CMS Releases FY 2021 Proposed Rule: SNF’s In-Line for 2.3% Payment Increase

BACKGROUND
The Centers for Medicare and Medicaid Services (CMS) are legally required to update the Medicare payment rates and quality programs on an annual basis. Each April, CMS publishes a proposed rule for the upcoming fiscal year and opens a comment period for stakeholders to review and provide comments before CMS releases the final rule.

WHAT YOU NEED TO KNOW
On April 10th CMS issued proposed rule (CMS-1737-P) for FY 2021. CMS recognizes that the healthcare industry is focused on the COVID-19 public health emergency, and as such, this proposed rule contains statutorily required payment updates as well as proposals that reduce provider burden which may help in their COVID-19 response. 

Key elements of the proposed rule include:

  • A net market basket increase of 2.3% resulting in an increase of $784 million in Medicare payments for SNF providers
    > Please refer to the table below for Unadjusted Federal Per Diem
    Rates by PDPM Component
  • Proposal to adopt the revised Office of Management and Budget (OMB) statistical area delineations with a 5% cap on wage index decreases from FY 2020 to FY 2021
  • Updates to the ICD-10 code mappings with additional codes/diagnosis now qualifying for “May be Eligible for Non-Orthopedic Surgery Category” or “May be Eligible for One of the Two Orthopedic Surgery Categories”
    > Additional substantive changes to clinical category as well as NTA
    mappings are also proposed that impact only a few diagnosis/ICD-10
    codes
  • CMS acknowledged it continues to monitor the impact of PDPM on patient outcomes and program payments but stated it would be premature to release any information or make changes to case-mix weights with the limited data available
    > CMS did state they may consider adjustments to case-mix weights in
    future rulemaking in order to maintain budget neutrality
  • Proposals related to the Skilled Nursing Facility Value Based Purchasing Program (SNF VBP)
    > Apply a 30-day Phase One Review and Correction Deadline to the
    baseline period
    > Estimated FY 2023 SNF VBP Program Performance Standards
    > > Achievement Threshold: 0.79025 (readmission rate of 21.0%)
    > > Benchmark: 0.82917 (readmission rate of 17.1%)
  • No changes to the Skilled Nursing Facility Quality Reporting Program (SNF QRP) were proposed

Preferred Therapy Solutions continues to provide its partners with vital information that may impact rehabilitation management, reimbursement policies, and clinical programs, supported with compliance and regulatory requirements that are necessary for a thorough understanding of practices and procedures. If you have any questions, please contact Matt Nash, Vice President of Strategic Development at mnash@preftherapy.com

SOURCE: CMS



















CMS Updates PDPM-ICD-10 Mappings for COVID-19

BACKGROUND
The Centers for Medicare & Medicaid Services (CMS) has the authority to update the list of ICD-10-CM codes used for capturing various payment components under PDPM. CMS has exercised this authority and has released an update of the PDPM DLL Package (V1.0004 FINAL). This update adds support for the new ICD-10-CM code for Coronavirus, U07.1, which takes effect April 1, 2020. 

WHAT YOU NEED TO KNOW
The new ICD-10-CM code for Coronavirus, U07.1, has been added to the list of acceptable codes that can be used in section I0020b of the MDS to indicate the resident’s primary reason for the Medicare Part A stay. Of significance for skilled nursing facility providers and MDS coordinators, the Coronavirus ICD-10-CM U07.1 will impact the case-mix adjusted components of PDPM as follows:

·    PT/OT: Qualify a patient for the Medical Management clinical category
·    SLP: Qualify a patient for the Non-Neurologic clinical category 
·    Nursing: The diagnosis itself does not have a direct impact to qualify a patient for any of the nursing case-mix groups, but the clinical characteristics and associated services related to a patient with Coronavirus will certainly influence nursing capture
·    NTA: The diagnosis does not currently qualify for any NTA points or additional NTA reimbursement

The Coronavirus ICD-10-CM code can be used on MDS’ with a target date of 04/01/2020 or later.
 
To download the ZIP file on the CMS updated FY2020 PDPM IDC-10 Mappings click here.
 
Preferred Therapy Solutions continues to provide its partners with vital information that may impact rehabilitation management, reimbursement policies, and clinical programs, supported with compliance and regulatory requirements that are necessary for a thorough understanding on practices and procedures. If you have any questions, please contact Matt Nash, Vice President of Strategic Development at: mnash@preftherapy.com
 
SOURCE: CMS