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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