April 21, 2024


Imagination at work

Skilled nursing, hospice and rehab facilities see payment increases in final rule

Photograph: FGTrade/Getty Photos

The Facilities for Medicare and Medicaid Companies has introduced last rules that enhance payment for expert nursing services, hospice and rehab services.

Proficient NURSING

CMS estimates that the impression of the payment guidelines in the final rule would outcome in an enhance of approximately $410 million in Medicare Part A payments beneath the Proficient Nursing Facility potential payment procedure for FY 2022. 

This estimate demonstrates at $411 million enhance from the update to the payment fees of one.2% – which is based on a 2.7% expert nursing facility market place basket update, much less a .eight share position forecast error adjustment and a .7 share position efficiency adjustment – and a $one.2 million lessen owing to the proposed reduction to fees to account for the new blood-clotting elements exclusion. 

The law involves that sure specified blood clotting elements made use of for the therapy of patients with hemophilia and other bleeding conditions and objects and similar products and services be excluded from the consolidated billing specifications for objects and products and services furnished on or soon after Oct one.

CMS is finalizing a proportional reduction in the Medicare Part A expert nursing facility price to account for this new exclusion. This methodology will outcome in an estimated lessen of approximately $one.2 million in combination Part A expert nursing facility paying out to offset the enhance in Part B paying out that will occur owing to these objects and products and services remaining excluded from consolidated billing.

These impression figures do not incorporate the expert nursing facility worth-based method reductions that are estimated to be $184.twenty five million in 2022.

The expert nursing facility good quality reporting method is a fork out-for-reporting method. SNFs that do not fulfill reporting specifications may possibly be issue to a two-share position reduction. 

CMS has adopted two new measures and updated the specs for another measure. In addition, CMS has produced a modification to the general public reporting of SNF good quality measures. 

CMS adopted a new statements-based measure on healthcare-linked infections that outcome in hospitalization. It also adopted the COVID-19 Vaccination Protection among Health care Staff Measure beginning with 2023 reporting. This measure will need SNFs to report on COVID-19 vaccinations of their employees to evaluate no matter if SNFs are having methods to restrict the unfold of COVID-19 among their workforce and to lower the threat of transmission in just their services.

Lastly, CMS sought opinions on the two requests for details on closing the wellness equity gap and Rapidly Health care Interoperability Resources or FHIR, in assist of digital good quality measurement in post-acute care good quality reporting plans.

More details on the rule is offered from the CMS Simple fact Sheet.

Patient-Driven PAYMENT Design

On Oct one, 2019, CMS carried out a new case-mix classification design, known as the Patient Driven Payment Design that would be spending budget neutral. Because implementation, there is an unintended enhance in payments of approximately five% or $one.7 billion in 2020. 

CMS acknowledges that the COVID-19 general public wellness unexpected emergency could have afflicted the knowledge. CMS sought remark on a possible methodology for recalibrating the parity adjustment to account for unintended increases in payments. 

Worth-Based Program

The worth-based method benefits SNFs with incentive payments based on the good quality of care they supply to Medicare beneficiaries, as measured by effectiveness on a single measure of healthcare facility readmissions. All expert nursing services that are compensated beneath Medicare’s potential payment procedure are involved in the worth-based method.

CMS will suppress the Proficient Nursing Facility 30-Working day All-Cause Readmission Measure for the 2022 worth-based method yr since of the general public wellness unexpected emergency. As section of a special scoring policy, CMS will assign a effectiveness rating of zero to all participating SNFs, irrespective of how they accomplish employing the formerly finalized scoring methodology.

The Consolidated Appropriations Act, 2021 involved a provision letting the Office of Wellbeing and Human Companies to develop the SNF worth-based method and utilize up to an supplemental 9 measures with regard to payments beginning in 2024, which may possibly consist of measures of useful position, client basic safety, care coordination or client encounter.

For every DIEM

CMS will lower the otherwise relevant federal for every diem price for every single SNF by 2% and award SNFs sixty% of that withhold, ensuing in a one.2% payback share. Lastly, SNFs that qualify for the very low-volume adjustment will proceed to acquire a hundred% of that 2% withhold.


CMS’s hospice last rule presents hospices a 2% enhance for an supplemental $480 million in their payments for 2022. This is a outcome of the 2.7% market place basket share increase reduced by a .7 share position efficiency adjustment. Hospices that are unsuccessful to fulfill good quality reporting specifications acquire a 2 share position reduction to the annual hospice payment update share enhance for the yr.

The payments also consist of an update to the statutory combination cap total, which restrictions the general payments for every client that are produced to a hospice annually. The cap total for 2022 is $31,297.61, compared to the 2021 cap total of $30,683.ninety three, an enhance of 2%. As a outcome of the changes mandated by the Consolidated Appropriations Act, 2021, this rule extends the many years that the cap total is updated by the hospice payment update share fairly than the buyer price index.

In addition, this rule finalizes changes to the Hospice Problems of Participation and Hospice Quality Reporting Program. 

The last rule also finalizes a Home Wellbeing Quality Reporting Program policy that becomes effective on Oct one, to get ready for general public reporting beginning in January 2022.

For sure statements-based measures, CMS is employing 3 quarters fairly than 4 quarters of knowledge for refreshes amongst January 2022 and July 2024. 

The rule rebases and revises the labor shares for all 4 stages of care: regimen property care, continuous property care, inpatient respite care and basic inpatient care based on the payment cost weights for every single degree of care from the 2018 Medicare cost report knowledge for freestanding hospices. 

The last 2022 labor shares are 66% for regimen property care, 75.2% for continuous property care, 61% for inpatient respite care and sixty three.five% for basic inpatient care.

As a outcome of this rule, the good quality reporting will have 4 good quality measures that capture care across the hospice stay, which includes a new measure known as the Hospice Care Index. This measure features 10 indicators of good quality that are calculated from statements knowledge. This statements-based measure will be publicly claimed no before than Could 2022.

This rule also finalizes the addition of the Buyer Evaluation of Health care Providers and Devices, or CAHPS Hospice Survey Star scores on Care Evaluate. 

Furthermore, the rule finalizes the addition of the statements-based Hospice Visits in the Very last Days of Life measure for general public reporting. The statements-based measures will use 8 quarters of knowledge to have a much larger inhabitants for small vendors, providing consumers extra vendors to look at. 

This rule also eliminates seven person Hospice Product Set measures since a extra broadly relevant measure, the Hospice Complete Evaluation Measure is offered and already publicly claimed. This measure can help to make sure all hospice patients acquire a holistic comprehensive evaluation. 

Lastly, CMS is supplying updates concerning its enhancement of a new Hospice Final result and Patient Analysis (HOPE) evaluation instrument.


The Inpatient Rehabilitation Facility Prospective Payment System payment fees and guidelines will be effective on Oct one. For 20222, CMS is updating the IRF PPS payment fees by one.9% based on the precise market place basket estimate of 2.six%, much less a .7 share position efficiency adjustment. 

In addition, the last rule contains an adjustment to the outlier threshold to retain outlier payments at three% of full payments. This adjustment will outcome in a .four share position lessen in outlier payments. CMS estimates that the general IRF payments would enhance one.five%, or by $130 million. 

The IRF QRP is a fork out-for-reporting method. IRFs that do not fulfill reporting specifications are issue to a 2% reduction in their annual enhance component.

CMS is adopting just one measure and finalizing its proposal to update the specs for another measure. In addition, CMS is finalizing its proposal to modify the number of quarters made use of for general public reporting of IRF good quality measures owing to the general public wellness unexpected emergency and sought opinions for two requests for details. For extra details, see the CMS Simple fact Sheet.

Medical Tools

CMS is finalizing a Medicare Strong Medical Tools Prosthetics, Orthotics and Materials payment provision adopted in an interim last rule with remark period of time issued on Could 11, 2018, as nicely as a provision that was involved in a proposed rule revealed in the Federal Register on November four, 2020.

CLOSING THE Wellbeing Fairness Gap IN Quality REPORTING

Dependable with the Biden Administration’s executive order on Advancing Racial Fairness and Help for Underserved Communities Via the Federal Authorities, CMS is bettering knowledge assortment to greater measure and analyze disparities across plans and guidelines.

CMS explained it been given feed-back on methods to achieve wellness equity for all patients by means of policy answers that will be precious in potential policy operate. 

Twitter: @SusanJMorse
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