Updates to the Fiscal Year (FY) 2022 proposed rule includes some minor mapping changes for the Payment-Driven Payment Model (PDPM), and two newly proposed SNF Quality Reporting Program (QRP) Quality Measures (QMs). Additional updates include requesting comment on the “Health Equity Gap” and the inclusion of additional quality measures for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP)
PDPM: Future Payment Reductions Promised
Providers initially enjoyed a 5% increase in payments following the implementation of PDPM, which was intended to be budget neutral. The Centers for Medicare and Medicaid Services (CMS) expressed the intent to reduce payments under PDPM by 5% to neutralize these payments as initially intended and is seeking comment as to whether cuts should be done all at once or over a two -year period. This plan involves adjusting the Case-Mix Indexes (CMIs) for the Case Mix Groups (CMGs) of each of the five case-mix adjusted rate components used to generate the rates under the PDPM methodology.
Some minor classification changes were made with the ICD-10 mappings which impact sickle-cell disease, esophageal conditions, multisystem inflammatory syndrome, neonatal cerebral infarction, vaping-related disorder, and anoxic brain damage.
There are two proposed SNF QRP QMs and one Request for Information (RFI):
- SNF Healthcare-Associated Infections (HAI) Requiring Hospitalization Measure
- Simply stated, looking at infections such as pneumonia and urinary tract infections in the SNF that resulted in hospitalization
- COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) Measure
- This measure would report vaccination percentages of healthcare workers in the SNF
- Closing the Health Equity Gap – RFI
- This is intended to collect data from all patients to attain health “equity” for all patients by identifying and correct racial disparities “through policy solutions.”
Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program
The CMS is proposing suppression of the SNF VBP readmission measure due to the potential impact from the pandemic. Their proposal includes continuing to withhold the 2% from all SNFs, but then paying back only 1.2% of the withheld amount to all SNFs except for low volume providers (that are currently and would remain index neutral).
Additionally, the CMS is seeking comment for the potential to add additional quality measures used for the SNF VBP in future years. Informational links:
