22/10/2021

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CMS proposes changes to skilled nursing facility prospective payment system

(Photo by Kathrin Ziegler/Getty Photos)

The Facilities for Medicare and Medicaid Solutions has issued a proposed rule that would update Medicare payment guidelines and premiums for expert nursing facilities underneath the Competent Nursing Facility possible payment system for fiscal 12 months 2022. 

The proposed rule also incorporates proposals for the SNF Quality Reporting Method and the SNF Value-Dependent Method.

According to CMS estimates, the impact of the payment guidelines in the proposed rule would result in an increase of about $444 million in Medicare Portion A payments to SNFs in FY22. 

This estimate reflects a $445 million increase from the update to the payment premiums of 1.three%, which is primarily based on a two.three% SNF marketplace basket update, minus a .eight percentage level forecast mistake adjustment and a .two percentage level multifactor productiveness adjustment, and a $1.two million reduce thanks to the proposed reduction to the premiums to account for the current blood-clotting elements exclusion. 

That exclusion involves that specified specified blood clotting elements utilised for the procedure of sufferers with hemophilia and other bleeding ailments be excluded from the consolidated billing necessities for goods and providers furnished on or after October 1.

As a result, CMS is proposing a proportional reduction in the Medicare Portion A SNF premiums to account for this new exclusion. If finalized, this would result in an estimated reduce of about $1.two million in mixture Portion A SNF investing. The reduction is meant to offset the increase in Portion B investing that will arise thanks to these goods and providers staying excluded from SNF consolidated billing.

The complete impact figures do not integrate the SNF VBP reductions, which are estimated to be $184.25 million in FY22.

What is THE Effect

The expert nursing facility excellent reporting program is a shell out-for-reporting program. SNFs that do not fulfill reporting necessities may possibly be subject matter to a two% reduction in their yearly update. CMS is proposing to undertake two new measures and update the specs for a different evaluate, and is also proposing a modification to the community reporting of SNF excellent measures.

In the meantime, the company is proposing to suppress the SNF 30-Working day All-Cause Readmission Measure mainly because circumstances triggered by the COVID-19 community health and fitness crisis have substantially affected the evaluate and the resulting general performance scores.

Particularly, to address the doable distortion of general performance scores and incentive payment multipliers, CMS is proposing to assign a general performance score of zero to all collaborating SNFs, irrespective of how they conduct working with the formerly finalized scoring methodology.

Per statute, the SNF VBP Method will have to withhold two% of SNF Medicare Portion A fee-for-company payment and redistribute 50-70% of the withhold in the kind of incentive payments.To keep compliance with the existing payback percentage coverage, CMS is proposing to minimize the if not relevant federal for every diem level for each SNF by two% and award SNFs 60% of that withhold, resulting in a 1.two% payback percentage to people SNFs, except for SNFs that are subject matter to the low volume adjustment coverage.

Long-term treatment facilities must continue to adhere to evidence-primarily based infection management methods and CMS’ Requirements for Participation, the company reported.

THE Larger sized Development

Compliance with the necessities is critical as nursing property inhabitants are extra vulnerable to intense infection from COVID-19 thanks to their age, fundamental health and fitness problems, and congregated environment, CMS reported.
 

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