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CMS Releases Proposed Rule Featuring Payment Updates for 2014

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for 2014 and would revise and rebase the SNF market basket. This proposed rule also includes a proposed policy for reporting the SNF market basket forecast error correction in certain limited circumstances and a proposed new item for the MDS Version 3.0.

Some of the major proposals include:

Payment changes

CMS estimates that aggregate payments to SNFs will increase by $500 million, or 1.4 percent, from payments in 2013. This estimated increase is attributable to the 2.3 percent market basket increase, reduced by the 0.5 percentage point forecast error correction and further reduced by the 0.4 percentage point multifactor productivity adjustment required by law.

Rebasing of the SNF market basket

CMS is proposing to rebase and revise the SNF market basket for 2014 and subsequent years to reflect more recent data. The current SNF market basket reflects data from 2004 and CMS is proposing to revise and update the SNF market basket using data from 2010. In addition, CMS is proposing to make changes to the components of the SNF market basket index by adding five cost categories for a total of 29 cost categories and revising several price proxies.

MDS change proposed

CMS is proposing to add an item to the MDS to record the number of distinct calendar days of therapy provided by all the rehabilitation disciplines to a beneficiary over the seven-day look-back period. CMS is also clarifying that the qualifying condition for the Medium Rehab (RM) Category requires 5 distinct calendar days of therapy. Similarly, CMS is clarifying that the qualifying condition for the Low Rehab (RL) Category would be clarified to require 3 distinct calendar days.

Currently, the number of days for each therapy disciplines reported on the MDS is summed without regard to the number of separate and unique days per week on which the patient receives therapy services across all rehabilitation disciplines. This results in some patients receiving higher SNF payments for an RM or RL Resource Utilization Group (RUG) when the patient actually does not meet the qualifying conditions for that RUG.

Read the proposed rule here. Comments must be received by 5 p.m. on July 1, 2013.

HCPro will continue to bring you updates and analysis of this proposed rule in the coming weeks.