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  • CMS Releases Proposed SNF Rule Heavy on Reporting Requirements

    Proposed US Centers for Medicare and Medicaid Services (CMS) rules for skilled nursing facilities (SNFs) would increase payments by $500 million in 2016 and set the stage for quality improvement and reporting requirements that, if not met, could result in loss of Medicare and Medicaid funding. The additional $500 million in aggregate funding represents a 1.4% increase.

    The majority of the rule focuses on how CMS plans to implement elements of the IMPACT Act. Passed into law last year and supported by APTA, the IMPACT Act is intended to standardize how data is collected and used across postacute care settings.

    Other parts of the proposal outline how a value-based purchasing program will be implemented beginning in 2019, and set up requirements for the submission of staffing information beginning in 2016.

    To meet provisions of the IMPACT Act, the proposed rule would require SNFs to report on several quality measures, including skin integrity, percentage of residents with new or worsened skin ulcers, incidence of major falls, and changes to their functional and cognitive status. Facilities that don't meet the reporting requirements by 2018 would be subject to a 2 percentage point payment reduction in annual updates.

    The proposed rule also sets out mandatory reporting on staffing at SNFs, including data on hours worked, resident case-mix and census, employee turnover and tenure, and hours of care provided per-resident per-day. The data would be collected on direct employees, agency employees, and contract staff; noncompliance could trigger penalties or exclusion from Medicare and Medicaid.

    In addition, CMS is seeking comments on an SNF value-based purchasing program, mandated by Congress, that would provide incentive payments to facilities based on performance beginning in 2019. The proposed rule would adopt a measure that evaluates 30-day hospital readmission rates for SNF patients, and CMS is accepting comments on policies related to that measure, mostly having to do with how performance would be measured, scored, and reported.

    The proposed SNF rule would also apply to noncritical access hospital "swing beds"—beds that are used for acute care or skilled care as needed.

    APTA has produced a summary of the proposed rule (.pdf), and will provide comments to CMS on behalf of its membership.


    • When a patient complete their 20 day or close to 20 day from my last 5 years experienced noticed that so called sub acute care nursing home sending patient back to hospital with non urgent reasons. When the patient is not quailed for acute care admission nursing home state their rooms are full or they need Physical therapy and occupational therapy eval. Why patient need Physical therapy eval if the patient is admitted to Observation with out any change in function.

      Posted by Geevar Varghese on 4/23/2015 10:43 PM

    • I feel like the proposed rule would be difficult to comply with in longterm care. We are already too heavily regulated. It will be near impossible to have face to face interaction with an md or arnp prior to transfers to hospitals

      Posted by christal woody on 9/16/2015 11:27 AM

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