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  • CMS Releases Proposed SNF Payment Rules, Report on Alternative Payment Systems

    Medicare payments to skilled nursing facilities (SNFs) will increase by $750 million in 2015, according to the US Centers for Medicare and Medicaid Services (CMS), which recently released a proposed payment and policy update. Along with the update, CMS has issued a report on possible alternatives to the prospective payment system (PPS) used in SNFs. The rule is on display at the Federal Register, and comments will be accepted until June 30, 2014.

    The payment change amounts to a 2% increase for SNFs. In addition the proposed rule seeks to:

    • Revise change of therapy (COT) policies to allow residents formerly but not currently in a therapy resource utilization group (RUG) to be reclassified into a new therapy RUG through the use of a COT other Medicare required assessment (OMRA), though use of the COT OMRA for initial classification of patients into a therapy RUG will still be prohibited
    • Tighten up rules governing how states can use the civil monetary penalty, and increase transparency around how this use is tracked and shared
    • Provide data about the status of the SNF therapy payment research project and therapy utilization patterns captured on CMS minimum data sets

    APTA will provide a detailed summary of the rule shortly and will submit comments on behalf of the association

    In conjunction with the payment and policy updates, CMS also released its initial findings from a project that looked at possible alternatives to the SNF PPS. The report explores 4 alternatives: a patient characteristics model that uses patient information to group patients with similar characteristics, a hybrid model that blends patient characteristics and a resource-based pricing adjustment, a fee schedule model that bases payment on actual therapy use rather than resource use, and a competitive bidding model that prices therapy services through a bidding process.

    As recommended by the consulting firm hired to conduct the analysis, CMS has selected the patient characteristics and hybrid models as a foundation for an alternative system. The development phase will include initial drafting, analysis, feedback from an expert panel, and a final summary. APTA is conducting a thorough analysis of the report and will provide commentary on the report findings to CMS.

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