CMS Proposes $887 Million Boost in Medicare Payments to Skilled Nursing Facilities in FY 2020 While Floating Expanded Group Therapy Definition

The Centers for Medicare & Medicaid Services (CMS) recently released its 232-page proposed rule to update the Medicare skilled nursing facility (SNF) prospective payment system (PPS) for federal fiscal year (FY) 2020, which begins on October 1, 2019. Overall, CMS projects that SNF PPS payments would rise by $887 million under the proposed rule. Specifically, CMS proposes a 2.5% increase factor, based on a SNF market basket update of 3.0% reduced by a 0.5 percentage point multifactor productivity adjustment. As we have reported previously, FY 2020 will mark the implementation of the new Patient-Driven Payment Model (PDPM) first announced during last year’s SNF PPS rulemaking cycle. PDPM focuses on a resident’s clinical condition and care needs rather than the volume of care provided. In structuring PDPM last year, CMS finalized a combined 50% limit on group and concurrent therapy furnished to a SNF resident, such that for each therapy discipline (i.e., physical…

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