Focus on what counts
Alerts

CMS FY19 Final Rule

October 2, 2019
view all archive

CMS FY2020 Final Rule
Excerpts from Federal Register 8/7/2019
https://www.federalregister.gov/documents/2019/08/07/2019-16485/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities

CMS FY2020 PDPM – Effective 10/1/19

  • Under the Patient-Driven Payment Model (PDPM), the total rate is calculated as a combination of six different component rates, five of which are case-mix adjusted. Given the sheer volume of possible combinations of these five case-mix adjusted components, it is not feasible to provide tables similar to those that have existed in prior rulemaking.
  • Wage index tables are available exclusively through the Internet. They can be found on the Centers for Medicare & Medicaid Services (CMS) website.
  • For Rhode Island-based facilities, the wage index is 1.036.
  • This final rule also updates requirements for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) which includes the adoption of two Transfer of Health Information quality measures, and standardized patient assessment data elements, that SNFs would be required to begin reporting with respect to admissions and discharges that occur on or after October 1, 2020.
  • This final rule will still reduce the adjusted federal per diem rate determined under section 1888(e)(4)(G) of the Act by 2%, and adjust the resulting rate by the value-based incentive payment amount earned by the SNF for that fiscal year under the SNF VBP (Value-Based Purchasing) Program. A revised VBP multiplier is effective October 1, 2019.
  • Overall, economic impact of the final rule is an estimated increase of $851millioninaggregatepaymentstoSNF’s during FY2020.
    • Overall, economic impact of the SNF VBP Program is an estimated reduction of $213.6 million in aggregate payments to SNFs during FY2020.
  • For FY2020, the growth rate of the 2014-based SNF market basket in the proposed rule was estimated to be 2.8%.
  • The PDPM case-mix classification system is effective beginning October 1, 2019.
    • Unadjusted federal per diem rates are divided into six components, five of which are case-mix adjusted components (Physical Therapy, Occupational Therapy, Speech-Language Pathology, Nursing, and Non-Therapy Ancillaries) and one of which is a non-case-mix component, as exists under RUG-IV.