Skilled nursing facilities will get a
$750 million, or 2.2%, boost for 2021.
In a final rule, the Centers for Medicare and
Medicaid Services has announced increased Medicare payment rates for inpatient
psychiatric facilities, skilled nursing facilities and hospices.
WHY THIS MATTERS: INPATIENT PSYCHIATRIC
FACILITIES
CMS is finalizing a 2.2% payment rate update,
an estimated $95 million, for the inpatient psychiatric facilities prospective payment system for
2021.
It is also finalizing its proposal to adopt
revised Office of Management and Budget statistical area delineations resulting
in wage index values being more representative of the actual costs of labor in
a given area.
The updates will allow advanced practice
providers, including physician assistants, nurse practitioners, psychologists
and clinical nurse specialists, to operate within the scope of practice allowed
by state law by documenting progress notes in the medical record of patients
for whom they are responsible, receiving services in psychiatric hospitals.
The current regulation is inconsistent with
other recent changes finalized throughout the hospital conditions of
participation and unnecessarily imposes regulatory burden on psychiatric
hospitals, CMS said.
WHY THIS MATTERS: SKILLED NURSING FACILITIES
CMS projects aggregate payments to skilled
nursing facilities will increase by $750 million, or 2.2%, for 2021, compared
to 2020.
Skilled nursing facilities are getting routine
technical rate-setting updates to their payment rates. The rule also finalizes
the adoption of the most recent Office of Management and Budget statistical
area delineations and applies a 5% cap on wage index decreases from 2020 to
2021.
In response to stakeholder feedback, CMS is
also finalizing changes to the ICD-10 code mappings, effective beginning
in FY 2021.
The ICD-10 code mapping relates to the
Medicare Patient-Driven Payment Model, which pays for care based on patient
characteristics, rather than volume. It classifies patients in a covered
Medicare Part A skilled nursing facility into
case-mix groups using ICD-10 codes.
Each year, CMS considers recommendations from
stakeholders on changes to the ICD-10 code mappings used. This year in response
to recommendations, CMS is finalizing changes to the ICD-10 code mappings
effective October 1.
Stakeholders may continue to provide feedback.
WHY THIS MATTERS: HOSPICES
For FY 2021, hospice payment rates are updated
by the market basket percentage increase of 2.4%, which is $540 million.
Hospices that fail to meet quality reporting requirements will receive a 2% reduction to the annual market basket percentage increase for the year.
Hospices that fail to meet quality reporting requirements will receive a 2% reduction to the annual market basket percentage increase for the year.
The hospice payment system includes a statutory
aggregate cap. The aggregate cap limits the overall payments made to a hospice
annually. The final hospice cap amount for FY 2021 is $30,683.93, which is
equal to the 2020 cap amount of $29,964.78, updated by the final FY 2021
hospice payment update percentage of 2.4%.
THE LARGER TREND: SKILLED NURSING FACILITIES
The skilled nursing facility value-based
program scores facilities on their performance on a single claims-based,
all-cause, all-condition hospital readmission measure.
To fund value-based incentive payments, the
law requires CMS to reduce the adjusted federal per diem rate otherwise
applicable to each skilled nursing facility by 2%, and then to redistribute
between 50% and 70% of that total reduction as incentive payments based on
performance.
Because of this legislative requirement, the
program results in Medicare savings.
Twitter: @SusanJMorse Email the
writer: susan.morse@himssmedia.com
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