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21018 Federal Register /Vol. 83, No. 89/Tuesday, May 8 ...

21018 Federal Register / Vol. 83, No. 89 / Tuesday, May 8, 2018 / Proposed Rules DEPARTMENT OF HEALTH AND Please allow sufficient time for mailed Readers who experience any problems HUMAN SERVICES comments to be received before the accessing any of these online SNF PPS. close of the comment period. wage index tables should contact Kia Centers for Medicare & Medicaid 3. By express or overnight mail. You Sidbury at (410) 786 7816. Services may send written comments to the To assist readers in referencing following address ONLY: Centers for sections contained in this document, we 42 CFR Parts 411, 413, and 424 Medicare & Medicaid Services, are providing the following Table of Department of Health and Human Contents. [CMS 1696 P]. Services, Attention: CMS 1696 P, Mail RIN 0938 AT24 Stop C4 26 05, 7500 Security Table of Contents Boulevard, Baltimore, MD 21244 1850. I. Executive Summary Medicare Program; Prospective For information on viewing public A.

21018 Federal Register/Vol. 83, No. 89/Tuesday, May 8, 2018/Proposed Rules DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 411, 413, and 424 [CMS–1696–P] RIN 0938–AT24

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Transcription of 21018 Federal Register /Vol. 83, No. 89/Tuesday, May 8 ...

1 21018 Federal Register / Vol. 83, No. 89 / Tuesday, May 8, 2018 / Proposed Rules DEPARTMENT OF HEALTH AND Please allow sufficient time for mailed Readers who experience any problems HUMAN SERVICES comments to be received before the accessing any of these online SNF PPS. close of the comment period. wage index tables should contact Kia Centers for Medicare & Medicaid 3. By express or overnight mail. You Sidbury at (410) 786 7816. Services may send written comments to the To assist readers in referencing following address ONLY: Centers for sections contained in this document, we 42 CFR Parts 411, 413, and 424 Medicare & Medicaid Services, are providing the following Table of Department of Health and Human Contents. [CMS 1696 P]. Services, Attention: CMS 1696 P, Mail RIN 0938 AT24 Stop C4 26 05, 7500 Security Table of Contents Boulevard, Baltimore, MD 21244 1850. I. Executive Summary Medicare Program; Prospective For information on viewing public A.

2 Purpose Payment System and Consolidated comments, see the beginning of the B. Summary of Major Provisions Billing for Skilled Nursing Facilities SUPPLEMENTARY INFORMATION section. C. Summary of Cost and Benefits (SNF) Proposed Rule for FY 2019, SNF D. Improving Patient Outcomes and FOR FURTHER INFORMATION CONTACT: Value-Based Purchasing Program, and Reducing Burden Through Meaningful Penny Gershman, (410) 786 6643, for Measures SNF Quality Reporting Program information related to SNF PPS clinical E. Advancing Health Information Exchange AGENCY: Centers for Medicare & issues. II. Background on SNF PPS. John Kane, (410) 786 0557, for A. Statutory Basis and Scope Medicaid Services (CMS), HHS. information related to the development B. Initial Transition for the SNF PPS. ACTION: Proposed rule. C. Required Annual Rate Updates of the payment rates and case-mix indexes. III. SNF PPS Rate Setting Methodology and SUMMARY: This proposed rule would FY 2019 Update update the payment rates used under Kia Sidbury, (410) 786 7816, for information related to the wage index.

3 A. Federal Base Rates the prospective payment system (PPS) B. SNF Market Basket Update Bill Ullman, (410) 786 5667, for for skilled nursing facilities (SNFs) for C. Case-Mix Adjustment information related to level of care fiscal year (FY) 2019. This proposed D. Wage Index Adjustment determinations, consolidated billing, E. SNF Value-Based Purchasing Program rule also proposes to replace the and general information. F. Adjusted Rate Computation Example existing case-mix classification Mary Pratt, (410) 786 6867, for methodology, the Resource Utilization IV. Additional Aspects of the SNF PPS. information related to skilled nursing A. SNF Level of Care Administrative Groups, Version IV (RUG IV) model, facility quality reporting program. Presumption with a revised case-mix methodology Celeste Bostic, (410) 786 5603, for B. Consolidated Billing called the Patient-Driven Payment information related to the skilled C.

4 Payment for SNF-Level Swing-Bed Model (PDPM) effective October 1, nursing facility value-based purchasing Services 2019. It also proposes revisions to the program. V. Proposed Revisions to SNF PPS Case-Mix regulation text that describes a Classification Methodology SUPPLEMENTARY INFORMATION: A. Issues Relating to the Current Case-Mix beneficiary's SNF resident'' status Inspection of Public Comments: All under the consolidated billing provision System for Payment of Skilled Nursing comments received before the close of Facility Services Under Part A of the and the required content of the SNF the comment period are available for Medicare Program level of care certification. The proposed viewing by the public, including any B. Summary of the Skilled Nursing Facility rule also includes proposals for the SNF personally identifiable or confidential Payment Models Research Project Quality Reporting Program (QRP) and business information that is included in C.

5 Revisions to SNF PPS Federal Base the Skilled Nursing Facility Value- a comment. We post all comments Payment Rate Components Based Purchasing (VBP) Program that received before the close of the D. Proposed Design and Methodology for will affect Medicare payment to SNFs. Case-Mix Adjustment of Federal Rates comment period on the following E. Use of the Resident Assessment DATES: To be assured consideration, website as soon as possible after they Instrument Minimum Data Set, Version comments must be received at one of have been received: http:// 3. the addresses provided below, no later Follow the search F. Proposed Revisions to Therapy than 5 on June 26, 2018. instructions on that website to view Provision Policies Under the SNF PPS. ADDRESSES: In commenting, please refer public comments. G. Proposed Interrupted Stay Policy to file code CMS 1696 P. Because of H. Proposed Relationship of PDPM to staff and resource limitations, we cannot Availability of Certain Tables Existing Skilled Nursing Facility Level of accept comments by facsimile (FAX) Exclusively Through the Internet on the Care Criteria transmission.

6 CMS Website I. Effect of Proposed PDPM on Temporary AIDS Add-On Payment Comments, including mass comment As discussed in the FY 2014 SNF PPS. J. Potential Impacts of Implementing the submissions, must be submitted in one final rule (78 FR 47936), tables setting Proposed PDPM and Proposed Parity of the following three ways (please forth the Wage Index for Urban Areas Adjustment choose only one of the ways listed): Based on CBSA Labor Market Areas and VI. Other Issues 1. Electronically. You may submit the Wage Index Based on CBSA Labor A. Other Proposed Revisions to the electronic comments on this regulation Market Areas for Rural Areas are no Regulation Text sradovich on DSK3 GMQ082 PROD with PROPOSALS4. to Follow longer published in the Federal B. Skilled Nursing Facility (SNF) Quality the Submit a comment'' instructions. Register . Instead, these tables are Reporting Program (QRP). 2. By regular mail.

7 You may mail available exclusively through the C. Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP). written comments to the following internet on the CMS website. The wage VII. Request for Information on Promoting address ONLY: Centers for Medicare & index tables for this proposed rule can Interoperability and Electronic Medicaid Services, Department of be accessed on the SNF PPS Wage Index Healthcare Information Exchange Health and Human Services, Attention: home page, at Through Possible Revisions to the CMS. CMS 1696 P, Box 8016, Baltimore, Medicare/Medicare-Fee-for-Service- Patient Health and Safety Requirements MD 21244 8016. Payment/ for Hospitals and Other Medicare- and VerDate Sep<11>2014 20:40 May 07, 2018 Jkt 244001 PO 00000 Frm 00002 Fmt 4701 Sfmt 4702 E:\FR\FM\ 08 MYP4. Federal Register / Vol. 83, No. 89 / Tuesday, May 8, 2018 / Proposed Rules 21019. Medicaid-Participating Providers and mix methodology called the Patient- which describes a beneficiary's SNF.

8 Suppliers Driven Payment Model (PDPM) effective resident'' status under the consolidated VIII. Collection of Information Requirements October 1, 2019. This proposed rule also billing provision, and 42 CFR. IX. Response to Comments X. Economic Analyses proposes updates to the Skilled Nursing (a)(1)(i), which describes the A. Regulatory Impact Analysis Facility Quality Reporting Program required content of the SNF level of care B. Regulatory Flexibility Act Analysis (SNF QRP) and Skilled Nursing Facility certification. Furthermore, in C. Unfunded Mandates Reform Act Value-Based Purchasing Program (SNF accordance with section 1888(h) of the Analysis VBP). Act, this proposed rule proposes, D. Federalism Analysis beginning October 1, 2018, to reduce the E. Congressional Review Act B. Summary of Major Provisions adjusted Federal per diem rate F. Regulatory Review Costs In accordance with sections determined under section 1888(e)(4)(G).

9 I. Executive Summary 1888(e)(4)(E)(ii)(IV) and 1888(e)(5) of of the Act by 2 percent, and to adjust the the Act, the Federal rates in this resulting rate by the value-based A. Purpose proposed rule would reflect an update incentive payment amount earned by This proposed rule would update the to the rates that we published in the the SNF for that fiscal year under the SNF prospective payment rates for FY SNF PPS final rule for FY 2018 (82 FR SNF VBP Program. Additionally, this 2019 as required under section 36530), as corrected in the FY 2018 SNF proposed rule proposes to update 1888(e)(4)(E) of the Social Security Act PPS correction notice (82 FR 46163), requirements for the SNF VBP, (the Act). It would also respond to which reflects the SNF market basket including requirements that would section 1888(e)(4)(H) of the Act, which update for FY 2019, as required by apply to the FY 2021 SNF VBP program requires the Secretary to provide for section 1888(e)(5)(B)(iv) of the Act (as year, changes to the SNF VBP scoring publication in the Federal Register , added by section 53111 of the methodology, and an Extraordinary before the August 1 that precedes the Bipartisan Budget Act of 2018).

10 This Circumstances Exception policy for the start of each fiscal year (FY), certain proposed rule also proposes to replace SNF VBP Program. Finally, this rule specified information relating to the the existing case-mix classification proposes to update requirements for the payment update (see section of this methodology, the Resource Utilization SNF QRP, including adopting a new proposed rule). This proposed rule also Groups, Version IV (RUG IV) model, quality measure removal factor and proposes to replace the existing case- with a revised case-mix methodology codifying in our regulations a number of mix classification methodology, the called the Patient-Driven Payment requirements. Resource Utilization Groups, Version IV Model (PDPM). It also proposes (RUG IV) model, with a revised case- revisions at 42 CFR (p)(3)(iv), C. Summary of Cost and Benefits TABLE 1 COST AND BENEFITS. Provision description Total transfers Proposed FY 2019 SNF PPS payment rate update.