The July 2020 Nursing Home Compare refresh, including quality measure results based on SNF QRP data submitted to CMS, is now available.

The following SNF QRP measures will displayed on NH Compare during the July 2020 refresh.

  1. Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay). Q4 2018 – Q3 2019 (10/01/18 – 09/30/19)
  2. Application of Percent of Long-Term Care Hospital (LTCH) Patients With an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function . Q4 2018 – Q3 2019 (10/01/18 – 09/30/19)
  3. Medicare Spending Per Beneficiary-PAC SNF QRP. Q4 2016 and Q3 2018(10/01/16 – 9/30/18)
  4. Discharge to Community-PAC SNF QRP. Q4 2016 and Q3 2018(10/01/16 – 9/30/18)
  5. Potentially Preventable 30-Day Post-Discharge Readmission Measure – SNF QRP. Q4 2016 and Q3 2018(10/01/16 – 9/30/18)

Visit the NH Compare website to view your updated quality data.

On July 31, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates the Medicare payment rates and the quality programs for SNFs.

These updates include routine technical rate-setting updates to the SNF PPS payment rates, as well as finalizes adoption of the most recent OMB statistical area delineations and applies a 5 percent cap on wage index decreases from FY 2020 to FY 2021.

CMS is also finalizing changes to the ICD-10 code mappings that would be effective beginning in FY 2021, in response to stakeholder feedback. CMS projects aggregate payments to SNFs will increase by $750 million, or 2.2 percent, for FY 2021 compared to FY 2020.

Updated Base Rates for PDPM Components

For FY 2021, the unadjusted federal rate per diem for urban and rural will be as follows, prior to adjustment for case-mix.

TABLE 3: FY 2021 Unadjusted Federal Rate Per Diem – URBAN

Table 4: FY 2021 Unadjusted Federal Rate Per Diem – RURAL

Click here to view the SNF PPS Final Rule Fact Sheet.

Link to the Final Rule – http://www.federalregister.gov/inspection.aspx

Source: Centers for Medicare & Medicaid Services, www.cms.gov

Update on CMS & MAC Claims Processing

Below is an update from AHCA on processing of Medicare claims under the Patient-Driven Payment Model. Please note particularly the part that suggests holding claims until Thursday, October 24.

On October 17th, CMS transmitted is quarterly update to all Medicare Administrative Contractors (MACs) as scheduled. CMS also indicated the MACs would need until October 24th to load, test, and launch the update.

Today, we have heard from several members about problems with claims submitted last Friday and yesterday. This likely is because the MACs require more time (e.g., until the targeted October 24th) to finish installation and testing.

Last evening, we informed CMS (both payment policy staff as well as MAC officers about the responses from MACs to-date (e.g., lower likely payments than billed). We will remain in contact with CMS in the coming days.

For now, we recommend holding submission of claims until October 24th – the date CMS indicated the MACs should be ready. On October 25th, COB, we will be in contact with membership about the result of claims submission. If problems persist, AHCA will escalate the issue quickly.