On July 29, 2016, CMS released three separate final rules updating the fiscal year 2017 payment rates for skilled nursing facilities (SNFs), hospices and inpatient rehabilitation facilities (IRFs).  Payments will increase under all three payment systems ‒ $920 million, or 2.4 percent for SNFs; $350 million or 2.1 percent for hospices; and $145 million or 1.9 percent for IRFs.  In addition, CMS finalized several new quality measures for each payment system as described below.  The regulations under all three final rules take effect on October 1, 2016.

In addition to updating the payment rates for SNFs, CMS finalized changes to the SNF Quality Reporting Program (QRP) by adopting four new measures.  Three of those measures are for the fiscal year 2018 payment determination and subsequent years to meet the resource use and other measure domain:

(1) Medicare Spending Per Beneficiary – Post-Acute Care (PAC) SNF QRP;

(2) Discharge to Community – PAC SNF QRP; and

(3) Potentially Preventable 30-Day Post-Discharge Readmission – SNF QRP. 

The remaining measure is for the fiscal year 2020 payment determination and subsequent years to meet the medication reconciliation domain:  Drug Regimen Review Conducted with Follow-Up for Identified Issues.  CMS also finalizes additional policies related to the SNF Value-Based Purchasing (VBP) Program.  For example, CMS specifies the SNF 30-Day Potentially Preventable Readmission Measure (SNFPPR) as the all-cause, all-condition risk-adjusted potentially preventable hospital readmission measure, which assesses the facility-level risk standardized rate of unplanned, potentially preventable hospital readmissions for SNF patients within 30 days of discharge from hospitals paid under the IPPS, critical access hospitals or psychiatric hospitals.  For a CMS Fact Sheet with more on the SNF final rule, click here.

In addition to updating the payment rates for hospices as described above, CMS finalizes changes to the Hospice Quality Reporting Program (QRP) in the hospice final rule.  Specifically, CMS provides a description of the Hospice CAHPS Experience of Care Survey, including details such as the model of survey implementation, survey respondents and eligibility criteria for the sample, and outlines participation requirements for the fiscal years 2019 and 2020 annual payment updates.  CMS also finalizes two new quality measures: (1) Hospice Visits When Death Is Imminent, which will assess hospice staff visits to patients and caregivers in the last three to seven days of life; and (2) Hospice and Palliative Care Composite Process Measure, which will assess the percentage of hospice patients who received care processes consistent with guidelines.  For a CMS Fact Sheet with more on the hospice final rule, click here.    

In addition to updating the payment rates for IRFs as described above, CMS finalizes changes to the IRF Quality Reporting Program (QRP) by adopting five new measures.  Three of those measures are finalized for the fiscal year 2018 payment determination and subsequent years to meet the resource use and other measure domains:

(1) Medicare Spending Per Beneficiary – Post-Acute Care (PAC) IRF QRP;

(2) Discharge to Community – PAC IRF QRP; and

(3) Potentially Preventable 30-Day Post-Discharge Readmission – IRF QRP.

One measure is for the fiscal year 2020 payment determination and subsequent years to meet the medication reconciliation domain – Drug Regimen Review Conducted with Follow-Up for Identified Issues.  The final measure is Potentially Preventable Within Stay Readmission for IRFs, which will be for the fiscal year 2018 payment determination and subsequent fiscal years.  For a CMS Fact Sheet with more on the IRF final rule, click here. 

All three final rules are scheduled to be published in the Federal Register on August 8, 2016.