2022 Skilled Nursing Facility Prospective Payment System Proposed Rule
2022 Skilled Nursing Facility Prospective Payment System Proposed Rule Overview
FY 2022 Proposed Updates to the SNF Payment Rates
On 10/1/21, the rates for Part A have a proposed increase of 1.3%, which equates to approximately $444 million more in payments to SNFs. These are the unadjusted rates that when multiplied by the case mix index values, determine each PDPM Case Mix Group rate.
Methodology for Recalibrating the PDPM Parity Adjustment
New Blood Clotting Factor Exclusion from SNF Consolidated Billing
The proposed rule includes establishing an additional category of excluded codes, specific to certain blood clotting factors and services for the treatment of hemophilia and other bleeding disorders, from consolidated billing requirements. This exclusion affects the Part A rates as the money from Part A to Part B, and as such, proposed adjustments to the Part A rates from the NTA and Nursing Components of PDPM are included.
Proposed changes in PDPM ICD-10 Code Mappings
Skilled Nursing Facility Quality Reporting Program (SNF QRP) update
The SNF QRP is a pay-for-reporting program where SNFs who do not meet reporting requirements may be subject to a two-percentage point (2%) reduction in their annual update. CMS is proposing to adopt two new measures and update the specifications for another measure.
Skilled Nursing Facility (SNF) Healthcare-Associated Infections (HAI) Requiring Hospitalization Measure
The proposed measure uses claims data to estimate the rate of HAIs acquired during SNF care and result in hospitalization. Some of the HAIs identified in this measure include sepsis, urinary tract infection, and pneumonia. The goal of the measure is to be able to assess and compare SNFs that have notably higher rates of HAIs acquired during SNF care and result in hospitalization. Implementation of the SNF HAI measure provides information about a facility’s adeptness in infection prevention and management and encourages improved quality of care.
COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) Measure
This measure would require SNFs to report on COVID-19 HCP vaccination in order to assess whether SNFs are taking steps to limit the spread of COVID-19.. Under this proposal, SNFs would report the vaccination data through the Centers for Disease Control and Prevention National Healthcare Safety Network beginning October 1, 2021.
Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program
Proposal to suppress the SNF readmission measure in the SNF VBP Program
CMS is proposing to suppress the SNF 30-Day All-Cause Readmission Measure for the FY 2022 SNF VBP Program Year due to the significant effects of COVID-10 on the measure.
- Under this proposed suppression policy, for all SNFs participating in the FY 2022 SNF VBP program, CMS would use the previously finalized performance period and baseline period to calculate each SNF’s risk-standardized readmission rate for the SNFRM, followed by assigning all SNFs a performance score of zero, resulting in identical performance scores and identical incentive payment multipliers.
- CMS would provide each SNF with its SNF readmission measure rate in confidential feedback reports so that the SNF is aware of the observed changes to its measure rates, and rates would be publicly reported with appropriate caveats noting the limitations of the data due to the PHE.
- CMS also outlines consideration for additional VBP measures, including: functional status, patient safety, and care coordination, as well as including measures expanded to all residents, not only Part A, and is requesting public comment.
HERE is a link to the CMS Fact Sheet.