News

BACKGROUND

The Centers for Medicare and Medicaid Services (CMS) are required to update the Medicare payment rates and quality programs on an annual basis. Prior to August 1 each year, CMS is required to publish the final rule for the upcoming fiscal year (FY).

WHAT YOU NEED TO KNOW

On July 31st, CMS issued the final rule CMS-1779-F for FY 2024. This final rule contains many areas of importance and significance for SNF providers specifically as it relates to payment, quality, PDPM, and more. Preferred Therapy Solutions is thoroughly reviewing the final rule and has planned an in-depth webinar for August 15th. Key elements of the proposed rule include:

PAYMENT UPDATE

• CMS estimates the aggregate impact of payment policies would result in an increase of approximately $1.4 billion in Medicare Part A payments to SNFs in FY 2024
• The actual payment update for FY 2024 is a 6.4% net market basket increase which is offset by a 2.3% decrease in SNF PPS rates as a result of the second phase of the PDPM parity adjustment calibration
• An additional $185 million in reductions is estimated based on the SNF VBP program

PATIENT DRIVEN PAYMENT MODEL

• CMS is proposing several changes to the PDPM ICD-10 code mappings and lists

SNF QUALITY REPORTING PROGRAM (QRP)

• CMS is finalizing the adoption of two new quality measures to become part of the SNF QRP
  1. Discharge Function Score measure for FY 2025
  2. COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date measure for FY 2026
• Of note, CMS did not finalize the inclusion of the CoreQ Short Stay Discharge measure for FY 2026 that was included in the proposed rule
• CMS finalized the proposal to modify the COVID-19 Vaccination Coverage Among Healthcare Personnel measure for FY 2025
• CMS finalized the removal of three quality measures from the SNF QRP:
  1. Application of Percent of LTC Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function for FY 2025
  2. Changes in Self-Care Score for Medical Rehabilitation Patients for FY 2025
  3. Changes in Mobility Score for Medical Rehabilitation Patients for FY 2025
• CMS finalized the proposal to increase the completion thresholds such that 100% of the required quality measure data is collected on at least 90% assessments submitted to CMS beginning with FY 2026; non-compliant facilities would be subject to a 2% payment reduction

SNF VALUE-BASED PURCHASING (VBP PROGRAM)

• CMS is finalizing the adoption of four new quality measures:
  1. Nursing Staff Turnover measure
  2. Discharge Function Score measure
  3. Long Stay Hospitalization Measure per 1000 Resident Days measure
  4. Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay) measure
• CMS finalized the replacement of the SNF 30-day All-Cause Readmission Measure with SNF Within-Stay Potentially Preventable Readmissions (SNF WS PPR)
• CMS is adopting a Health Equity Adjustment to be included in the SNF VBP program. This adjustment is designed to reward SNFs that perform well and whose resident population contains at least 20% dual eligibility status residents
• CMS finalized the proposal to Increase the payback percentage of the automatic 2% payment withhold from 60% to an estimated 66%

CMS Fact Sheet for the FY 2024 Final Rule can be located here.

SOURCE: https://www.cms.gov/

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