CMS Final Rule under PPS for SNFs for FY 2020

August 21, 2019

CMS issued a proposed rule on July 30, 2019, with updates to the Patient-Driven Payment Model (PDPM), Quality Reporting Program (QRP), and the Value Based Purchasing Program (VBP) for fiscal year 2020 ( beginning on 10/1/19 and ending on 9/30/20).

See here for the final rule. The final rule was published in its official form on 8/7/19.

PDPM Highlights

Updated Unadjusted Federal Per Diem Rates (Urban/Rural) for FY 2020
Slight changes by .01 on case mix indexes for a few of PDPM groups
Definition of group therapy: group therapy in a Part A setting is defined as a qualified therapist or therapy assistant treating two to six patients at the same time who are performing the same or similar activities
Implementation of a subregulatory process for updating the ICD-10 codes. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM.html

QRP Highlights

Adopt two measures:
- Transfer of Health Information to the Provider-Post-Acute Care (PAC), and
- Transfer of Health Information to the Patient- Post-Acute Care (PAC)
Update of specification for the Discharge to Community – PAC SNF QRP measure to exclude baseline nursing facilities (NF) residents from the measure
Expand data collection to all SNF residents regardless of payor not finalized at this time.
Public display of Drug Regimen Review Conducted with Follow-Up for identified issues for 2020 as technically feasible
CMS is adopting a number of enhancements and standardization of resident assessment data

VBP Highlights

Changing the name of SNF Potentially Preventable Readmission Measure (SNFPPR) to SNF Potentially Preventable Readmission after Hospital Discharge. CMS intends to submit the SNFPPR measure to the National Quality Forum for endorsement review as soon as that is feasible
Final FY 2022 SNF VBP Program Performance Standards (Table 15 in final rule)

No updates were proposed to the SNF VBP scoring policies or updates to the incentive payment
SNF has fewer than 25 eligible stays during baseline:
- The baseline the RSRR ( improvement score) would not be displayed;
- And receives an assigned SNF performance score as a result, only the assigned SNF performance score would be displayed;
- SNF has zero eligible cases, no information would be displayed.