CMS Issues Proposed Rules for Rehab and Skilled Nursing Facilities

On April 17, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that would update Medicare payment policies for Medicare Inpatient Rehabilitation Facilities (IRF). Two days later, on April 19, CMS issued another proposed rule, this one updates the Medicare payment rates and the quality programs for skilled nursing facilities (SNFs).

Let’s start with the proposed rule (CMS-1710-P) for inpatient rehab facilities, which CMS says will “rebase and revise the IRF market basket to reflect a 2016 base year rather than the current 2012 base year.â€

The rule proposes a 2.3 percent, or $195 million, increase in Medicare payments to inpatient rehabilitation facilities in fiscal year 2020, as compared to 2019. Rural facilities would realize a larger pay increase than those in urban areas, with IRF payments per discharge estimated to increase by 4.3 percent in rural areas compared with a 2.2 percent in urban areas.

CMS also is proposing updates to the IRF Quality Reporting Program. The proposal includes the adoption of two new measures, the modification of an existing measure and the adoption of new standardized patient assessment data elements. The program applies to freestanding IRF’s, as well as inpatient rehabilitation units of hospitals or critical access hospitals paid by Medicare under the IRF Prospective Payment System (PPS).

The two measures CMS is proposing to adopt are: (1) Transfer of Health Information to the Provider–Post-Acute Care (PAC); and (2) Transfer of Health Information to the Patient–Post-Acute Care (PAC). Both support CMS’ Meaningful Measures priority of promoting effective communication and coordination of care, specifically the Meaningful Measure area of the transfer of health information and interoperability.

CMS also is proposing to adopt a number of standardized patient assessment data elements (SPADEs) to assess cognitive function and mental status, special services, treatments and interventions, medical conditions and comorbidities, impairments, and social determinants of health (race and ethnicity, preferred language and interpreter services, health literacy, transportation, or social isolation).

CMS says the addition of these SPADEs to the IRF-Patient Assessment Instrument (IRF-PAI) “will improve coordination of care and facilitate communication between PAC providers and other members of the healthcare community, which is in alignment with CMS’s strategic initiative to improve interoperability.â€

CMS will accept comments on this proposed rule until June 17.

With regard to the second proposed rule, (CMS-1718-P) skilled nursing facilities (SNFs) could receive an $887 million or 2.5 percent increase in aggregate payments in fiscal year 2020. The rule would update the Medicare payment rates and quality programs for SNFs as part of CMS’ “continuing efforts to strengthen the Medicare program by better aligning payment rates for these facilities with the costs of providing care and increasing transparency so that patients are able to make informed choices,†the agency stated.

The proposed rule includes policies that would continue a commitment to shift Medicare payments from volume to value.

CMS is also proposing to adopt two new quality measures designed to assess how health information is shared. They are : 1) Transfer of Health Information from the SNF to another Provider, and 2) Transfer of Health Information from the SNF to the Patient.

CMS will accept comments on this proposed rule until June 18.

The Health Law Offices of Anthony C. Vitale can assist providers in understanding how the proposed rules will affect your revenue and compliance obligations and/or prepare comments to the Secretary of HHS regarding the proposals.