CMS proposes more than $1 billion in additional reimbursement for post-acute care providers

Authored by Mark Ross

The Centers for Medicare and Medicaid Services (CMS) recently released its annual proposed pay rules for skilled nursing facilities, hospices, inpatient psychiatric facilities and inpatient rehab facilities, which included more than $1 billion in raises and various policy changes that are intended to reduce the burden on post-acute care providers and their patients.

There are several updates and initiatives included in the proposed skilled nursing facility rule:

  • A 2.4 percent increase in reimbursement or $850 million more than FY 2018; for FY 2018, skilled nursing facilities received a 1 percent increase in reimbursement or $370 million
  • A new payment system that ties skilled nursing facility payments to patients' conditions and care needs rather than volume of services provided
  • Streamlining patient assessment documentation standards, which could save facilities an estimated $2 billion over a 10-year period.
  • New standards which take into account the cost associated with the measures skilled nursing facilities report—as well as their benefit—to determine which reporting measures should be eliminated

The rule said, “our goal is to move the program forward in the least burdensome manner possible, while maintaining a parsimonious set of meaningful quality measures and continuing to incentivize improvement in the quality of care provided to patients."

The CMS also proposed that hospices receive a 1.8 percent reimbursement increase in 2019—that translates to $340 million or nearly double the previous year’s increase. The CMS also announced potential changes to the Hospice Compare page on Medicare’s website to ensure the information provided is accurate and up to date.

For inpatient psychiatric facilities and inpatient rehabilitation facilities, the CMS is suggesting a less than 1 percent raise for FY 2019, which is similar to the increases these providers received last year. The CMS also proposed to eliminate eight quality measures for inpatient psychiatric facilities, including ones that tracked patient flu vaccination rates and tobacco and alcohol use. Further, the CMS is proposing changes to coverage criteria for inpatient rehabilitation providers in an effort to reduce regulatory burden (e.g., removing certain duplicative documentation requirements).

The proposed rules would go into effect October 1. The deadline for comment submission on the proposals is June 26.

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