Proposed rule gives skilled nursing facilities a 4.1% increase
CMS wants to expand its ability to impose financial penalties for health and safety deficiencies.
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Skilled nursing facilities get a 4.1% payment increase for 2025, according to a proposed rule released by the Centers for Medicare and Medicaid Services under the Skilled Nursing Facility Prospective Payment System.
The update represents a market basket of 2.8%, plus a 1.7% market basket forecast error adjustment, and a negative 0.4% productivity adjustment.
These figures do not incorporate the value-based purchasing reductions for certain skilled nursing facilities subject to the net reduction in payments. These adjustments are estimated to total $196.5 million in 2025.
CMS proposes to update the SNF market basket base year from the current 2018 base year to a new base year of 2022 and to update the payment rates based on the 2025 market basket increase factor, as adjusted by the productivity adjustment and forecast error correction.
The proposed $4.1% payment increase for 2025 compares to a 4% increase for 2024 issued in the CMS final rule last year.
CMS also proposes to update the wage index using the Core-Based Statistical Areas to improve the accuracy of wages and wage-related costs for the area in which the facility is located.
Expanded Penalties
The proposed rule includes revisions to CMS' existing nursing home enforcement authority on safety and quality of care. It expands the penalties that can be imposed to allow for more per instance and per day civil monetary penalties.
The revisions will allow CMS to expand the mix and number of penalties in response to situations that put residents' health and safety at risk and, therefore, encourage facilities to promptly correct and maintain lasting compliance, CMS said.
CMS' current enforcement authority allows civil money penalties (CMPs) for noncompliance. Penalties can currently be imposed per day or per instance depending on the health and safety deficiencies identified, with per day penalties applied until the noncompliance is corrected and per instance penalties applied for isolated instances.
However, these penalties may not be imposed during the same survey, and per instance penalties may not be imposed concurrently for the same deficiency.
The severity of enforcement sanctions is based on the harm or potential harm to residents caused by noncompliance. This restricts the use of multiple penalties for one deficiency, which is aimed at encouraging faster correction and sustained compliance, CMS said.
CMS said it looks forward to receiving comments on how to use this proposed flexibility to better hold nursing homes accountable for failing to provide safe, quality care for their residents.
Patient-Driven Payment Model ICD-10 Code Changes
The Patient-Driven Payment Model (PDPM) uses the International Classification of Diseases, ICD-10 codes in several ways, including using the person's primary diagnosis to assign patients to clinical categories.
CMS is proposing several changes to the PDPM ICD-10 code mappings to allow providers to give more accurate, consistent, and appropriate primary diagnoses that meet the criteria for skilled intervention during a Part A SNF stay.
The proposed rule also includes a Request for Information seeking input from commenters on potential future updates to the Non-Therapy Ancillary (NTA) component of PDPM.
Quality Reporting
CMS has included updates to the Quality Reporting Program to better account for adverse social conditions that negatively impact individuals' health or healthcare.
CMS proposes adding four new social determinants of health (SDOH) items, and modifying one SDOH assessment item.
Email the writer: SMorse@himss.org
