CMS Announces 2019 Medicare Payment Rules, Policy Changes for SNFs

The Centers for Medicare and Medicaid Services (CMS) has finalized and issued three 2019 Medicare payment rules for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS), Inpatient Rehabilitation Facility PPS, and Inpatient Psychiatric Facility PPS.

In an effort to modernize the Medicare system, the final rules focus on easing provider burden as well as patients over paperwork. The agency’s Patients Over Paper work initiative reduces unnecessary burden on providers by easing documentation requirements and offering more flexibility.

The agency has established an innovative new classification system under the SNF PPS rule known as the Patient Driven Payment Model (PDPM), which ties skilled nursing facility payments to patients’ conditions and care needs rather than volume of services provided. CMS estimates that this model will save providers an estimated $2 billion over the next decade.

CMS noted that these rules incorporate the continued work on the agency’s Meaningful Measures initiative—a prudent measure set that focuses on the most critical quality issues and patient safety with the least burden for clinicians and providers. Policies incorporated in the Inpatient Rehabilitation Facility PPS and Inpatient Psychiatric Facility PPS final rules ensure that the measures providers must report are patient-centered and outcome-driven rather than process-oriented. The agency hopes that these changes will allow providers to work with a smaller set of meaningful health care measures and spend more time on patient care, where applicable.

The agency also noted that the final rule for the Inpatient Rehabilitation Facility PPS will reduce the administrative and documentation burden for providers by approximately 300,000 hours. CMS explains that providers are allowed more time to be spent on direct patient care by reducing the regulatory documentation burden.

“Based on changes contained within this final rule, CMS estimates that the FY 2019 aggregate impact will be an increase of $820 million in Medicare payments to SNFs, resulting from the FY 2019 SNF market basket update required to be 2.4 percent by the Bipartisan Budget Act of 2018,” CMS explained in a final rule fact sheet. “Absent the application of this statutory requirement, the FY 2019 market basket update factor would have been 2.0 percent which reflects the SNF FY 2019 market basket index of 2.8 percent, reduced by the multifactor productivity adjustment of 0.8 percent.”

CMS estimates that the 2.0% update will result in an approximate increase of $670 million in Medicare payments to SNFs.

The complete 2019 SNF PPS final rule is available under “Special Filings” at the Federal Register’s Public Inspection Desk website: https://www.federalregister.gov/inspection.aspx.

—Julie Gould

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