The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service prospective payment system (PPS) for skilled nursing facilities (SNFs) for federal fiscal year (FY) 2025.
Key provisions include:
- Increasing the per diem federal rate by a net 4.2% after the market basket update, productivity adjustment and other adjustments.
- Updating the base year data used to determine the SNF market basket from 2018 to 2022.
- Updating the wage index used under the SNF PPS to reflect data from the 2020 decennial census.
- Increasing the labor-related share of the per diem rate from 71.1% to 72%.
- Making technical updates to the code mappings used to classify patients under the Patient Driven Payment Model that assigns patients to clinical categories.
- Revising the regulations to allow the CMS to impose additional financial penalties on facilities with health and safety deficiencies as identified.
- Adopting four new patient assessment items related to health-related social needs, with SNFs required to collect and report specific data elements related to living situation, food and utilities beginning with the FY 2027 SNF quality reporting program (QRP).
- Modifying the transportation item on the patient assessment item to simplify response options while also using a defined 12-month look-back period.
- Adopting a data validation process for the SNF QRP beginning with the FY 2027 program.
- Proposing operational updates to the SNF Value-Based Purchasing program, including policies regarding measure removal and review and corrections.
- Updating the case mix methodology used to calculate the Total Nurse Staffing measure.
The MHA will provide SNFs with an updated facility-specific impact analysis and additional details on the final rule, effective Oct. 1, in the near future. Members with questions should contact Vickie Kunz at the MHA.