CMS proposes $887 million boost to SNFs

The CMS on Friday proposed increasing payments to skilled nursing facilities by $887 million, or 2.5%, in federal fiscal 2020, as the agency hopes to align their pay with value-based care.

The agency said in a notice that it will use a new case-mix model starting in October. The model will focus Medicare payments based on the patient's condition and resulting care rather than the amount of care provided.

The SNF Value-Based Purchasing Program currently scores any SNF on measures such as hospital readmissions.

The program will reduce an SNF's Medicare payments by 2 percentage points if an SNF doesn't meet the requirements. The agency will redistribute 60% of the funds collected in the program as incentive payments.

The proposed rule also releases two new quality measures to assess how health information is shared at SNFs: transferring health information from the SNF to another provider and transferring health information to a patient.

Another key change is an update to the definition of group therapy under the SNF prospective payment system. Currently group therapy is defined by the CMS as being exactly four patients.

However, other payment systems such as the one for inpatient rehabilitation facilities allow groups of two to qualify for the therapy type.

"For more fair and consistent therapy definitions across care settings, we are proposing to adopt the definition of group therapy used in the IRF PPS," the agency said in a release. "CMS believes aligning the group therapy definition serves to improve the agency's consistency in payment policies across [post-acute care] settings, and to create opportunities for site neutral payments."

The decision comes a few days after the CMS released a proposed boost in payments to IRFs by $195 million for federal fiscal 2020 compared to 2019.

The CMS also proposed to increase hospice payments by 2.7%, a $540 million increase in payments.

However, if a hospice fails to meet quality reporting requirements then they will get a 2 percentage point cut.

The agency also made changes to the Hospice Quality Reporting Program, which evaluates hospice facilities based on 10 measures.

The CMS will continue to collect data on the measure on hospice visits over the last seven days, but it proposes to not publicly report the measure at this time.

"This measure identifies if hospice patients received at least one hospice visit from a medical social worker, chaplain or spiritual counselor, licensed practical nurse, or aide during their final seven days of life, and is calculated using data from the Hospice Item Set," an agency release said. "CMS has decided not to publicly report this measure at this time to allow for further testing to determine if changes to the measure specifications or how it is displayed on Hospice Compare are needed."