CMS Proposes Rules to Reform SNF and Hospice Payments and Encourage Interoperability

CAST | May 16, 2018

Proposals would raise payments to skilled nursing facilities and hospices, simplify patient classification, and increase patient access to data.

In late April, the Centers for Medicare & Medicaid Services (CMS) proposed new post-acute care payment rules that will raise Medicare payments to skilled nursing facilities by $850 million (2.4%) in fiscal year 2019, launch a simplified patient classification system a year later, and improve interoperability. Hospices would see a $340 million (1.8%) increase in payments for fiscal year 2019.
 
The Patient-Driven Payment Model (PDPM) would replace the Resource Utilization Group system, or RUG-IV, used to categorize Part A residents into various payment groups based on their level of need. This rule is said to be much simpler than the one proposed last spring, known as RCS-1, for which LeadingAge submitted comments.
 
In its announcement, CMS said the new model would reduce the number of payment group combinations by 80%, use more standardized items for payment calculations and “greatly simplify” providers' paperwork. CMS also said that reduced reporting requirements would save $2 billion systemwide in the next 10 years and better connect healthcare professionals and patients.
 
McKnight’s Long-Term Care News reported the changes, then reactions in “LTC providers see 'great improvement' in proposed new Medicare payment system.”
 
Katie Smith Sloan, LeadingAge's president and CEO, released a statement expressing support for the proposal: “LeadingAge is pleased to see that the 2.4 percent market basket increase required by the Bipartisan Budget Act will increase SNF payments by $850 million, and that CMS heard our message loud and clear that the new classification system needed significant changes.” Smith Sloan also told McKnight's she is pleased that the proposals contain “extensive quality provisions” and changes to the Value-Based Purchasing and Quality Reporting programs.
 
Cynthia Morton, executive vice president of the National Association for the Support of Long-Term Care, also supported the proposal, according to McKnight's.
 
The proposals would allow rehabilitation physicians to conduct some meetings without being physically in the room and remove overly prescriptive admission documentation requirements, McKnight’s reported. 

Interoperability

The proposed policies also begin implementing parts of the government-wide MyHealthEData initiative, and CMS has released a Request for Information (RFI) seeking stakeholder feedback as it considers revising Conditions of Participation related to interoperability, as a way to increase electronic sharing of data by providers.
 
CMS proposes that the Medicare and Medicaid Electronic Health Record Incentive Programs (also known as the “Meaningful Use” program) will be renamed “Promoting Interoperability.” Its proposed changes will make the program more flexible and less burdensome, emphasize measures that require the exchange of health information between providers and patients, and incentivize providers to make it easier for patients to obtain their medical records electronically.
 
Under the proposed rule, providers must use the 2015 Edition of certified electronic health record technology in 2019 as part of demonstrating meaningful use to qualify for incentive payments and avoid reductions to Medicare payments.
 
In announcing CMS's new Data Driven Patient Care Strategy, CMS Administrator Seema Verma said, “We know we can’t achieve value-based care until we put the patient at the center of our healthcare system…. The Data Driven Patient Care Strategy will empower patients with the information they need as consumers of healthcare to enable them to make informed decisions about the care they need. Ultimately, the cornerstone of a patient-centered system is data—quality data, cost data and a patient’s own data.” 

Submitting Comments

The proposed rule was published in the Federal Register. CMS is collecting comments on these proposals until June 26, with the final rules expected to take effect on Oct. 1, 2018.
 
CMS notes that in responding to the RFI, commenters should provide clear and concise proposals that include data and specific examples. CMS will not respond to RFI comment submissions in the final rule but will actively consider all input in developing future regulatory proposals or future sub-regulatory guidance.       

Interested in Interoperability?

Read our article on the LTPAC Health IT Summit if you are interested in interoperability and in 

  • Learning about interoperable products that support exchange of information across disparate systems, 
  • Hearing case studies from provider who used such technologies, or 
  • Seeing some of these products demonstrating interoperability and information exchange. 

Then register today to attend the Summit, which will take place June 24-26, 2018, at the Washington Hilton Hotel in Washington, DC.