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CMS FY2021 Final Rule

Excerpts from Federal Register 8/5/2020 for Skilled Nursing Facilities

October 27, 2020

 

Michael Criscione
Elizabeth DeRita

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The Centers for Medicare & Medicaid Services (CMS) Final Rule:
Excerpts from Federal Register 8/5/2020
https://www.federalregister.gov/documents/2020/08/05/2020-16900/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities 

CMS FY2021 PDPM - Effective 10/1/2020

  • 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.
  • Final wage index tables are available exclusively through the Internet. They can be found on the CMS Web site at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html 
  • For Rhode Island-based facilities, the wage index is 1.019.
  • For FY2021, the growth rate of the 2014-based Skilled Nursing Facility (SNF) market basket in the final rule was 2.2% and has taken into consideration macroeconomic data through June 2020, and the uncertainty due  to COVID-19. Each per diem component of the federal rate has been adjusted by this market basket factor.
    • Beginning with FY 2018, SNFs that fail to submit data, as applicable, in accordance with sections 1888(e)(6)(B)(i)(II) and (III) of the Social Security Act for a fiscal year will receive a 2.0 percentage point reduction to their market basket update for the fiscal year involved.
  • Overall economic impact of the final rule is an estimated increase of $750 million in aggregate payments to SNF's during FY2021.
    • The economic impact of the SNF Value-Based Purchasing (VBP) Program is an estimated reduction of $199.54 million in aggregate payments to SNFs during FY2021.
  • This final rule also updates the code mappings used under Prospective Payment Systems (PPS) for classifying patients into case-mix groups.
  • The OMB delineations used to identify a facility’s status as an urban or rural facility and to calculate the wage index have also been updated.
  • There were no updates to the  SNF VBP payment policies.
    • VBP incentive payment multipliers can be accessed in the SNF’s MDS CASPER folder, under tab 2, “Facility Performance.”
  • SNF’s now have a 30-day review and correction deadline for the baseline period quality measure reports typically issued in December.
  • CMS will continue to monitor the impact of PDPM implementation on patient outcomes and program outlays. Due to the limited amount of data available in these areas, no information will released at the present time.