While there is an in-person option at the Four Seasons Hotel in Baltimore, MD, please note there is also a webinar-based option that is free. Both options require registration. The event will cover a number of topics including the changes to the RAI Manual and MDS 3.0 Item Sets, information on the Patient Driven Payment Model (PDPM) and how it relates to SNF QRP, new and current quality measures, available reports, etc.
Annually, the Centers for Medicare & Medicaid Services (CMS) releases proposed payment and policy rules that reflect the expected payment update for Medicare reimbursement. If Congress does not supersede existing stature payment updates are based on a formula in current law. That was the case for SNFs with a proposed 2.5% payment update and hospice with a 2.7% payment update for FY 2020. These numbers could change in the final rule, but typically little if at all, based on updated market data.
Last year, the Bipartisan Budget Act of 2018 made significant changes to the Medicare home health payment system, including a budget neutral transition to a 30-day unit of service beginning on January 1, 2020. As part of this law, Medicare rates to home health providers under the Patient-Driven Groupings Model (PDGM) will be reduced by 6.42% ($1,873.91 for a 30-day unit if service to $1,753.68) due to the behavioral assumptions allowed to reach budget neutrality.
The Centers for Medicare & Medicaid Services released the proposed Fiscal Year (FY) 2020 Payment and Policy Changes for Medicare Skilled Nursing Facilities (CMS-1718-P) on April 19. LeadingAge will be submitting comments to CMS during the rule comment period which closes at 5pm EST on June 18. Our draft is available to members for review and we invite feedback for inclusion in our final comments.
Here are the issues on which our congressional advocacy is
LeadingAge noted that the proposed $35,308 annual salary threshold for the exemption is in line with the $35,000 level we had proposed when an update in the exemption was considered in 2015 and 2017. We understand the need to update the threshold, which has not been adjusted for several years. Adequate compensation is especially important given the need to recruit more people into the long-term services and supports field.
On May 7, the White House Office of Management and Budget (OMB) published a request for comment on potential changes to how the federal government measures poverty.
Payment Update
Current law sets forth a formula that guides CMS’ proposed payment update that can be changed if Congress passes legislation to change the existing formula. In the proposed rule the payment update for fiscal year (FY) 2020 is 2.7% based on the estimated inpatient hospital market basket update of 3.2% minus the multifactor productivity adjustment estimated at 0.5%. CMS indicates this to be a $540 million increase in payments. However, that is a simplistic overview of the payment adjustment for this rule as it affects hospice rates.
This year, SNFs can access a new SNF QRP Provider Threshold Report in the CASPER system that shows, by measure, whether the SNF is sufficiently reporting data. Just because an MDS has been submitted for admission or discharge does not mean the appropriate fields are completed to satisfy the reporting requirements. Last year, some SNFs were cut 2% because submitted MDS data contained dashes in key Section GG fields and as such were deemed non-reporting.
The two models for additional testing include a:
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