CMS Issues FY 2019 SNF PPS Final Rule/Webinar Today!

Carl J. Pucci in Finance & Reimbursement

CMS has issued the 2019 SNF PPS Final Rule, which includes a market basket increase of 2.4%, as previously announced in the Proposed Rule. NYSHFA will calculate the revised SNF PPS rates, effective 10/1/18, over the next few weeks. Additionally, CMS has finalized the Patient-Driven Payment Model (PDPM) which replaces the current RUGS-based SNF PPS. The implementation of PDPM is 10/1/19. Below is the AHCA bulletin which includes links to the Final Rule, the AHCA summary and CMS fact sheet. 

Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS- 1696-F] outlining proposed Fiscal Year (FY) 2019 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). The FY19 final rule establishes a market basket increase of 2.4 percent, a figure statutorily mandated by Congress, and will start October 1, 2018.  

Based on changes contained within this final rule, CMS indicates aggregate payments to SNFs will increase in FY19 by $820 million, or 2.4 percent, from payments in FY18 - $30 million less than in the Notice of Proposed Rulemaking. AHCA is exploring potential issues with FY19 rates and impact analysis. At the same time, CMS notes that the overall economic impact of the SNF Value-Based Purchasing Program (VBP) is an estimated reduction of $211 million in aggregate payment to SNFs during FY19. 

Additionally, today, CMS finalized a payment system called the Patient-Driven Payment Model (PDPM) to replace the current RUGs-based SNF PPS. The PDPM is an updated version of the 2017 Advanced Notice of Proposed Rulemaking Resident Classification System Version 1 (RCS-1). CMS notes RCS-1 was revised based on stakeholder input. The implementation date for the final system is October 1, 2019 (FY20) and will be done in a budget neutral manner. 

Of note, AHCA has identified a number of anomalies in various tables throughout the final rule primarily pertaining to the FY19 RUG rates, as well as the FY19 Impact Analysis. AHCA staff and Reimbursement Committee members are in the process of analyzing these and other items that changed from the proposed to the final rule. 

Please find a summary of the final rule here. Please note that an AHCA/NCAL log-in is required to view this document. You can view the FY19 Final Rule here, as well as the fact sheet here. The FY19 SNF PPS wage index will be posted in the coming weeks. 

AHCA will host a member webinar today, August 1 at 3 PM Eastern on the FY19 Skilled Nursing Facility PPS Final Rule. Please plan to join the webinar 15 minutes prior to the scheduled start time by clicking here

You will be asked to enter your display name, email address, and number of people sitting in with you. Once this information has been added, press "Enter Meeting" to join. Please be sure to test your computer in advance here 

Based on changes contained within this final rule, CMS indicates aggregate payments to SNFs will increase in FY19 by $820 million, or 2.4 percent, from payments in FY18 - $30 million less than in the Notice of Proposed Rulemaking. AHCA is aware there are a number of errors in the FY19 rates and related tables. We have begun work to identify the errors and opened dialogue with CMS. Additionally, CMS finalized a payment system called the Patient-Driven Payment Model (PDPM) to replace the current RUGs-based SNF PPS. You can view AHCA's summary of the final rule here. (Please note that an AHCA/NCAL log-in is required to view this document.) 

If you need technical assistance during the webinar, please send a message in the chat or email ahca@commpartners.com. A recording will be available following today's session. 

NYSHFA CONTACT: 

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36