CMS Proposes a 3.7% Boost in Skilled Nursing Facility Payments

CMS has issued a proposed rule that includes a 3.7 percent payment update for skilled nursing facilities (SNFs) and changes to the SNF Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) Program for fiscal year (FY) 2024.

The payment policies in the 2024 SNF Prospective Payment System Proposed Rule would result in a $1.2 billion increase in Medicare Part A payments to SNFs. This update reflects a $2 billion increase from the 6.1 percent net market basket update, resulting from a 2.7 percent SNF market basket increase, a 3.6 percent market basket forecast error adjustment, and a 0.2 percent decrease for productivity.

The update also reflects a 2.3 percent or $745 million reduction resulting from the second phase of the Patient Drive Payment Model (PDPM) parity adjustment recalibration. The FY 2023 SNF PPS proposed rule established a PDPM parity adjustment factor of 4.6 percent with a two-year phase-in: 2.3 percent in FY 2023 and 2.3 percent in FY 2024.

SNFs received a reimbursement boost of 2.7 percent or $904 million in the FY 2023 final rule.

CMS has proposed changes to the SNF QRP, including the adoption of three measures, the removal of three measures, and the modification of one measure. The rule would also make policy changes to the program and initiate public reporting of four measures, including the Transfer of Health Information to the Provider—PAC Measure and the Transfer of Health Information to the Patient—PAC Measure.

The rule proposed adopting the Discharge Function Score measure starting in FY 2025, which assesses functional status based on the share of SNF residents who meet or exceed an expected discharge function score.

The CoreQ: Short Stay Discharge measure, also proposed for adoption, would start in FY 2026 and calculates the share of individuals discharged from an SNF within 100 days of admission who are satisfied with their SNF stay.

The final proposed adoption is the COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date measure, starting in FY 2026. This measure reports the share of stays in which residents in an SNF have received the recommended COVID-19 vaccinations per the CDC’s most recent guidelines.

The COVID-19 Vaccination Coverage among Healthcare Personnel would be modified under the rule, requiring SNFs to newly report the cumulative number of healthcare personnel who are up to date with recommended COVID-19 vaccinations.

CMS is proposing to remove the Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function measure, the Application of the IRF Functional Outcome Measures: Change in Self-Care Score for Medical Rehabilitation Patients measure, and the Change in Mobility Score for Medical Rehabilitation Patients measure starting in FY 2025.

The proposed rule also includes changes to the SNF VBP program. CMS has proposed adopting four new quality measures to oversee staffing, hospitalizations, and discharges. The measures include the Nursing Staff Turnover measure, Discharge Function Score measure, Long Stay Hospitalization Measure per 100 residents, and Percent of Residents Experiencing One or More Falls with Major Injury.

The agency proposed replacing the Skilled Nursing Facility 30-day All-Cause Readmission Measure with the Skilled Nursing Facility Within Stay Potentially Preventable Readmissions measure starting with the FY 2028 program year and FY 2025 performance year.

The rule includes policy changes to the SNF VBP, including adopting a Healthy Equity Adjustment, increasing the payback percentage policy, and updating administrative methodology policies.

The proposed rule can be accessed here.