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CMS Final Rule under PPS for SNFs for FY 2020

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)
    Measure IDMeasure DescriptionAchievement ThresholdBenchmark
    SNFRMSNF 30-Day All-Cause Readmission Measure (NQF #2510)0.790250.82917
  • 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.

If you have questions or concerns, please contact us.

If you’d like to learn more about our post-acute care services, click here.

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