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Skilled nursing, hospice and rehab facilities see payment increases in final rule

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The Facilities for Medicare and Medicaid Solutions has released closing regulations that raise payment for qualified nursing facilities, hospice and rehab facilities.


CMS estimates that the influence of the payment insurance policies in the final rule would consequence in an raise of roughly $410 million in Medicare Portion A payments under the Skilled Nursing Facility possible payment process for FY 2022. 

This estimate reflects at $411 million raise from the update to the payment costs of one.2% – which is based mostly on a 2.seven% qualified nursing facility market basket update, fewer a .8 percentage stage forecast error adjustment and a .seven percentage stage efficiency adjustment – and a $one.2 million lower because of to the proposed reduction to costs to account for the new blood-clotting aspects exclusion. 

The legislation needs that certain specified blood clotting aspects utilized for the procedure of sufferers with hemophilia and other bleeding conditions and objects and similar services be excluded from the consolidated billing prerequisites for objects and services furnished on or after October one.

CMS is finalizing a proportional reduction in the Medicare Portion A qualified nursing facility price to account for this new exclusion. This methodology will consequence in an estimated lower of roughly $one.2 million in mixture Portion A qualified nursing facility shelling out to offset the raise in Portion B shelling out that will take place because of to these objects and services currently being excluded from consolidated billing.

These influence figures do not include the qualified nursing facility value-based mostly method reductions that are estimated to be $184.25 million in 2022.

The qualified nursing facility excellent reporting method is a shell out-for-reporting method. SNFs that do not meet reporting prerequisites may well be subject matter to a two-percentage stage reduction. 

CMS has adopted two new steps and up to date the specifications for one more evaluate. In addition, CMS has manufactured a modification to the public reporting of SNF excellent steps. 

CMS adopted a new statements-based mostly evaluate on healthcare-involved bacterial infections that consequence in hospitalization. It also adopted the COVID-19 Vaccination Protection amid Healthcare Personnel Measure beginning with 2023 reporting. This evaluate will involve SNFs to report on COVID-19 vaccinations of their employees to assess whether or not SNFs are taking steps to limit the distribute of COVID-19 amid their workforce and to lessen the risk of transmission within just their facilities.

Lastly, CMS sought feedback on the two requests for information and facts on closing the wellness equity gap and Quick Healthcare Interoperability Methods or FHIR, in assist of electronic excellent measurement in put up-acute care excellent reporting systems.

Far more information and facts on the rule is readily available from the CMS Truth Sheet.

Affected individual-Pushed PAYMENT Product

On October one, 2019, CMS carried out a new situation-mix classification design, termed the Affected individual Pushed Payment Product that would be finances neutral. Since implementation, there is an unintended raise in payments of roughly 5% or $one.seven billion in 2020. 

CMS acknowledges that the COVID-19 public wellness unexpected emergency could have impacted the info. CMS sought comment on a prospective methodology for recalibrating the parity adjustment to account for unintended boosts in payments. 

Price-Dependent Method

The value-based mostly method benefits SNFs with incentive payments based mostly on the excellent of care they supply to Medicare beneficiaries, as measured by overall performance on a one evaluate of medical center readmissions. All qualified nursing facilities that are compensated under Medicare’s possible payment process are bundled in the value-based mostly method.

CMS will suppress the Skilled Nursing Facility 30-Day All-Result in Readmission Measure for the 2022 value-based mostly method year since of the public wellness unexpected emergency. As part of a specific scoring plan, CMS will assign a overall performance rating of zero to all collaborating SNFs, irrespective of how they conduct employing the beforehand finalized scoring methodology.

The Consolidated Appropriations Act, 2021 bundled a provision permitting the Division of Well being and Human Solutions to broaden the SNF value-based mostly method and use up to an added 9 steps with respect to payments beginning in 2024, which may well include things like steps of purposeful standing, patient safety, care coordination or patient knowledge.

For every DIEM

CMS will lessen the in any other case relevant federal per diem price for every single SNF by 2% and award SNFs sixty% of that withhold, resulting in a one.2% payback percentage. Lastly, SNFs that qualify for the very low-volume adjustment will carry on to get one hundred% of that 2% withhold.


CMS’s hospice closing rule offers hospices a 2% raise for an added $480 million in their payments for 2022. This is a consequence of the 2.seven% market basket percentage increase reduced by a .seven percentage stage efficiency adjustment. Hospices that are unsuccessful to meet excellent reporting prerequisites get a 2 percentage stage reduction to the annual hospice payment update percentage raise for the year.

The payments also include things like an update to the statutory mixture cap amount, which boundaries the total payments per patient that are manufactured to a hospice every year. The cap amount for 2022 is $31,297.61, as opposed to the 2021 cap amount of $30,683.ninety three, an raise of 2%. As a consequence of the improvements mandated by the Consolidated Appropriations Act, 2021, this rule extends the decades that the cap amount is up to date by the hospice payment update percentage rather than the shopper price tag index.

In addition, this rule finalizes improvements to the Hospice Situations of Participation and Hospice High quality Reporting Method. 

The closing rule also finalizes a Household Well being High quality Reporting Method plan that gets to be efficient on October one, to put together for public reporting beginning in January 2022.

For certain statements-based mostly steps, CMS is employing 3 quarters rather than 4 quarters of info for refreshes involving January 2022 and July 2024. 

The rule rebases and revises the labor shares for all 4 levels of care: regime dwelling care, constant dwelling care, inpatient respite care and standard inpatient care based mostly on the payment price tag weights for every single level of care from the 2018 Medicare price tag report info for freestanding hospices. 

The closing 2022 labor shares are 66% for regime dwelling care, 75.2% for constant dwelling care, 61% for inpatient respite care and sixty three.5% for standard inpatient care.

As a consequence of this rule, the excellent reporting will incorporate 4 excellent steps that capture care across the hospice remain, like a new evaluate termed the Hospice Care Index. This evaluate features ten indicators of excellent that are calculated from statements info. This statements-based mostly evaluate will be publicly described no previously than May 2022.

This rule also finalizes the addition of the Purchaser Assessment of Healthcare Companies and Devices, or CAHPS Hospice Study Star scores on Care Review. 

Furthermore, the rule finalizes the addition of the statements-based mostly Hospice Visits in the Last Days of Lifetime evaluate for public reporting. The statements-based mostly steps will use 8 quarters of info to have a more substantial inhabitants for small suppliers, offering individuals more suppliers to examine. 

This rule also removes 7 individual Hospice Item Established steps since a more broadly relevant evaluate, the Hospice Thorough Assessment Measure is readily available and now publicly described. This evaluate allows to make certain all hospice sufferers get a holistic in depth assessment. 

Lastly, CMS is providing updates with regards to its development of a new Hospice Outcome and Affected individual Evaluation (HOPE) assessment instrument.


The Inpatient Rehabilitation Facility Prospective Payment Process payment costs and insurance policies will be efficient on October one. For 20222, CMS is updating the IRF PPS payment costs by one.9% based mostly on the specific market basket estimate of 2.six%, fewer a .seven percentage stage efficiency adjustment. 

In addition, the closing rule consists of an adjustment to the outlier threshold to sustain outlier payments at 3% of whole payments. This adjustment will consequence in a .four percentage stage lower in outlier payments. CMS estimates that the total IRF payments would raise one.5%, or by $a hundred thirty million. 

The IRF QRP is a shell out-for-reporting method. IRFs that do not meet reporting prerequisites are subject matter to a 2% reduction in their annual raise aspect.

CMS is adopting 1 evaluate and finalizing its proposal to update the specifications for one more evaluate. In addition, CMS is finalizing its proposal to modify the number of quarters utilized for public reporting of IRF excellent steps because of to the public wellness unexpected emergency and sought feedback for two requests for information and facts. For more information and facts, see the CMS Truth Sheet.

Clinical Products

CMS is finalizing a Medicare Resilient Clinical Products Prosthetics, Orthotics and Provides payment provision adopted in an interim closing rule with comment time period issued on May eleven, 2018, as effectively as a provision that was bundled in a proposed rule released in the Federal Register on November four, 2020.

CLOSING THE Well being Equity Gap IN High quality REPORTING

Dependable with the Biden Administration’s govt get on Advancing Racial Equity and Help for Underserved Communities Through the Federal Federal government, CMS is enhancing info collection to greater evaluate and review disparities across systems and insurance policies.

CMS reported it received suggestions on methods to attain wellness equity for all sufferers via plan answers that will be useful in potential plan perform. 

Twitter: @SusanJMorse
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