CMS Finalizes SNF Medicare Payment and Policy Rule

The Centers for Medicare and Medicaid Services (CMS) has finalized the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) payment and policy rule for federal fiscal year (FFY) 2021, which starts Oct. 1, 2020. The final rule closely mirrors the proposed rule, although updated economic data results in a final market basket increase of 2.2 percent, which CMS estimates will increase total Medicare payments by $750 million. The proposed rule had included a 2.3 percent increase.

CMS makes no structural changes to the Patient-Driven Payment Model (PDPM) implemented last year while adopting some updates to ICD-10 code mapping to improve how patients are classified into PDPM payment categories. Along with the annual update to the wage index, the rule finalizes proposed changes to geographic delineations that impact wage index region assignments for certain counties while capping any wage index decrease for such counties at 5 percent. Three counties in New York State are impacted by the change: Dutchess, Orange, and Putnam.

The rule also finalizes Value-Based Purchasing (VBP) performance periods and performance standards for upcoming program years and applies the 30-day Phase One Review and Correction deadline to the baseline period quality measure quarterly report. CMS is not making any other changes to the VBP measure, scoring, or payment policies at this point.

While promising to consider recommendations related to COVID-19 that were submitted as part of the comment process, CMS did not address them, indicating that the issue was outside of the scope of the proposed rule. We will provide a more thorough summary of the final rule, along with updated PDPM rate tables and wage index comparisons, shortly. A CMS fact sheet is available here; the rule text is here.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841