CMS Finalizes Plans for Pay Hike, Less Regulation

Abstract

Regulatory changes impacting post-acute care facilities for fiscal year 2019 are expected to increase reimbursements while reducing bureaucratic burden, according to federal health officials. The Centers for Medicare & Medicaid Services long-term care hospital prospective payment system (LTCH PPS) final rule for fiscal year 2019 will raise overall payments to acute care facilities by 3%, including monies for new technology add-ons and uncompensated care, according to the agency. The standard net payment rates will increase by .09% ($39 million). Skilled nursing facilities will see a 2.4% rise in reimbursements — about $820 million over fiscal year 2018. The threat of the “25% rule” that would have reduced total reimbursements if more than a quarter of a long-term care hospital’s patients came from a single acute-care hospital has also been eliminated by the final rule. Because the changes are budget-neutral, CMS is imposing an annual decrease of about 0.9% to the standard payment rate for LTCHs through 2021. For site-neutral cases, the cut will impact only the standard rate portion of their combined payment. A new “case-mix” model for skilled nursing home facilities will go into effect in October 2019, giving providers time to learn the new ICD-10-based payment system that is tied to what is clinically relevant, rather than to the volume of services provided. The new model also decreases patient assessments documentation requirements, a move that is expected to save facilities approximately $2 billion over 10 years. Other changes include allowing post-admission physician evaluations to count as face-to-face physician visits. The rule takes effect October 1, 2018. For more information, go to https://bit.ly/2vyfr8y Whitney McKnight is a Washington, DC-based health policy freelance writer.