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Program News and Announcements

General SNF PPS Announcements/News

In an effort to establish a comprehensive approach to Medicare Part A SNF payment reform, we are expanding the scope of the SNF Therapy Payment Research project.  Although we always intended to ensure that any revisions to therapy payment would consider an integrated approach with the remaining payment methodology, we now plan to examine potential improvements and refinements to the overall SNF PPS payment system. This expansion will allow for improving the ability for Medicare to pay adequately and appropriately for all services provided during a Medicare Part A SNF stay.  Refer to the SNF PPS Payment Model Research web page for further details.

MDS 3.0 changes effective for FY 2015.  A zip file below contains two documents related to MDS 3.0 changes effective for FY 2015. The first is a memo which describes the transition guidelines for the changes to the COT OMRA, outlined in the FY 2015 SNF PPS final rule (79 FR 45647 through 45649). The second is a memo which clarifies certain issues and scenarios related to these COT OMRA changes.

CMS-1605-F: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2015 is on public display at the Office of the Federal Register. CMS-1605-F published on August 5, 2014 and is available for download from the "List of SNF Federal Regulations" web page. The associated wage index file is available on the "Wage Index" web page.

CMS-1605-P: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2015 published on May 6, 2014 and is available for download from the "List of SNF Federal Regulations" web page. The associated wage index file is available on the "Wage Index" web page.

Observations on Therapy Utilization Trends - This memo discusses two notable trends the CMS have observed related to resident classification and therapy utilization by SNF providers for Medicare Part A residents.

Jimmo v. Sebelius Settlement Agreement – Program Manual Clarifications (Fact Sheet).  As explained in the previously-issued Jimmo v. Sebelius Settlement Agreement Fact Sheet (see Downloads section below), the Centers for Medicare & Medicaid Services (CMS) is issuing revised portions of the relevant program manuals used by Medicare contractors.  For additional information, please see the Jimmo v. Sebelius Settlement Agreement – Program Manual Clarifications (Fact Sheet) in the Downloads section below.  The Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius can be found in CR 8458 and in associated MLN Matters Article, MM8458.

Jimmo v. Sebelius Settlement Agreement (Fact Sheet) - On January 24, 2013, the U. S. District Court for the District of Vermont approved a settlement agreement in the case of Jimmo v. Sebelius.  For additional information, please see the Jimmo v. Sebelius Settlement Agreement (Fact Sheet) in the Downloads section below.