SUMMARY: This proposed rule would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2014, would revise and rebase the SNF market basket, and would make certain technical and conforming revisions in the regulations text. This proposed rule also includes a proposed policy for reporting the SNF market basket forecast error correction in certain limited circumstances and a proposed new item for the Minimum Data Set (MDS), Version 3.0.
DATES: To be assured consideration, comments must be received no later than 5 p.m. on July 1, 2013.
SNF PPS 2014 Draft Rule Proposes to:
- Add item O0420 to the MDS Item Set, “Distinct Calendar Days of Therapy”. Effective October 1, 2013, facilities would be required to record under this item the number of distinct calendar days of therapy provided by all the rehabilitation disciplines over the 7- day look-back period for the current assessment, which would be used to classify the resident into the correct Rehabilitation RUG category based on the requirements for number of days of therapy.
- Revise and rebase the market basket total cost data from 2004 to data reflective of FY 2010 based SNF market basket index for routine, ancillary, and capital-related expenses.
- Increase rates by 1.4 % including the multifactor productivity and the SNF market basket update.
- Discusses presumption of coverage for residents admitted directly from the hospital and who qualify for one of the upper 52 RUG levels provided that the services are also reasonable and necessary.
- Specifically invites public comments identifying HCPCS codes in any of these four service categories (chemotherapy items, chemotherapy administration services, radioisotope services, and customized prosthetic devices) representing recent medical advances that might meet the criteria for exclusion from SNF consolidated billing.
- Currently, the therapy payment rate component of the SNF PPS is based solely on the amount of therapy provided to a patient during the 7-day look-back period, regardless of the specific patient characteristics. The amount of therapy a patient receives is used to classify the resident into a RUG category, which then determines the per diem payment for that resident. CMS has contracted with Acumen, LLC and the Brookings Institution to identify potential alternatives to the existing methodology used to pay for therapy services received under the SNF PPS.
Here is the link for the full text of the proposed rule and instructions on where to submit comments: