COVID-19, Payment/economy, Skilled Nursing Facility

CMS proposes payment rule for FY 2021

On April 10, 2020, CMS issued a proposed rule [CMS-1737-P] for fiscal year (FY) 2021 that updates the Medicare payment rates and quality programs for SNFs.

The proposed rule affects Medicare payment to SNFs, as well as includes proposals that reduce provider burden and may help providers in the COVID-19 response, according to the CMS fact sheet. 

CMS projects aggregate payments to SNFs will increase by $784 million, or 2.3 percent, for FY 2021 compared to FY 2020. This estimated increase is attributable to a 2.7 percent market basket increase factor with a 0.4 percentage point reduction for multifactor productivity adjustment.

The rule also includes  changes to the ICD-10 code mappings that would be effective beginning in FY 2021.

CMS is also changing geographic delineations which might alter urban/rural status for SNFs, a status used to calculate the wage index (see Tables 11 and 12 in proposed rule). CMS is applying a 5% cap to wage index decreases.

The Value-Based Purchasing (VBP) is not changing much.  In the FY 2021 SNF PPS proposed rule, CMS is proposing to align the SNF VBP Program regulation text at 42 CFR § 413.338 with previously finalized policies, to apply the 30-day Phase One Review and Correction deadline to the baseline period quality measure quarterly report, and to establish performance periods and performance standards for upcoming program years.

CMS is not proposing to make any changes to the measures, SNF VBP scoring policies, or payment policies. The name of the SNFPPR measure is still changing to “Skilled Nursing Facility Potentially Preventable Readmissions after Hospital Discharge” to further distinguish the measure from the similar measure for use in the SNF Quality Reporting Program (QRP).

CMS is accepting comments on the rule until June 9, 2020.