Change tables, MDS mockups, and data specifications.

The Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1718-F] for Fiscal Year (FY) 2020 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). This final rule is part of the agency’s continuing efforts to strengthen the Medicare program by better aligning payment rates for these facilities with the costs of providing care and increasing transparency so that patients are able to make informed choices. The final rule [CMS-1718-F] can be downloaded from the Federal Register at: https://www.federalregister.gov/documents/2019/08/07/2019-16485/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities.

OVERVIEW

This fact sheet discusses three major provisions of the final rule:

·        SNF payment policy under the SNF Prospective Payment System (PPS)

·        SNF Value-Based Purchasing Program (VBP)

·        SNF Quality Reporting Program (QRP). 

This final rule includes policies that continue to move forward agency commitments to shift Medicare payments from volume to value, with the continued implementation of the SNF VBP and SNF QRP to improve program interoperability, operational quality and safety.

During this call, learn about your Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) Program Performance Score Report. CMS experts present a high level summary of the program and highlight the payment year 1 results (FY 2019 program year).

A question and answer session follows the presentation; however attendees may email questions in advance to SNFVBP@rti.org with "SNF VBP Aug 27 NPC" in the subject line. These questions may be addressed during the call or used for other materials following the call.

Videos and post-training materials (includes answers to knowledge checks and interactive sessions) from the May 2019 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Provider Training held in Kansas City, MO, on May 7 and 8, 2019, are now available.

Please note: Post-training materials include answers to knowledge checks and interactive sessions. Additionally, Section GG presentation has been updated to include links to videos shown during the training.

This table provides the data collection timeframes for quality measures in the Skilled Nursing Facility Quality Reporting Program (SNF QRP) displayed on the Nursing Home Compare website for Calendar Year (CY) 2019. The first column displays the plain language measure name used on the Compare website, the second column displays the full technical measure name, the third column displays the reporting cycle which describes the collection period and refresh frequency, and the last four columns contain the timeframe for each quarterly Compare website refresh.

Effective 6/1/19, there will be enhancements to the upcoming Provider Preview Reports. The next SNF Provider Preview Report is scheduled for August 1, 2019. The updates will include:

• Pressure Ulcer Measure Transition

 -The current pressure ulcer measure, Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678), will last appear on the May 2019 SNF Provider Preview Report. Starting August 1, 2019, this measure will be removed.
 -The new pressure injury measure, Changes in Skin Integrity Post-Acute Care, will first display on the August 2020 Provider Preview Report.

• Ending suppression of the PPR claims-based measure:  
 -Potentially Preventable 30-Day Post-Discharge Readmission Measure for Inpatient Rehabilitation Facility Quality Reporting Program
• Displaying measure short names in place of their long names and many aesthetic changes to field labels and headings.

• Update of the Discharge to Community Measure  
 -The refined measure results for the Discharge to Community Measure will be reflected for the first time in the fall 2019 Quarterly Refresh for the Nursing Home Compare website and the related August 2019 Provider Preview Reports.

The DTC-PAC measure was first displayed on the Nursing Home Compare website in fall 2018 and will be refreshed in fall 2019. CMS has refined the statistical methodology for assigning providers to performance categories for public display to align with the Potentially Preventable Readmissions measures in the PAC QRPs and the Hospital-Wide Readmission measure in the Inpatient QRP. This refinement results in greater variation in provider performance categories, allowing better discernment of providers that underperform or overperform considerably compared with the national rate. The refinement will be reflected for the first time in the fall 2019 Quarterly Refresh for the Nursing Home Compare website, and the related August 2019 Provider Preview Reports.

Background

·        The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) directed the Secretary to specify and publicly report measures reflecting successful discharge to community for use in the SNF QRP.

·        The SNF QRP DTC measure was finalized in the Fiscal Year 2017 SNF PPS Final Rule. Confidential feedback reports were distributed to SNF providers in fall 2017 and the measures were first displayed on the Nursing Home Compare website in fall 2018.

·        For the fall 2019 public display refresh of the DTC measure, and in future years, CMS has refined the method by which we assign providers to performance categories to align with the claims-based Potentially Preventable Readmissions measures in the SNF QRP and the Hospital-Wide Readmission measure in the Inpatient QRP.

·        Our revised methodology results in greater variation in performance categories, allowing better discernment of provider performance, including those that underperform or overperform considerably compared with the national rate. This refinement will be reflected in the fall 2019 Quarterly Refresh of the Nursing Home Compare website, as well as the August 2019 SNF Provider Preview Reports.

CMS has released two key documents in conjunction with this announcement:  FAQS for Potentially Preventable Readmission Measures for the Post-Acute QRPs and Fact Sheet  for Potentially Preventable Readmission Measures for the Post-Acute QRPs.

• Measure
• Scoring Methodology & Payment Adjustment
• Confidential Feedback Reporting & Review and Corrections
• Extraordinary Circumstance Exception
• Public Reporting of SNF VBP Program Data
• Resources

Skilled Nursing Facility Quality Reporting Program Data Collection & Final Submission Deadlines for the FY 2020 and FY 2021 SNF QRP

These two tables provide the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2021 Skilled Nursing Facility Quality Reporting Program (SNF QRP) and FY 2021 SNF QRP. The first column  in each table displays the measure name, the second column displays the data collection time frame, and the third column displays the final data submission deadlines.