Center for Medicare Advocacy Comments on Proposed Update to Medicare Reimbursement for Skilled Nursing Facilities

The Center for Medicare Advocacy’s comments on the proposed annual update to Medicare Part A reimbursement for skilled nursing facilities[1] focus largely on the tremendous (but predicted) decline in therapy services following introduction of the Patient-Driven Payment Model (PDPM) on October 1, 2019. Under PDPM, total therapy declined 30%, from 91 minutes per resident per day to 62 minutes per resident per day, and therapy services shifted from individual therapy to group and concurrent therapy. The Centers for Medicare & Medicaid Services (CMS) claims that residents were not harmed by the changes in therapy, citing the absence of change in three self-reported quality measures: falls with major injuries, stage 2-4 pressure ulcers, and hospital admissions. However, the Center cites research studies documenting the substantial underreporting by facilities of these measures.

The Center calls on CMS to enforce its requirement that group and concurrent therapy be limited to, at most, 25% of a resident’s therapy minutes.  Further, with respect to PDPM, the Center opposes CMS’s plan to delay prospective recalibration of Medicare rates.  A decade ago, CMS immediately recalibrated Medicare reimbursement rates, even though the overpayments were more than twice as high as under PDPM.

The Center supports the introduction of a measure under the Quality Reporting Program to address health care associated infections (HAIs). However, the Center opposes limiting the new measure to HAIs that require inpatient hospitalization. The Center supports a second new measure – a COVID-19 vaccination measure – and encourages CMS to include all workers who have direct contact with residents, not just health care personnel.

Finally, CMS proposes to expand the Value-Based Purchasing Program to measures beyond the 30-day all cause rehospitalization measure. The Center supports the expansion of these measures, but opposes measures based on facilities’ self-reported assessment data and so-called “satisfaction” measures.

Comments on the proposed rules, CMS-1746-P, are due June 7, 2021.

The Center’s comments are available at: https://medicareadvocacy.org/center-comments-on-snf-reimbursement-fy-2022/.

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[1] CMS, “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2022,” 86 Fed. Reg. 19954 (Apr. 15, 2021), https://www.govinfo.gov/content/pkg/FR-2021-04-15/pdf/2021-07556.pdf. See CMA, “CMS Confirms Steep Decline in Therapy at Nursing Facilities” (CMA Alert, May 6, 2021), https://medicareadvocacy.org/cms-confirms-steep-decline-in-therapy-at-nursing-facilities/