Saltmarsh Siren: CMS Issues Final Prospective Payment System Rule for Fiscal Year 2024

8/9/2023 - By Cade Crawford

On July 31, 2023, a final rule to update Medicare payment policies and rates for skilled nursing facilities under the SNF PPS system was issued by CMS for fiscal year 2024. Key updates include changes to the SNF Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) Program for FY 2024 and beyond, as well as the adoption of a measure to address staff turnover.

Other important topics addressed by this final rule are:

An estimated aggregate impact of the payment policies would result in a net increase of 4% or approximately $1.4 billion in Part A payments to SNFs in fiscal year 2024.

This is an estimated $2.2 billion increase resulting from the 6.4% net market base update to the payment rates. This estimated increase is based on a 3% SNF market base increase plus a 3.6% market basket forecast error adjustment and less a 0.2% productivity adjustment.
In addition, there is a negative 2.3%, or approximately $789 million, decrease in the FY 2024 SNF PPS rates as a result of the second phase of the Patient Driven Payment Model (PDPM) parity adjustment recalibration.

CMS is adopting two new measures in the SNF Quality Reporting Program, removing three measures from the SNF QRP, and modifying one measure. This rule will also make policy changes to the SNF QRP and begin public reporting of four measures.

CMS is adopting the Discharge Function Score (DC Function) measure beginning with the FY 2025.
CMS is adopting the COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date (Patient/Resident COVID-19 Vaccine) measure beginning with the FY 2026.
CMS is modifying the COVID-19 Vaccination Coverage among Healthcare Personnel (HCP COVID-19 Vaccine) measure beginning with the FY 2025.
CMS is removing the Application of the IRF Functional Outcome Measures: Change in Self-Care Score for Medical Rehabilitation Patients (Change in Self-Care Score) measure; and the Application of the IRF Functional Outcome Measures: Change in Mobility Score for Medical Rehabilitation Patients (Change in Mobility Score) measure beginning with the FY 2025.

CMS is adopting four new quality measures, replacing one quality measure, and finalizing several policy changes in the SNF Value-Based Purchasing Program.

The Nursing Staff Turnover Measure will begin in the FY 2026 program year.
The Discharge Function Score Measure will begin in the FY 2027 program year.
The Long Stay Hospitalization Measure per 1,000 Resident Days will begin in the FY 2027 program year.
The SNF 30-Day All-Cause Readmission Measure will be replaced with the SNF Within Stay Potentially Preventable Readmission Measure beginning with the FY 2028 program year.

To read more about the changes from this final rule, visit Fiscal Year (FY) 2024 Skilled Nursing Facility Perspective Payment System Final Rule - CMS-1779-F | CMS.

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