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Volume XII, Number 229

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CMS Proposes Rate Changes and New Nursing Staffing Rules That Will Significantly Impact Skilled Nursing Facilities

  • CMS estimates its proposal will result in a decrease of $320 million in Medicare Part A payments to skilled nursing facilities.

  • CMS is seeking stakeholder input on the effects of direct-care staffing requirements for long-term care facilities.

On April 11, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a Proposed Rule to update Medicare payment rates for skilled nursing facilities (SNF) under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year 2023. The Proposed Rule also includes proposals for the SNF Quality Reporting Program and the SNF Value-Based Program (SNF VBP), and seeks stakeholder comment on various items. The SNF PPS Proposed Rule aims to realize the Biden-Harris Administration’s goal to improve the quality of nursing homes. 

With a combined proposed update to the payment rates of 3.9%, or $1.4 billion, and a 4.6%, or $1.7 billion, decrease in the SNF PPS rates as a result of unintentional overpayments that were made during the transition to the Patient Driven Payment Model, CMS estimates the payment policies of the proposed rule will, in the aggregate, result in a decrease of $320 million in Medicare Part A payments to SNFs in 2023. 

For the SNF QRP, CMS proposes to adopt the Influenza Vaccination Coverage among Healthcare Personnel (HCP) measure as a new measure, to revise the compliance date for certain requirements to October 1, 2023, and to revise regulation text to include a new paragraph containing the data completion thresholds required for SNFs to meet the compliance threshold for the annual payment update.  

CMS is also proposing to adopt three new measures into the SNF VBP for the FY 2026 and FY 2027 Program Years, including two claims-based measures and one payroll-based journal staffing measure. For FY 2026, CMS is proposing the adoption of the Total Nursing Hours per Resident Day measure, a structural measure that uses auditable electronic data to calculate the total nursing hours provided per resident day. 

Finally, CMS is seeking input from stakeholders on additional items, including: 

  • The effects of direct care staffing requirements for Long-Term Care (LTC) facilities, and 

  • The implementation of a Nursing Home Staff Turnover measure in the SNF VBP, which is comprised of the total nurse staff that have left an SNF over the last year.

Comments on the proposals are due by June 10, 2022.

© 2022 ArentFox Schiff LLPNational Law Review, Volume XII, Number 104
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About this Author

Diane Roldán Attorney Health and Business Law ArentFox Schiff San Francisco
Partner

Diane helps clients avoid and resolve disputes. She counsels clients at every stage of the litigation process, from the initial complaint to the winning verdict, and in forums ranging from informal mediations to The Hague’s Peace Palace. In 2021, Diane was recognized by Chambers USA and the Legal 500 as a top attorney.

Diane specializes in the health care sector. She represents hospitals, medical staffs, residency programs, ambulatory surgery centers, health care districts, and major health care systems throughout California in...

415-805-7985
David S. Greenberg Partner ArentFox Schiff LLP
Partner

David advises the health care industry on regulatory and compliance matters, disputes, and government investigations.

David concentrates his practice on regulatory issues related to the Affordable Care Act, the False Claims Act, the Anti-Kickback Statute, the Stark Laws, managed care laws, state licensure, self-disclosures, reimbursement and payment, and participation in Medicare, Medicaid, and other government health care programs. He is experienced in conducting internal investigations and representing health care companies in state and...

202-775-5756
Rachel Hold-Weiss Partner ArentFox Schiff LLP
Partner

Rachel is a Partner in the New York office where she focuses on health care regulatory, transactional, and litigation matters focusing on post-acute providers.

After working as an associate and partner at ArentFox Schiff, Rachel went in-house as counsel to a home care company with operations in 11 states. Rachel re-joined ArentFox Schiff in 2017 and continues to represent various health care clients, with a focus on the representation of post-acute care providers.

214-484-3999
Fernanda Sanchez Jara Associate ArentFox Schiff LLP
Associate

Fernanda represents small and large companies as well as individuals in various business and commercial matters. She defends employers in a range of industries.

Prior to joining ArentFox Schiff, Fernanda was a Law Clerk at the Los Angeles Center for Law and Justice, where she assisted survivors of domestic violence and other crimes. Fernanda was also a Student Volunteer at the Self-Help desk of the U.S. Bankruptcy Court for the Central District of California.

213-988-6688
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