August 1, 2017

Inpatient rehab, skilled nursing facilities will see payment bump in FY 2018, CMS says

Daily Briefing

CMS on Monday issued final rules increasing payments for inpatient rehabilitation facilities (IRF) and skilled nursing facilities (SNF) for fiscal year (FY) 2018.

The rules will take effect Oct. 1.

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Inpatient rehabilitation facilities proposed rule

Under CMS' final rule for IRF payments, IRFs will see their Medicare payments for FY 2018 increase by about 1 percent, or about $75 million, when compared with FY 2017 payments. The increase was called for under MACRA.

CMS said it will keep facility-level adjustment factors for FY 2018 at their current levels. Further, CMS will no longer apply a 14.9 percent rural adjustment for 20 IRF providers that were designated as rural in FY 2015 and then changed to urban under FY 2016 regulations, in accordance with a three-year phase-out of the rural adjustment for such providers.

In addition, CMS will eliminate a 25 percent payment penalty on late IRF patient assessment instrument submissions. CMS also finalized some changes to ICD-10 lists to ensure they continue to reflect the types of patients who should count toward the IRF presumptive test for demonstrating compliance with the 60 percent rule. For instance, CMS said it will count certain ICD-10 codes for patients with traumatic brain injury or hip fracture conditions.

In response to feedback from industry stakeholders, CMS said it would not add new standardized patient assessment data to the IRF Quality Reporting Program beginning in FY 2020. However, CMS said it will revise current IRF quality reporting measures related to pressure ulcers and eliminate the all-cause unplanned readmission measure for FY 2018.

IRFs that do not submit the required quality reporting data will be subject to a 2 percentage point payment reduction in FY 2018, CMS said.

Skilled nursing facilities proposed rule

Under CMS' final rule for SNFs payments, SNFs will see their FY 2018 Medicare payments increase by 1 percent, or about $370 million, when compared with FY 2017 payments—an increase also called for under MACRA.

In response to feedback from industry stakeholders, CMS said it will not add new standardized patient assessment data to the SNF quality reporting program beginning in FY 2020. However, CMS said it will replace current SNF quality reporting measures related to pressure ulcers. CMS said that SNFs that do not submit the required reporting data under the SNF quality reporting program will be subject to a 2 percentage point payment reduction beginning in FY 2018.

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CMS also finalized proposed performance standards for the SNF value-based purchasing program, which is slated to start on Oct. 1, 2018. CMS said it will limit the program to one readmission measure for each year and will reduce by 2 percent the total amount of Medicare payments to SNFs to fund the value-based payment incentives.

CMS said, "The total amount of value-based incentive payments that can be made to SNFs' in a fiscal year will be 60 percent of the total amount withheld from SNFs' Medicare payments for that fiscal year," adding, "SNFs ranked in the lowest 40 percent" will receive "less than the amount they would otherwise be paid in the absence of the" program (AHA News, 7/31; Dickson, Modern Healthcare, 7/31; CMS IRF factsheet, 7/31; CMS SNF factsheet, 7/31).

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The Playbook for Hospital/Post-Acute Care Collaboration

Alignment between acute and post-acute care providers is essential for success, but identifying and developing strong partnerships often proves challenging.

To support both acute care systems and PAC providers in creating strong and successful alignment, this playbook collects our best resources on partnership development—from best-practice guidance to data analysis to ready-to-use tools.

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