SNF Prospective Payment System: FY 2022 Final Rule Posted

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

Late Thursday afternoon, July 29, 2021, CMS issued a final rule updating Medicare payment policies and rates for Skilled Nursing Facilities (SNFs) under the SNF Prospective Payment System (PPS) for Fiscal Year (FY) 2022.  In addition, the final rule includes several policies that update the SNF Quality Reporting Program and the SNF Value-Based Program (VBP) for FY 2022.

CMS estimates that the aggregate impact of the payment policies in this final rule would result in an increase of approximately $410 million in Medicare Part A payments to SNFs in FY 2022. This estimate reflects a $411 million increase from the update to the payment rates of 1.2%, which is based on a 2.7% SNF market basket update, less a 0.8 percentage point forecast error adjustment and a 0.7 percentage point productivity adjustment, and a $1.2 million decrease due to the proposed reduction to the SNF PPS rates to account for the recent blood-clotting factors exclusion. These impact figures do not incorporate the SNF VBP reductions that are estimated to be $184.25 million in FY 2022.  CMS is delaying adjustments to PDPM reimbursement for 1 year – we’ll see adjustments in FY 2023.

The final rule (290 pages) also includes:

  • Methodology for recalibrating the Patient Driven Payment Model (PDPM) parity adjustment
  • Section 134 of the Consolidated Appropriations Act, 2021 – New Blood Clotting Factor Exclusion from SNF Consolidated Billing
  • Changes in PDPM ICD-10 code mappings
  • SNF Healthcare-Associated Infections (HAI) Requiring Hospitalization Measure
  • Transfer of Health (TOH) Information to the Patient-PAC Quality Measure
  • COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) Measure
  • Public Reporting of Quality Measures with Fewer than Standard Numbers of Quarters Due to COVID-19 PHE Exemptions
  • Measure Suppression and Special Scoring Policies for the SNF VBP Program
  • Expanded SNF VBP Program

More Information:

The unpublished FR can be found here.