This week, CMS published the Final Rule, Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2016, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and Staffing Data Collection. This final rule not only updates the FY2016 payment rates for SNFs but also finalizes requirements for several significant changes coming for SNFs in the coming years as outlined in the IMPACT Act and the Affordable Care Act. The rule is effective 10/1/15, with the exception of 483.75(u)-Staffing Data Collection, which is effective 7/1/16.
Highlights include:
FY2016 SNF PPS Payment Rates: Based on the final rule, CMS projects that aggregate payments in FY2016 to SNFs will increase by 1.2 percent. LeadingAge has updated their FY 2016 SNF Rate Calculator to reflect the final rule published August 4 in the Federal Register. This calculator will also be posted and accessible via myLeadingAge.
SNF Value-Based Purchasing – Mandated by 10/1/18: The SNF VBP was part of the Protecting Access to Medicare Act of 2014 (PAMA) which authorized establishment of the SNF VBP Program beginning with FY 2019 and established a 2 percent withhold to SNF Part A payments that can be partially earned back based on a SNF’s performance and level of improvement on metrics. PAMA requires CMS to select a risk-adjusted re-hospitalization measure and to calculate a score for each SNF, taking into account both relative performance and degree of improvement from a baseline period. CMS is also required to provide the measure and score reports to SNFs for review and to display this information on Nursing Home Compare.
The final rule adopts the SNF 30-Day All-Cause Readmission Measure, (SNFRM) (National Quality Forum/NQF #2510), as the all-cause, all-condition readmission measure that will be used in the SNF VBP Program. This measure estimates the risk-standardized rate of all-cause, unplanned, hospital readmissions for SNF Medicare beneficiaries within 30 days of their prior proximal short-stay acute hospital discharge based on claim data. CMS is required to replace this measure with an all-condition, risk-adjusted potentially preventable hospital readmission rate which will be addressed in future rulemaking.
The proposed rule also seeks comment on SNF VBP Program policies such as value-based Incentive payments; public reporting; SNF-specific performance information; and aggregate performance information which CMS will address in the FY 2017 SNF PPS proposed rule.
SNF Quality Reporting Program (QRP): This final rule adopts the 3 measures as required for the IMPACT act for payment determinations beginning with FY 2018: new or worsened pressure ulcers; falls with major injury; and assessment and care planning for functional status. Beginning October 1, 2017, SNFs that do not satisfactorily report required quality data to CMS under the SNF QRP will have their market basket percentage updates reduced by two percentage points. CMS will propose additional quality measures and resource use measures in future rulemaking.
The finalized, NQF-endorsed metrics include:
- Skin Integrity: Percent of Short-Stay Residents with Pressure Ulcers that are New or Worsened (outcome measure which is the same SNFs currently report through the MDS).
- Major Falls: Application of Percent of Long-Stay Residents Experiencing One or More Falls with Major Injury(outcome measure that will be calculated for residents receiving services under a SNF Part A stay).
- Functional Status: Application of Percent of Residents with Admission and Discharge Functional Assessment and Care Plan Addressing Function (process measure that will be collected from a new section of the MDS: GG related to the Self-Care and Mobility Sections of the CARE tool and from the QIES system).
Payroll-Based Staffing: The Rule amends the requirements for long-term care (LTC) facilities (SNFs/NFs) to incorporate the provisions in the Affordable Care Act (ACA) and IMPACT Act regarding submission of payroll-based staffing data, including the category of work performed and the hours of work provided by each category per resident per day.
CMS amends section 483.75-Administration by adding a new paragraph (u), Mandatory Submission of Staffing Information Based on Payroll Data in a Uniform Format, which requires facilities to electronically submit complete and accurate direct care staffing information, including information for agency and contract staff, based on payroll and other verifiable and auditable data. The rule specifies that staffing information submitted must include each individual’s start date, end date (if applicable), hours worked and whether the individual is an employee of the facility or is engaged by the facility as contract or agency staff. Facilities must submit direct care staffing information on the schedule specified by CMS, but no less frequently than quarterly.
Compliance will be determined under survey; failure to report or inaccuracy of information submitted may result in imposition of one or more remedies.
The final rule defines Direct Care staff as “those individuals who, through interpersonal contact with residents or resident care management, provide care and services to allow residents to attain or maintain the highest practicable physical, mental, and psychological well-being. Direct care staff does not include individuals whose primary duty is maintaining the physical environment of the long term care facility (for example, housekeeping).”
CMS is establishing a voluntary submission period beginning October 2015, including a phased-in approach to registration and training, allowing facilities to test their submission methods prior to the July 1, 2016 implementation date. The results of this voluntarily reported data will not be used/applied to the CMS Nursing Home 5-Star Quality Rating System for calendar year 2016. CMS plans to maintain a feedback loop with providers and to continue use of the CMS Form 671 during the initial implementation period. (Evvie Munley, LeadingAge)