The Centers for Medicare & Medicaid Services (CMS) published the final rule updating Medicare rates for skilled nursing facilities for federal Fiscal Year (FY) 2022 in the August 4, 2021 Federal Register. The rates will be effective from October 1, 2021 through September 30, 2022. Fiscal year 2022 represents the third year of the Patient Driven Payment Model (PDPM) payment system for skilled nursing facilities.
The final rule included some very good news for SNF providers! Following a proposed rule in which CMS indicated its intent to reduce PDPM rates by a 5% “parity adjustment” to ensure PDPM budget neutrality, the final rule ultimately provides for a 1.2% net market basket increase over FY 2021, which is estimated to increase nationwide SNF payments by approximately $411 million. While the parity adjustment was not implemented for FY 2022 PDPM rates, we expect the issue to arise again in next year’s proposed rule, which will be released in April 2022.
The final rule also made adjustments to the technical mapping of certain conditions between ICD-10 diagnoses and PDPM groupings. CMS has posted an updated PDPM ICD-10 mapping file on its website to assist providers with coding crosswalks and classification logic.
PDPM RATES EFFECTIVE 10/1/2021
The links in the list below provide the detailed calculations of the PDPM rates for each of the 15 CBSAs in Ohio. The rates provided for the individual CBSAs are shown prior to the Quality Reporting Program and Value-Based Purchasing adjustments.
Please select the CBSA from the list below in which your county resides to open a printable PDF file. If you are not sure which CBSA to choose, please click the first link to open a crosswalk between the county names and the CBSA names.
DETAILED CALCULATIONS BY OHIO CBSA NAME
- Akron
- Canton-Massillon
- Cincinnati
- Cleveland-Elyria
- Columbus
- Dayton-Kettering
- Huntington-Ashland (Lawrence Cty, OH)
- Lima
- Mansfield
- Rural Ohio
- Springfield
- Toledo
- Weirton-Steubenville (Jefferson Cty, OH)
- Wheeling, WV (Belmont Cty, OH)
- Youngstown-Warren-Boardman
With the move from 66 groups in the RUG-IV system to over 28,000 possible groups in PDPM, as well as tapering of the non-therapy ancillary and therapy components, these rates are not as meaningful as the RUG-IV rates we provided in previous years, as all six components must be combined to determine the daily rate.
We have developed a calculator to assist in calculating rates for all PDPM groups. The calculator can assist you in seeing changes in reimbursement over the course of a Part A stay due to the potential impacts of tapering and AIDS diagnoses. Please contact us for more information if you are interested.
These rates are subject to change. If a Correction Notice is issued that affects any Ohio counties, we will update our website links with the new rates.
SNF VALUE-BASED PURCHASING PROGRAM
In previous years, providers who scored well on the SNF Value-Based Purchasing (VBP) hospital readmission measures had the opportunity to earn an increase to their PDPM rates, while those who ranked lower could lose up to 2% of their PDPM rates. However, due to the COVID-19 Public Health Emergency, CMS made the decision to suppress the hospital readmission calculations used for SNF VBP for FY 2022. As a result, CMS will apply an identical adjustment to most providers, who will see a .8% reduction to their PDPM rates. Low utilization providers (e.g., those with fewer than 25 stays) will not be affected by VBP and will not receive a reduction to their rates. While these adjustments will remain in effect throughout FY 2022, we expect the SNF VBP calculations to return to normal after the Public Health Emergency is lifted.
SNF QUALITY REPORTING PROGRAM (QRP)
Effective October 1, 2018, SNFs that failed to submit required quality data to CMS under the SNF Quality Reporting Program will have their Medicare payment rates reduced by two percentage points. The majority of the reporting is done via the MDS assessment. As a result, most facilities met the requirements and avoided the payment reductions. However, facilities that did not respond to CMS “Review and Correct” reports may not have qualified for the QRP, and as a result, will have their rates reduced by 2% through September 30, 2022.
Important note: due to the impacts of COVID-19 during Q1 and Q2 of calendar year 2020, the SNF QRP payment impact is based upon data collected only in Q3 and Q4 or calendar year 2020
The FY 2022 final rule included two new measures for the SNF QRP:
- SNF Healthcare-Associated Infections Requiring Hospitalizations will be used beginning October 1, 2022. The measure will include conditions such as sepsis, UTIs, and pneumonia that were acquired during an SNF stay.
- COVID-19 Vaccination Coverage Among Healthcare Personnel will be used beginning October 1, 2021. Providers must report one week of data each month to the CDC’s National Healthcare Safety Network (NHSN).
PROVIDER RELIEF FUND REPORTING
CMS has granted healthcare providers a 60-day grace period for Provider Relief Fund (PRF) reporting due September 30, 2021 (Reporting Period 1). Providers who file after September 30, 2021, will be considered out of compliance but will be placed back into compliance immediately following the submission of their report. Further, while not technically an extension of the due date, CMS will not initiate recoupment or other enforcement actions for providers during the grace period. The grace period applies only to the due date of the submission. It does not change the Period of Availability for use of PRF payments (i.e., funds received between April 2020 and June 2020 must be used in full by June 30, 2021).
We are available to help with Provider Relief Fund reporting. With HRSA guidance lacking in many areas, errors or oversights in reporting could lead to recoupments of your much-needed Provider Relief Funds. Please contact your HW Healthcare Advisor if you need assistance with your PRF reporting.
Throughout the ongoing COVID-19 pandemic, the Department of Health & Human Services (HHS) and various states have assisted healthcare providers with funding to support the additional expenses and lost revenue incurred due to the virus. Various terms and conditions governing how the funds can be used have been attached to these payments and guidance from HHS has been constantly changing. We invite you to visit our website to view the articles we have published regarding the provider relief funding, as well as the Payroll Protection Program and many other COVID-19 topics of interest.
HW HEALTHCARE ADVISORS
Our team consists not only of CPAs, but also highly trained and experienced billing/revenue cycle consultants, certified medical office managers, and LNHAs. We are dedicated to working with the regulatory, operational, and reimbursement challenges that providers face in an ever-changing healthcare environment.
We can assist you in streamlining your processes, optimizing your operations, and identifying potential opportunities and risks. Please contact any of our HW Healthcare Advisors to discuss how we can help you and your facility stay on the path to success.
anderson@hwco.com
