REMINDER: CMS Comments on FY 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Proposed Rule (CMS 1765-P) DUE BY June 5th, 2022

At this time, it is critically important that CMS hear from a significant number of providers to understand the impact of the proposed financial impact rule. We need you, and as many people in your organization as possible, to help with this effort. Comments do not have to be overly long, but CMS needs to hear from you in your own words.
There are two key items in the proposed rule to note:
  • A possible delay or phase-in of the proposed parity adjustment to Medicare rates.
    • In the proposed rule, CMS is proposing a $320 million decrease in Medicare Part A payments to SNFs beginning October 1, 2022. CMS has calculated the payment increase it should make to rates, a forecast error adjustment (due to under forecasting inflation), and a required parity adjustment to make sure rates under PDMP are budget neutral with what they would have been under the RUGs model. Absorbing the full parity adjustment in one year would be extremely difficult for SNFs, so providers need to ask for a phase-in of the parity adjustment.
  •  Information on revising the requirements for LTC facilities to establish mandatory minimum staffing levels.
    • This may be the only chance nursing facilities have to weigh in with CMS on staffing minimum proposals before any regulations are written. Comments about your current staffing challenges are needed. Framing concerns about mandatory staffing levels in terms of how this would affect resident care (i.e., access to care, reduced admissions, etc.) will be most impactful.
Below are some helpful hints to organize your comments:
  • Describe Yourself, Your Operation, and Your Commitment to Quality
    • Mention what you do, why you work in LTC, and what your residents mean to you.
    • Describe your building (i.e., location, # of units, profile of your residents).
    • Mention if you are 3-Star or better or have won an AHCA Quality Award; discuss your quality efforts.
  • Discuss How Difficult the Past Two Years Were
    • Describe the sacrifices you and your team have made and the tragedy of the losses.
    • Give a specific example of a team member who has worked tirelessly.
  • Explain the Impact of a 4.6% Reduction
    • Tell CMS how a proposed cut to nursing homes' Medicare rates in FY 2023 would be detrimental to your residents, colleagues, and organization.
    • Ask for the parity adjustment to be phased-in.
    • Explain from your own perspective how a reduction will impact patient care.
    • Explain your loss in census, increased labor costs, and ongoing COVID costs. If you are worried about closing, let them know.
  • Discuss Your Workforce Challenges
    • Let them know how many open positions you have and how hard recruitment is.
    • Discuss your inability to fill shifts, use of agency staff, and related costs.
    • Tell them that a staffing mandate will not create workers—the workers are not out there.
(For more details on the proposed rule, AHCA/NCAL has developed a summary of the greatest impacts on members.)
The deadline to submit comments is 5:00 pm on June 10, 2022. We encourage you to submit your comments as soon as possible. We have provided information below on how to prepare and send your comments.
Staff Contact: