News, Payment/economy, Skilled Nursing Facility

CMS finalizes 1% increase for SNF’s FY 2018 payment rates and changes to quality programs

As expected, SNFs will receive a 1% increase in federal payments for FY 2018, roughly $370 million more than they received in FY 2017. Though the increase amount doesn’t come as a surprise with its original proposal being published back in April, it’s much lower than the $800 million that was proposed for SNFs last year. The final rule, confirming the payment increase, published in the Federal Register on August 4, also mirrors other changes to SNFs’ quality programs laid out in a proposed rule published by CMS in April.

Finalized changes to the SNF Quality Reporting Program include a 2%-point reduction that will be assigned to SNFs that fail to submit the required data for quality measures. The final rule also replaces the current pressure ulcer measure with an updated version titled Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury, and adopts four new outcome-based functional measures on resident functional status, which are:

  1. Change in Self-Care Score for Medical Rehabilitation Patients (NQF #2633)
  2. Change in Mobility Score for Medical Rehabilitation Patients (NQF #2634)
  3. Discharge Self-Care Score for Medical Rehabilitation Patients (NQF #2635)
  4. Discharge Mobility Score for Medical Rehabilitation Patients (NQF #2636)

Additionally, CMS confirms in the final rule that they will begin publicly reporting the following six new measures for display by fall of 2018:

  1. Percentage of short-stay residents who were successfully discharged to the community (Medicare claims- and Minimum Data Set [MDS]-based)
  2. Percentage of short-stay residents who have had an outpatient emergency department visit (Medicare claims- and MDS-based)
  3. Percentage of short-stay residents who were rehospitalized after a nursing home admission (Medicare claims- and MDS-based)
  4. Percentage of short-stay residents who made improvements in function (MDS-based)
  5. Percentage of long-stay residents whose ability to move independently worsened (MDS-based)
  6. Percentage of long-stay residents who received an antianxiety or hypnotic medication (MDS-based)

The last change of note is that beginning with the FY 2019 SNF QRP, the data SNFs report on the measure Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678) must meet the definition of standardized resident assessment data and that beginning with the FY 2020 SNF QRP, the data SNFs report on the measures: Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631); and Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury must meet the definition of standardized resident assessment data. However, in response to the comments received for the FY 2020 program year, CMS is not finalizing the additional proposed standardized data elements.

To read the final rule, click here. For a fact sheet that includes additional provisions on the End-Stage Renal Disease Quality Incentive Program and the SNF Value-Based Purchasing Program, click here.