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An Analysis and Commentary on Federal Health Care Issues by Larry Goldberg

CMS Proposes Skilled Nursing Facility FY 2020 PPS Update

The Centers for Medicare and Medicaid Services (CMS) have issued a proposed rule to update the Medicare payment rates and the quality programs for skilled nursing facilities (SNFs) for FY 2020.

CMS will begin using a new case-mix model, the Patient Driven Payment Model (PDPM), which focuses on the patient’s condition and resulting care needs rather than on the amount of care provided in order to determine Medicare payment. CMS proposes to revise the definition of group therapy under the SNF PPS, and to implement a subregulatory process for updating the code lists (International Classification of Diseases, Tenth Version (ICD-10) codes) used under PDPM.

The rule also finalizes updates to the SNF Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) Program.

The 232-page document is scheduled for publication in the Federal Register on April 25th. A copy is currently available at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-08108.pdf. This link will, of course, change upon publication. A 60-day comment period ending June 18th is provided.

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