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CMS FY17 Final Rule

October 10, 2016
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Excerpts from Federal Register 8/5/16

SNF PPS Rates

  • Wage index tables are no longer published in the Federal Register.  Instead, these tables will be available exclusively through the Internet. The wage index tables for this final rule are available exclusively through the CMS Web site here
  • Overall economic impact of the final rule is an estimated increase of $920 million in aggregate payments to SNF’s during FY17
  • For FY17, inflation of 2.7% on the 2010-based market basket rate is applied
  • Updated FY17 PPS rates are located in the following excel file: CMS FY17 SNF PPS Rates

SNF Value-Based Purchasing (VBP) Program

  • Promotes higher quality and more efficient healthcare for MCR beneficiaries
  • Implemented in various health care settings, including physician offices, ambulatory surgical centers (ASCs), hospitals, nursing homes, home health agencies (HHAs), and dialysis facilities.
  • Links a portion of Medicare payments to provider reporting or performance on quality measures.
    • SNF 30-day all-cause readmission measure, claims based requiring no additional data collection or submission burden
    • SNF 30-day potentially preventable readmission measure, focuses on readmissions that are potentially preventable and also unplanned
  • Have proposed to adopt calendar year 2015 claims (1/1/15-12/31/15) as the baseline period as the basis for calculating performance standards.
  • The Act requires that the value-based incentive payment percentage be based on the SNF performance score and must be appropriately distributed so that the highest-ranked SNFs receive the highest payments, the lowest-ranked SNFs receive the lowest payments, and that the payment rate for services furnished by SNFs in the lowest 40 percent of the rankings be less than would otherwise apply. Finally, the total amount of value-based incentive payments must be greater than or equal to 50 percent, but not greater than 70 percent, of the total amount of the reductions to payments for the FY specified.
  • The Act requires that we make available to the public on the Nursing Home Compare Web site or its successor information regarding the performance of individual SNFs with respect to a FY, including the performance score for each SNF for the FY and each SNF's ranking. Additionally, the Act requires that we periodically post aggregate information on the SNF VBP Program on the Nursing Home Compare Web site or its successor, including the range of SNF performance scores, and the number of SNFs receiving value-based incentive payments and the range and total amount of those payments.
  • In the FY 2016 SNF PPS final rule (80 FR 46457), it was finalized that, for the FY 2019 payment determination, data would be collected from the 2nd through 4th quarters of FY 2017 (that is, data for residents who are admitted from January 1st and discharged up to and including September 30th) to determine whether a SNF has met its quality reporting requirements for that FY. In the FY 2016 SNF PPS final rule it was also finalized that beginning with the FY 2020 payment determination, it would move to a full year of fiscal year (FY) data collection.
  • In the FY 2016 SNF PPS final rule (80 FR 46457), it was also finalized that FY 2018 data would be collected in a manner that would remain consistent with the usual October release schedule for the MDS. However, to align with the data reporting cycles in other quality reporting programs, in contrast to fiscal year data collection that was finalized last year, it is now being proposing to move to calendar year (CY) reporting following the initial reporting of data from October 1, 2016, through December 31, 2016, as finalized in the FY 2016 SNF PPS final rule (80 FR 46457), for the FY 2018 payment determination.
  • Section 1899B(f) of the Act requires the Secretary to provide confidential Start Printed Page 52048feedback reports to post-acute care providers on their performance for the measures specified under paragraphs (c)(1) and (d)(1), beginning 1 year after the specified application date that applies to such measures and PAC providers.
If you have any questions, please contact Michael Criscione at mcriscione@citrincooperman.com.