On July 31, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare payment policies and rates for skilled nursing facilities under the Prospective Payment System (PPS) for fiscal year 2024. AHCA provided a summary of the final rule. Your AHCA login is required to view the summary.Highlights — The final rule provides for the following:
- Net Market Basket: Increase for SNFs of 4% (approximately $1.4 billion) beginning October 1, 2023. This is 0.3% more than was originally proposed in April. This 4% market basket update, after rounding, reflects:
- A $2.2 billion increase resulting from the 6.4% net market basket update to the payment rates, which is based on a 3.0% SNF market basket increase plus a 3.6% market basket forecast error adjustment and less a 0.2% productivity adjustment; and
- A negative 2.3%, or approximately $789 million, decrease in the FY 2024 SNF PPS rates as a result of the second phase of the Patient Driven Payment Model (PDPM) parity adjustment recalibration.
- Consolidated Billing: CMS finalized, as proposed, the addition of marriage and family therapists and mental health counselors to the list of practitioners whose services are excluded from the consolidated billing provision, effective January 1, 2024.
- SNF Quality Reporting Program (QRP):
- CMS is adopting two measures, removing three measures, and modifying one measure.
- This rule makes policy changes to the SNF QRP and begins public reporting of four measures.
- CMS is not adopting the CoreQ short-stay discharge measure that was proposed in April 2023.
- SNF Value-Based Purchasing (VBP):
- CMS is adopting four new quality measures, replacing one quality measure, and finalizing several policy changes in the SNF VBP Program.
- CMS is increasing the payback percentage policy under the SNF VBP program from the current 60% to 66% to increase bonuses provided to the high-performing, high duals SNFs beginning in the FY 2027 program year.
- Civil Monetary Penalties: The final rule eliminated the requirements for facilities to actively waive their right to a hearing in writing in order to receive the 35% penalty reduction and created in its place a constructive waiver process that would operate automatically when CMS has not received a timely request for a hearing.
