase of $705 million in payments from FY 2024)
- Hospice cap of $34,364.85
- Addition of two new process measures to the hospice QRP
- Adoption and implementation of the HOPE patient-level data collection tool, beginning with FY 2025, and functionally replace the existing Hospice Item Set structure upon implementation
- Request for input on potential data collection items related to four SDOHs that may be relevant to the hospice setting
- Changes to the Hospice Consumer Assessment of Healthcare Providers and Systems Survey based on the results of a mode experiment conducted in 2021
CHA will issue comprehensive summaries of the rules in the near future.