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  • SNF and IRF Proposed Rules Continue CMS Push Toward Quality Reporting, Value-Based Payment

    Continued emphases on quality reporting and new payment models are at the center of the Centers for Medicare and Medicaid Services’ (CMS) proposed 2017 rules for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs), along with an $800 million increase in payments to SNFs, and a $125 million increase for IRFs.

    CMS is proposing an overall payment increase of 2.1%, or an estimated $800 million, but the rule also includes notice that CMS is continuing its push for quality-reporting measures required by the Improving Post Acute Care Transformation (IMPACT) Act. The 2017 proposed rule adds to the list of quality measures that will be required of SNFs beginning in 2018 to include data on discharge to community, Medicare spending per beneficiary, and potentially preventable 30-day readmissions. The proposal also stipulates that by 2020, SNFs will be required to supply reports on drug regimen reviews with follow-up.

    The rule also provides a few more details on how CMS intends to create a value-based purchasing program (VBP) for SNFs as it continues to research different models. According to a fact sheet from CMS, the agency will seek public comment on performance standards, performance periods, scoring methodology, and the development of confidential feedback reports. APTA will advocate for a physical therapy representative to serve on the technical expert panel that will review input.

    Next year's payment increase for IRFs is proposed to drop slightly from this year's overall 1.6% increase, down to 1.45% overall (estimated $125 million), though the final amount may be updated "if more data becomes available," according to a CMS fact sheet.

    Like the SNF proposed rule, the IRF proposal also establishes more quality-reporting requirements around many of the same areas that will be required of SNFs (discharge, spending, readmissions, drug regimen review, etc). Additionally, the IRF rule would add 4 new measures to the facilities' public reporting requirements, including reports to a publicly accessible CMS website, such as Hospital Compare.

    APTA will submit comments on both proposed rules by the June 20 deadline. In addition, the association will develop fact sheets on the rules to help members understand what's being proposed.

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