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Blog: Breaking News: CMS Final Rule Is Released! Here’s What You Need to Know

CMS released the Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule for fiscal year (FY) 2024 on July 31, 2023.  We’ve provided the CMS Fact Sheet here and pulled out a few of the significant updates that vary from the proposed rule released this spring.

FY 2024 Updates to the SNF Payment Rates

CMS announced a 4% increase vs. the proposed 3.7%.

This estimate reflects:

  • $2.2 billion increase resulting from the 6.4% net market basket update to the payment rates
  • 3.0% SNF market basket increase
  • 3.6% market basket forecast error adjustment
  • 0.2% productivity decrease
  • Negative 2.3% (approx. $789 million) decrease in the FY 2024 SNF PPS rate
  • PDPM second phase parity adjustment recalibration

Note: These figures do not incorporate the payment reductions that certain SNFs may be subject to under the SNF VBP.

Skilled Nursing Facility Quality Reporting Program (SNF QRP)

SNFs not meeting requirements are subject to a 2% reduction in their Annual Payment Update (APU).

  • DC Function Score: Percentage of SNF residents who meet or exceed an expected Discharge Function Score that uses self-care and mobility items from Section GG on the MDS, which have replaced the late loss ADL items previously used to assess changes in functional outcomes. 
  • COVID-19 Vaccine: Percentage of residents and healthcare personnel who are up to date per CDC guidelines.
  • Data Completion Threshold for MDS Assessment Items: 100% of assessment questions must now be complete on 90% of assessments submitted to CMS. If less than 90% are 100% complete, there will be a 2% payment reduction penalty. Note: Dashing a MDS assessment question renders it incomplete.
  • Transfer of Health Information to Subsequent Provider or Patient/Family/Caregiver at Time of DC: Percentage of patient stays with a DC assessment indicating a current reconciled medication list was provided.
  • NOT MOVING FORWARD with CoreQ: CMS is not moving forward with the CoreQ Short Stay Discharge Resident Satisfaction Survey requirement.

Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program

The SNF VBP Program rewards SNFs with incentive payments based on the quality of care they provide. All SNFs paid under Medicare’s SNF PPS are included in the program.

Additions to the Final Rule

  • Staff Turnover Measure will begin FY 2024.
  • DC Function Outcome Score is the same as the QRP.
  • Long-Stay: hospitalization measure and percentage of residents experiencing one or more falls with major injury.

The final rule in its entirety can be downloaded from the Federal Register here

The Point Is: Effective October 1, 2023, several changes carry potential financial repercussions. Should your teams need additional support, we are here to provide education, resources and data to help monitor and ensure success.

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