Wednesday, July 11, 2018

CMS Announces FY 2019 NF PPS Pricer Update Effective October 1, 2018

Dan Ciolek


The Centers of Medicare and Medicaid Services (CMS) announced in a MLN Matters article that they issued instructions to the Medicare Administrative Contractors (MACs) about updates to the Skilled Nursing Facility Prospective Payment System (SNF PPS) rates for Fiscal Year (FY) 2019.  For FY 2019, the SNF payment increase factor is 2.4 percent.  These rate changes (before any facility-level adjustments related to the SNF Value-Based Payment (VBP) and Quality Reporting Program (QRP)) will be effective October 1, 2018.  Billing staff should be aware to look for further details from their MAC.

Background
Annual updates to the PPS rates are required by Section 1888(e) of the Social Security Act, as amended by the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA), the Medicare, Medicaid, and State Children’s Health Insurance Plan (SCHIP) Benefits Improvement and Protection Act of 2000 (BIPA), and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), relating to Medicare payments and consolidated billing for SNFs.
Each July, CMS publishes the SNF payment rates for the upcoming FY (that is, October 1, 2018, through September 30, 2019) in the Federal Register, available online. The update methodology typically includes a forecast error adjustment whenever the difference between the forecasted and actual change in the SNF market basket exceeds a 0.5-percentage point, and an update to the Federal rates using the latest SNF full market basket adjusted for productivity. However, for FY 2019, the SNF payment increase factor is 2.4 percent, as required by Section 53111 of the Bipartisan Budget Act of 2018.

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