CMS proposes changes and updates to policies and payment rates used under Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for 2025; issued fact sheet.
SNF Payment Rates
Updated SNF PPS rates by 4.1% based on the proposed SNF market basket of 2.8%.
Plus 1.7% market basket forecast error adjustment, -0.4% productivity adjustment.
Also proposed to update SNF market basket base year from 2018 base to 2022.
Updated payment rates used under SNF PPS based on the FY 2025 SNF market basket increase factor, as adjusted by productivity adjustment and forecast error correction.
Proposes updates to the SNF Quality Reporting Program (QRP) to better account for adverse social conditions that negatively impact individuals’ health or health care.
Further, made changes to CMS’ enforcement policies to impose more equitable and consistent civil monetary penalties (CMP) for SNFs for health and safety violations.
Updated the SNF PPS wage index using the Core-Based Statistical Areas (CBSAs) defined within the new OMB Bulletin 23-01 to improve accuracy of wages and costs.
Patient-Driven Payment Model
Patient-driven payment model (PDPM) utilizes the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10) codes in several ways.
Including using the person’s primary diagnosis to assign patients to clinical categories.
Changes to PDPM ICD-10 code mappings to allow providers to provide more accurate primary diagnoses that meet criteria for skilled intervention during Part A SNF stay.
Nursing Home Enforcement
Expanded ability to impose financial penalties to drive correction of deficiencies.
Allowed more per instance and per day civil money penalties (CMPs) to be imposed.
SNF Quality Reporting Program
Additionally, proposed to add four new social determinants of health (SDOH) items and modify one SDOH assessment item for the SNF quality reporting program (QRP).
SNFs included in SNF QRP participate in a process to validate data submitted under the SNF QRP through the Minimum Data Set (MDS) beginning with the FY 2027 SNF QRP.
Sought feedback on future measure concepts for SNF QRP with request for information (RFI) on quality measure concepts under consideration for future SNF QRP years.
SNF Value-Based Purchasing Program
Proposed to adopt a measure retention and removal policy to the SNF VBP program.
Updated case-mix methodology utilized as part of the Total Nurse Staffing measure.
Additionally, proposed administrative policy updates, including an update of the Review and Correction policy that was previously finalized for the SNF VBP program.
Consultation
Comments on proposed amendments must be submitted by May 28, 2024.
Jul. 2024 CMS Final Rule
On Jul. 31, 2024, CMS issued final rule updating the policies for SNF PPF for FY 2025.
Updated Medicare payment policies, rates for SNF which result in a 4.2% net increase in Medicare Part A payments to SNFs, considering error and productivity adjustments.
Adopting measure selection, retention, removal policy for SNF value-based purchasing program, technical measure update policy, and a review and correction policy update.
Final rule scheduled to be published in fed register on Aug. 6, effective Oct. 1, 2024.
Aug. 6, 2024 CMS Federal Register
On Aug. 6, 2024, CMS published final rule in federal register, effective Oct. 1, 2024.
