CMS proposes changes to skilled nursing PPS

The Centers for Medicare and Medicaid Services is proposing fairly drastic changes in its prospective payment system for skilled nursing facilities.

CMS is presenting two potential options for the SNF PPS: The first includes a cut in payments of 11.3 percent, or $4.47 billion, as an adjustment to higher-than-projected utilizations of the highest-paid therapy categories over the last quarter. This would be offset to some extent by a 2.7 percent increase as part of the market basket update.

The second proposal would be a net increase of 1.5 percent, or $530 million, which would represent the market basket update, minus a 1.2 percent productivity update. CMS also would impose new limitations on group therapies, which have grown in utilization.

CMS noted that refinements in SNF payments made last October "may have inadvertently triggered a significant increase in overall payment levels."

Comments on the proposed rule changes are due on June 27.

In addtion to the rule change proposals, CMS released the final PPS rules for psychiatric inpatient facilities. It included a 3.2 percent market basket update, adjusted downward .25 percent under a mandate from the Patient Protection and Affordable Care Act. Average payments are expected to increase 2.74 percent.

For more information:
- read the CMS news release
- read the related AHA News Now piece

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