CMS Proposes Changes to Payment Systems in 2019

PUBLISHED: May 1, 2018
Relevant to: Behavioral Health, Critical Access Hospitals, Hospice, Hospitals, Long Term Care

The U.S. Centers for Medicare and Medicaid Services (CMS) has issued proposed payment rules to update Medicare policies and rates under the Skilled Nursing Facilities Prospective Payment System (SNF PPS), Inpatient Rehabilitation Facilities Prospective Payment System (IRF PPS), Hospice Wage Index and Payment Rate Update, and Inpatient Psychiatric Facility Prospective Payment System (IPF PPS).

Links to each of the proposed payment rules is provided below. Highlights from some of proposed payment policies include:

Skilled Nursing Facility Prospective Payment System

  • As part of the SNF PPS, CMS is proposing a Patient Driven Payment Model (PDPM), an innovative new system for SNF payment that ties payment to patients’ conditions and care needs rather than volume of services provided. The proposed new PDPM is designed to improve the incentives to treat the needs of the whole patient, instead of focusing on the volume of services the patient receives, which requires substantial paperwork to track over time. Under the new SNF PPS case-mix model, patients will have more opportunity to choose a skilled nursing facility that offers services tailored to their condition and preferences, as the payment to nursing homes will be more based on the patient’s condition rather than the specific services provided by each skilled nursing facility.

Inpatient Rehabilitation Facilities Prospective Payment System

CMS is proposing the adoption of the following coverage criteria:

  • Allow the post-admission physician evaluation to count as one of the face-to-face physician visits.
  • Allow the rehabilitation physician to lead the interdisciplinary team meeting remotely without any additional documentation requirements.
  • Remove the admission order documentation requirement in an effort to reduce duplicative documentation requirements.

Want to read the full alert and receive alert emails?

Browse Additional Alerts