CMS Proposed Rule Features 3.7% Medicare Payment Increase

Proposal also includes updates to SNF reporting and purchasing programs.

The Centers for Medicare & Medicaid Services (CMS) have issued a proposed rule featuring a 3.7% Medicare payment increase under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year 2024.

As part of the Biden administration's efforts to improve the safety and quality of care in the nation's nursing homes, the proposed rule includes proposals for both the SNF Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) Program for fiscal year 2024 onward.

The rule would also eliminate the requirement that facilities waive their right to a hearing in writing, instead considering a facility's failure to submit a request in a timely manner a constructive waiver.

Payment Rates Increase

After considering feedback from stakeholders on the FY 2023 SNF PPS proposed rule, and to ensure accurate Medicare Part A SNF payments, CMS finalized a PDPM parity adjustment factor of 4.6% in the FY2023 SNF PSS final rule. The adjustment would be phased in over a two-year period, resulting in a 2.3% reduction to SNF PPS payment rates in FY2023 and again in FY2024.

These impact figures don't incorporate the SNF VBP reductions for certain SNFs subject to the net reduction in payments under the SNF VBP. Those adjustments are estimated to total $184.85 million in FY2024.

Changes to SNF QRP measures

There are three proposed adoptions, one modification, and three proposed removals to the SNF QRP measures.

Proposed adoptions

Discharge Function Score (DC Function) — Would assess a facility's status by assessing the percentage of SNF residents who meet or exceed an expected discharge function score, and uses mobility and self-care items already collected on the Minimum Data Set (MDS); would replace Application of Functional Assessment/Care Plan measure.

CoreQ: Short Stay Discharge — Would calculate the percentage of individuals discharged from an SNF, within 100 days of admission, who are satisfied with their SNF stay via questionnaire responses.

COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date — would report the percentage of stays in which residents in an SNF are up to date with recommended COVID-19 vaccinations in accordance to most recent U.S. Centers for Disease Control (CDC) guidance.

Proposed Modifications

COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) — The proposed modification would require SNFs to report the cumulative number of HCP who are up to date with recommended COVID-19 vaccinations in accordance to most recent CDC guidance.

Proposed Removals

Application of Percent of Long-Term Care Hospital (LTCH) Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function — Measure performance among SNFs is so high and unvarying that meaningful distinctions in improvements in performance can no longer be made and the proposed DC Function measure is more strongly associated with desired resident functional outcomes.

CMS proposed the removal of the Application of the IRF Functional Outcome measure and Change in Mobility Score for Medical Rehabilitation Patients measure because the costs associated with both measures outweigh the benefits of their use in the program.

Changes to SNF VBP measures

There are four adoptions, one replacement, and a few policy changes proposed for the SNF VBP measures.

Proposed Adoptions

Nursing Staff Turnover — A structural measure that has been collected and publicly reported on Care Compare and assesses the stability of the staffing within an SNF using nursing staff turnover; facilities would begin reporting for this measure in FY2024, with payment effects to begin in FY2026.

Discharge Function Score — Would assess functional status by assessing the percentage of SNF residents who meet or exceed and expected discharge function score, and use mobility and self-care items already collected on the MDS; also proposed for the SNF QRP.

Long Stay Hospitalization Per 100 residents — Would assess the hospitalization rate of long-stay residents.

Percent of Residents Experiencing One or More Falls With Major Injury — Would assess the falls with major injury rates of long-stay residents.

Proposed Replacement

Skilled Nursing Facility 30-Day All-Cause Readmission Measure — This measure will be replaced with the Skilled Nursing Facility Within Stay Potentially Preventable Readmissions.

Proposed Policy Changes

• Increasing the payback percentage policy from 60% to a level such that the bonuses provided to the high-performing, high-duals SNFs do not come at the expense of the other SNFs.
• Updating administrative methodology policies that are required to address the changes needed to accommodate the proposed addition of quality measures into the program's scoring methodology.
• Additional updates on the validation process being established for the quality measures and standardized assessment data for SNFs.