Skilled Nursing Facility Prospective Payment System Final Rule Issued (CMS 1802-F)

• By: Angela Westhoff
• On: 08/15/2024 15:18:24
• In: Legislative/Government Affairs

At the end of July, CMS issued the final rule for the skilled for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2025 update.
 
Medicare rates are increasing by more than 4% in the coming fiscal year; however, it is disappointing to see that CMS enhanced its enforcement provisions around civil monetary penalties. CMS expanded the penalties that can be enforced allowing for more per instance and per day CMPs to be imposed, permitting both types of penalties to be imposed, not to exceed the statutory daily limits. Enforcement updates go into effect on October 5, 2025. However, CMS will operationalize these requirements beginning in March 2025.
 
Here are some highlights of the final rule:

• The final rule increases SNF PPS rates by 4.2%, or approximately $1.4 billion, beginning October 1, 2024. This is based on the SNF market basket increase of 3.0%, plus a 1.7% market basket forecast error adjustment, and a negative 0.5% productivity adjustment.
• The above impact figures do not incorporate the SNF Value-Based Purchasing (VBP) reductions for certain SNFs subject to the net reduction in payments under the SNF VBP program; those adjustments are estimated to total $187.7 million in FY 2025. CMS finalized several operational and administrative proposals for the SNF VBP program.
• CMS also finalized updates to the SNF Quality Reporting Program (QRP), SNF VBP program, SNF PPS Patient-Driven Payment Model ICD-10 Code Mappings, and the SNF PPS wage index.
• The rule finalizes revisions to regulation surrounding enforcement authority related to Civil Monetary Penalties (CMP) that were outlined in the proposed rule. Under this new policy, State Survey Agencies, along with CMS would have the authority to issue Per Diem and Per Instance CMPs on the same survey, as well as the authority to issue multiple Per Instance CMPs when the same type of noncompliance is identified on more than one day. CMS or the States would also be able to impose CMPs for the number of days of previously cited noncompliance since the last three standard surveys for which a CMP has not yet been imposed.
• These enforcement updates go into effect October 5, 2025 (60-days after it is published in the Federal Register, scheduled to be published on August 6, 2024). However, CMS will operationalize these requirements beginning March 3, 2025.

AHCA has developed a summary of the final rule. You will be required to log in as a member to access.

Staff contact: awesthoff@mehca.org