Volume XXX, Number 5
 May 2015

CMS Releases SNF PPS Proposed Rule for FY 2016

On Wednesday, April 15, 2015 the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2016 update. Highlights of the proposed rule include:

  • The proposed rule provides for a net market basket increase for SNFs of 1.4% beginning October 1, 2015.
  • The establishment of a Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP), which implements a 2% withhold to SNF Part A payments that can be earned back based on a SNF’s re-hospitalization rate and level of improvement, as is required by the Protecting Access to Medicare Act of 2014 (PAMA).
  • SNF Quality Reporting Program (SNF QRP): New data reporting and measurement requirements for this program, established by the IMPACT Act of 2014, are proposed. The three measures being proposed are (1) new or worsened pressure ulcers, (2) falls with major injury, and (3) assessment and care planning for functional status. The data reporting requirements to implement these measures are specified in the proposed rule as well as the imposition of 2% penalty for failure to report.
  • Electronic reporting of staffing data: CMS proposes steps for implementation of the Affordable Care Act (ACA) requirement for electronic reporting of staffing data. Proposed data submission requirements include hours worked, hire and termination dates and a standardized occupation category for all employees and contract staff, to be reported into a CMS data system on a quarterly schedule starting July 2016.

The American Health Care Association (AHCA) has prepared a summary of the 150-plus page rule. To view the summary, which includes staff contacts by section, click here (if you would like to request a username and password for AHCA’s members area click here).  Additionally, AHCA /NCAL has updated its SNF PPS Medicare rate calculator based on the FY 2016 NPRM. To view and utilize the calculator, please click here.

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