The Centers for Medicare & Medicaid Services (CMS) finalized the Fiscal Year (FY) 2019 Medicare payment rule for the Skilled
Nursing Facility (SNF) Prospective Payment System (PPS). The rule establishes a
market basket increase of 2.4 percent, a figure statutorily mandated by
Congress, and will start October 1, 2018.
CMS anticipates aggregate payments to SNFs will increase by
$820 million from payments in in the previous Fiscal Year. This is $30 million
less than in the proposed payment rule issued previously this year. AHCA has begun work to identify errors and opened dialogue with CMS.
Additionally, CMS finalized a payment system called the
Patient-Driven Payment Model (PDPM) to replace the current PPS. The PDPM is an
updated version of a proposed change to the payment system announced in 2017.
The implementation date for the final system is October 1, 2019 and will be
done in a budget neutral manner.
PDPM is composed of five case-mix-adjusted payment
components: Physical Therapy (PT), Occupational Therapy (OT), Speech Language
Pathology (SLP), Nursing, and Non-Therapy Ancillaries Services (NTAS).
Reimbursement would be based on the sum of the five component rates. The model
also limits the use of group and concurrent therapy to 25% of all therapy
given.
Mark Parkinson, President and CEO at the American Health
Care Association (AHCA), said in a statement
that while the 2.4% increase is necessary for struggling providers, the therapy
limits were reason for concern.
“The therapy language in the rule criticizes skilled nursing
providers for providing therapy when CMS has promulgated rules over the last 20
years that encourage therapy,” the statement said. “[T]his rule micromanages
patient care and therapy minutes at a time when providers are already
overburdened by unnecessary regulation.”
Both the final rule and a fact sheet are available online. The FY19 SNF PPS wage index
will be posted in the coming weeks.
AHCA is offering PDPM-intensive sessions at our AHCA/NCAL Convention
& Expo in San Diego take place on Sunday, October 7 and Wednesday, October
10th, more information can be found here.
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