Final Rule Released: What You Need to Know to Win the Race to October 1st

The Centers for Medicare and Medicaid Services issued the FY 2020 Skilled Nursing Facility Prospective Payment System Final Rule which will take effect on October 1, 2019.  This rule finalizes payment policies for Medicare Part A in SNFs and updates the SNF Quality Reporting and Value-Based Purchasing Programs. Below are the highlights:

• SNF market basket percentage is 2.4% or $851 million for FY 2020 (decreased from the proposed update of 2.5%).
• The unadjusted urban and rural federal per diem rates will decrease slightly compared to the proposed rule rates.
• Come October 1, 2019, group therapy will be defined as, “a qualified rehabilitation therapist or therapy assistant treating two to six patients at the same time who are preforming the same or similar activities.”
• The sub-regulatory process for updating the ICD-10 codes used to classify patients under PDPM has been finalized for FY 2020.
• Two new quality measures for the SNF QRP related to transfer of health information have been adopted.
• Baseline nursing home residents will be excluded from the Discharge to Community Measure.
• The quality measure for Drug Regimen Review Conducted with Follow-Up for Identified Issues will be publicly displayed.
• The “5-Day Assessment” will be called “Initial Medicare Assessment.”
• Clarification on the optional Interim Payment Assessment was provided stating, “…the SNF’s underlying responsibility to remain fully aware of (and respond appropriately to) any changes in its resident’s condition is in no way discretionary. Moreover, the discussion of the IPA in the FY 2019 SNF PPS final rule (83 FR 39233) clearly envisions a role for this assessment that is not strictly limited to payment alone: “We continue to believe that it is necessary for SNFs to continually monitor the clinical status of each and every patient in the facility regularly regardless of payment or assessment requirements and we believe that there should be a mechanism in place that would allow facilities to do this.” At the same time, in making the IPA optional, we recognized “. . . that providers may be best situated, as in the case of the Significant Change in Status Assessment, to determine when a change has occurred that should be reported through the IPA.”

For more information see  the CMS Press Release and Fact Sheet.

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