Medicare Payment and Reimbursement

FY2019 Skilled Nursing Facility Proposed Rule Summary

May 15, 2018 11:05 am

HFMA Executive Summary

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule updating for FY 2019 the Medicare skilled nursing facility (SNF) payment rates, quality reporting requirements, and the SNF Value-Based Purchasing Program (VBP). For more information on these highlights, download a full summary of the rule.

Impact
CMS estimates that the overall impact of the proposed rule will be an increase of $850 million (2.4 percent) in Medicare payments to SNFs during FY 2019. This overall total and percentage increase, however, does not take into account the estimated reduction of $211 million in aggregate payments to SNFs from the SNF VBP program during FY 2019.

Regulatory Change

Of particular importance, CMS proposes to replace the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV) model, with a revised case-mix methodology called the Patient Driven Payment Model (PDPM), effective beginning FY 2020. CMS is not proposing to adopt any new measures for the SNF Quality Reporting Program (QRP) in this proposed rule. On the SNF VBP, CMS proposes updates to its policies including the performance and baseline periods for the FY 2021 VBP Program year, an adjustment to the SNF VBP scoring methodology, and an Extraordinary Circumstances Exception policy.

Comments on the proposed rule are due by June 26, 2018.

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