CMS proposes more than $1 billion in raises for post-acute care providers

(Updated on April 28)

The CMS on Friday called for post-acute care providers to receive a $1 billion raise next year as part of its annual prospective pay rules for skilled nursing facilities, hospices, inpatient psychiatric facilities and inpatient rehab facilities.

The agency also proposed various policy changes for each provider type to reduce burden on them and the patients that use their facilities.

Skilled nursing facilities would receive a 2.4% bump, or $850 million more, compared to what they received this year. Last year, they garnered a 1%, or $370 million, raise.

As part of the SNF pay rule, the CMS is proposing a patient driven payment model, an new system that ties SNF payments to patients' conditions and care needs rather than volume of services provided.

The model also would reduce documentation standards around patient assessments, savings facilities approximately $2 billion over 10 years.

As part of the CMS' meaningful measure initiative, it is considering adopting new standards to help determine what measures SNFs report should get the axe. The changes would include taking into account costs that are associated with a measure and weighing them against the benefit of its continued use in the program, according to the proposed rule.

It's unclear what measures could be on the choppig block, but the CMS asked for comments on if they should make this change.

"Our goal is to move the program forward in the least burdensome manner possible, while maintaining a parsimonious set of meaningful quality measures and continuing to incentivize improvement in the quality of care provided to patients," the rule said.

The CMS proposed that hospices receive a 1.8%, or $340 million, increase in reimbursement next year. That's up from the 1%, or $180 million, bump they got last year. Hospices would also see some technical changes to the Hospice Compare policies site to ensure accurate information is posted. Since its launch last August, the site has been riddled with incorrect addresses, phone numbers and profit status for providers.

For inpatient psychiatric facilities, the agency is suggesting a less than 1% or $50 million raise. That's similar to a modest 1% or $45 million increase they received last year.

The CMS also proposed to eliminate eight quality measures for the facilities, including ones that tracked patient flu vaccination rates and tobacco and alcohol use.

Finally, inpatient rehab providers may end up receiving an additional $75 million, or 0.9%, increase next year if its rule is finalized. That is identical to what they received last year.

To reduce regulatory burden on rehabilitation providers, the CMS proposed revising coverage criteria including allowing post-admission physician evaluation to count as one of the face-to-face physician visits, allowing the rehabilitation physician to lead the interdisciplinary team meeting remotely without any additional documentation requirements and removing certain duplicative documentation requirements.

Comments on the proposals are due June 26.

An edited version of this story can also be found in Modern Healthcare's April 30 print edition.