The proposed rule includes PPS Payment Updates, Parity Adjustments, PDPM Code Mapping Updates. There are also updates related to SNF consolidated billing, SNF QRP, and SNF VBP.

Highlights for payments are:

• 3.9% market basket update based on a 2.8% SNF market basket update plus a 1.5 percentage point market basket forecast error adjustment and less a 0.4 percentage point productivity adjustment that will result in a $1.4 billion increase to PPS payments.
• 4.6% PDPM parity adjustment that will result in an estimated decrease of $1.7 billion.
• Permanent 5% cap on annual wage index decreases

Overall this will result in a net annual decrease of approximately $320 million.

There are some updates to PDPM ICD-10 code mappings.

• SNF Quality Reporting Program (QRP): compliance date revisions for certain QRP requirements and new influenza vaccination coverage for health care personnel measure
• SNF Value Based Purchasing (VBP): suppress the SNF 30-Day All Cause Readmission Measure for the FY 2023 program year and add 3 new measures for FY 2026 & 2027 SNF VBP program expansion years 
• Healthcare Associated Infections Requiring Hospitalization
• Total nursing hours per resident day
• Discharge to community

LeadingAge National has a high level summary of the payment rates, PDPM changes, and  the requests for information on staffing and infection isolation.

The proposed rule can be found here. CMS has also produced a fact sheet.

Stakeholders are invited to submit comments until June 10. LeadingAge is planning to provide a template with comments for members to submit to CMS.

Questions?

Contact:

David Carter
Director Health Care Finance & Policy
6c: 360.888.5702