FACT SHEET
FOR IMMEDIATE RELEASE
July 30,
2015
Contact: CMS Media Relations
(202) 690-6145 | CMS
Media Inquiries
Final
fiscal year 2016 payment and policy changes for Medicare Skilled Nursing
Facilities
Overview
On July
30, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final
rule [CMS-1622-F] outlining Fiscal Year (FY) 2016 Medicare payment rates for
skilled nursing facilities (SNFs). The FY 2016 rates and other issues discussed
in the final rule are summarized below.
The final
rule promotes policies that continue to shift Medicare payments from volume to
value. The Administration has set measurable goals and a timeline to move the
Medicare program, and the health care system at large, toward paying providers
based on the quality, rather than the quantity of care they give patients. The
final rule includes policies that advance that vision and support building a
health care system that delivers better care, spends health care dollars more
wisely and results in healthier people.
Changes
to Payment Rates under the SNF Prospective Payment System (PPS)
Based on
final changes contained within this final rule, CMS projects that aggregate
payments in FY 2016 to SNFs will increase by $430 million, or 1.2 percent, from
payments in FY 2015. This estimated increase is attributable to a 2.3 percent
market basket increase, reduced by a 0.6 percentage point forecast error
adjustment and further reduced by 0.5 percentage point, in accordance with the
multifactor productivity adjustment required by law.
SNF Quality Reporting Program (QRP)
The
Improving Medicare Post-Acute Care Transformation Act of 2014 (P.L. 113-185)
(IMPACT Act), enacted on October 6, 2014, requires the implementation of a
quality reporting program for SNFs and standardized data reporting across four
post-acute care settings, including home health agencies, inpatient
rehabilitation facilities, skilled nursing facilities and long term care
hospitals.
Beginning
with FY 2018, 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.
For
the FY 2018 SNF QRP and subsequent years, CMS proposed and is finalizing the
adoption of three measures addressing three quality domains identified in the
IMPACT Act: (1) skin integrity and changes in skin integrity; (2) incidence of
major falls; and (3) functional status, cognitive function, and changes in
function and cognitive function.
The
finalized measures are identified below in the Summary Table of Domains and
Finalized Measures for the SNF QRP. CMS intends to propose additional
quality measures and resource use measures in future rulemaking.
Summary
Table of Domains and Finalized Measures for SNF Quality Reporting Program
|
Domain
|
Finalized
Measures
|
|
Skin Integrity and Changes in
Skin Integrity
|
Outcome Measure: Percent
of Residents or Patients with Pressure Ulcers that are New or Worsened
(Short-Stay) (NQF #0678; Measure Steward: CMS)
|
|
Incidence of Major Falls
|
Outcome Measure:
Application of Percent of Residents Experiencing One of More Falls with Major
Injury (Long Stay) (NQF #0674; Measure Steward: CMS)
|
|
Functional Status, Cognitive
Function, and Changes in Function and Cognitive Function
|
Process Measure:
Application of Percent of Patients or Residents With an Admission and
Discharge Functional Assessment and a Care Plan that Addresses Function
(NQF#2631) (Endorsed on July 23, 2015; Measure Steward: CMS)
|
SNF VBP Program
Section 215 of the Protecting
Access to Medicare Act of 2014 added new subsections (g) and (h) to section
1888 to the Social Security Act (Act). New subsection 1888(h) authorizes the
establishment of a Skilled Nursing Facility Value-Based Purchasing (SNF VBP)
Program beginning with FY 2019 under which value-based incentive payments are
made to SNFs in a fiscal year based on their performance on an adopted hospital
readmission measure for this program.
Measures
The rule finalizes adoption of the
Skilled Nursing Facility 30-Day All-Cause Readmission Measure, (SNFRM) (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.
The Act also requires CMS to
replace this measure with an all-condition, risk-adjusted potentially
preventable hospital readmission rate. CMS intends to address this topic in
future rulemaking.
Future Policy Considerations
In the proposed rule, CMS sought
public comments on numerous issues related to the SNF VBP Program’s
policies. CMS intends to propose additional details of the SNF VBP in the
FY 2017 SNF PPS proposed rule.
Staffing Data Collection
The Affordable Care Act of 2010
(Pub. L. 111-148, March 23, 2010) added a new section 1128I to the Act to
promote greater accountability for LTC facilities (defined as skilled nursing
facilities and nursing facilities pursuant to new subsection 1128I(a) of the
Act). As added by the Affordable Care Act, subsection 1128I(g) pertains to the
submission of staffing data by LTC facilities, and specifies that the
Secretary, after consulting with state long-term care ombudsman programs,
consumer advocacy groups, provider stakeholder groups, employees and their
representatives and other parties the Secretary deems appropriate, shall
require a facility to electronically submit to the Secretary direct care
staffing information, including information for agency and contract staff,
based on payroll and other verifiable and auditable data in a uniform format
according to specifications established by the Secretary in consultation with
such programs, groups, and parties.
For more information
The final rule is on display at the
Federal Register’s Public Inspection Desk at http://www.federalregister.gov/inspection.aspx.
For further information, see http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/index.html.
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