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CMS Proposed Rule for Updates to PDPM, QRP, & VBP for FY 2020

CMS issued proposed rule on April 25, 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). Click here to read the full proposed rule.

Comments on the proposed rule must be received by CMS no later than 5 p.m. on June 18, 2019.

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. See CMS’s website for more details.

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
  • Public display of Drug Regimen Review Conducted with Follow-Up for identified issues
  • Revise to reflect enhancements and standardization of resident assessment data under consideration for the future

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
  • Estimated FY 2022 SNF VBP Program Performance Standards
    • Estimated FY 2022 SNF VBP Program Performance Standards
  • No changes are proposed to the SNF VBP scoring policies or updates to the incentive payment
  • SNF has fewer than 25 eligible stays during baseline, the RSRR (improvement score) would not be displayed

If you have questions or would like to discuss these changes or your organization’s preparation for upcoming changes, please contact us.

Nancy Hublar, RAC-CT (nhublar@blueandco.com or 502-992-3528)
Nicole Cameron, RHIA, CDIP, CCS (ncameron@blueandco.com or 317-713-7915)
Landon Hackett, CPA, MSA (lhackett@blueandco.com or 317-713-7929)
Jennifer Scott, RN, BSN, PLNC, CDP (jscott@blueandco.com or 502-992-2567)

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

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