CMS Posts FY 2019 SNF PPS Final Rule

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare®

Just a few minutes ago, CMS posted 3 final rules, including that for SNF PPS.

“The Skilled Nursing Facilities (SNF) PPS final rule incorporates the agency’s Patients Over Paperwork initiative through avenues that reduce unnecessary burden on providers by easing documentation requirements and offering more flexibility. As part of the agency’s actions to modernize Medicare, the SNF PPS rule establishes an innovative new classification system, the Patient Driven Payment Model (PDPM), which ties skilled nursing facility payments to patients’ conditions and care needs rather than volume of services provided. The move to this model is expected to also save providers an estimated $2 billion over the next decade.”

The final rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection. It is 424 pages in length.

Please visit this Fact Sheet on the SNF PPS Final Rule.

“This fact sheet discusses three major provisions of the final rule: the changes to the case-mix classification system used under the SNF Prospective Payment System (PPS), the SNF Value-Based Purchasing Program (VBP), and the SNF Quality Reporting Program (QRP). The major FY 2019 policies and other issues discussed in the final rule are summarized below.

The final rule includes policies that continue a commitment to shift Medicare payments from volume to value, with continued implementation of the SNF VBP and SNF QRP.”

Included in this Final Rule is movement from the current RUG-IV reimbursement system.   “Effective October 1, 2019, CMS will be using a new case-mix model, the Patient-Driven Payment Model, which focuses on the patient’s condition and resulting care needs rather than on the amount of care provided in order to determine Medicare payment. The final rule also modernizes Medicare through innovation in SNF, meaningful quality measure reporting, reduced paperwork, and reduced administrative costs.”

The Fact Sheet and Final Rule are must-reads for all skilled facilities.

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