Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
Late in the day on Friday, April 10, 2020, CMS posted the public inspection copy of the FY2021 SNF PPS Proposed Rule – CMS-1737-P. This 93-page document is scheduled to be published in the Federal Register on April 15, 2020 online at federalregister.gov/d/2020-07875 on that date.
Stakeholder comments are due to CMS no later than 5 PM on June 9, 2020.
Here’s the Table of Contents for the proposed rule:
- Executive Summary
- Summary of Major Provisions
- Summary of Cost and Benefits
- Advancing Health Information Exchange
- Background on SNF PPS
- Statutory Basis and Scope
- Initial Transition for the SNF PPS
- Required Annual Rate Updates
III. Proposed SNF PPS Rate Setting Methodology and FY 2021 Update
- Federal Base Rates
- SNF Market Basket Update
- Case-Mix Adjustment
- Wage Index Adjustment
- SNF Value-Based Purchasing Program
- Adjusted Rate Computation Example
- Additional Aspects of the SNF PPS
- SNF Level of Care–Administrative Presumption
- Consolidated Billing
- Payment for SNF-Level Swing-Bed Services
- Revisions to the Regulation Text
- Other Issues
- Proposed Changes to SNF PPS Wage Index
- Technical Updates to PDPM ICD-10 Mappings
- Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP)
- Collection of Information Requirements
VII. Response to Comments
VIII. Economic Analyses
- Regulatory Impact Analysis
- Regulatory Flexibility Act Analysis
- Unfunded Mandates Reform Act Analysis
- Federalism Analysis
- Reducing Regulation and Controlling Regulatory Costs
- Congressional Review Act
- Regulatory Review Costs
The corresponding Fact Sheet contains these statements regarding the Proposed Rule (bolding and italics added by me):
- CMS is publishing this proposed rule consistent with the legal requirements to update Medicare payment policies for skilled nursing facilities on an annual basis.
- The proposed rule includes proposals required by statute and that affect Medicare payment to SNFs, as well as proposals that reduce provider burden and may help providers in the COVID-19 response.
- These updates include routine technical rate-setting updates to the SNF PPS payment rates, as well as a proposal to adopt the most recent Office of Management and Budget (OMB) statistical area delineations and apply a 5 percent cap on wage index decreases from FY 2020 to FY 2021. We are also proposing changes to the ICD-10 code mappings that would be effective beginning in FY 2021, in response to stakeholder feedback. Finally, this rule includes minor administrative proposals related to the SNF Value-Based Purchasing (VBP) Program. CMS is not proposing to make any changes to the measures, SNF VBP scoring policies, or payment policies.
- 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.