Proposed Fiscal Year 2020 Payment and Policy Changes for Medicare Skilled Nursing Facilities

On April 19, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1718-P] for Fiscal Year (FY) 2020 that updates the Medicare payment rates and the quality programs for skilled nursing facilities (SNFs).

Key areas addressed in the proposed rule include:

  1. Proposal of a sub-regulatory process for ICD-10 codes since codes are being used for payment.
  2. Alignment of Post-Acute Care (PAC) therapy definitions, notably “group” therapy in the SNF would be redefined to consist of 2-6 residents to align with other PAC payment systems instead of the current SNF requirement of exactly 4 participants.
  3. Name change for the Value-Based Purchasing Quality Measure (QM) to Skilled Nursing Facility Potentially Preventable Readmission after Hospital Discharge (SNFPPR) and updated reporting requirements for SNFs with fewer than 25 or no eligible stays and a 30 day deadline for Phase One review and Correction requests.
  4. The SNF Quality Reporting Program (QRP) is to be updated and two new QMs are being added that relate to Health Information transfer.
  5. New MDS items will be added to accommodate the new QRPs.
  6. Comments and thoughts on the proposed rule will be accepted until June 18, 2019.