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Program News and Announcements

General SNF PPS Announcements/News

MDS 3.0 changes effective for FY 2015.  The 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), can be found below.

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.

MDS 3.0 changes effective for FY 2014.  The memo which describes the transition guidelines for these changes can be found below. This memo also references an FY2013 Medicare transition RUG, which will appear on the Final Validation Report under error message number -1067 and which may be used to bill certain SNF days of service.

CMS-1446-F: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2014 (78 FR 47936) has published on August 6, 2013 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.

Information on the prospective payment system and its full legislative history entitled "Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Legislative History" can be found in the Download section of the main SNF PPS web page.

CMS-1446-P: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2014 is on public display at the Office of the Federal Register. CMS-1446-P 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.

Effective May 19, 2013, CMS is revising the MDS correction policy outlined in Chapter 5 of the MDS 3.0 RAI manual. Training materials associated with this change are available in the downloads section below.

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.

SNF Monitoring

In the FY 2012 SNF PPS final rule, we stated we would monitor the impact of certain FY 2012 policy changes on various aspects of the SNF PPS. Specifically, we have been monitoring the impact of the following FY 2012 policy changes:

  • Recalibration of the FY 2011 SNF parity adjustment to align overall payments under RUG-IV with those under RUG-III,
  • Allocation of group therapy time to pay more appropriately for group therapy services based on resource utilization and cost, and
  • Implementation of changes to the MDS 3.0 patient assessment instrument, most notably the introduction of the Change-of-Therapy (COT) Other Medicare Required Assessment (OMRA).

Please see the downloads section below for the latest information from our monitoring efforts.

SNF Value-Based Purchasing Report to Congress

The Affordable Care Act requires the Secretary of Health and Human Services to develop a plan to implement a value-based purchasing (VBP) program for payments under the Medicare program for skilled nursing facilities (SNFs). The Secretary shall submit the report containing this plan to Congress.

The Report to Congress describes the current efforts to improve quality and payment efficiency in SNFs. In addition, it considers the steps required in designing and implementing a SNF VBP program for payments under the Medicare program. CMS views VBP as an important step forward in revamping how Medicare pays for health care services; moving the program towards rewarding better value, outcomes, and innovations, instead of merely volume.

The SNF VBP Report to Congress was authorized under Section 3006(a) of the Patient Protection and Affordable Care Act (Pub. L. 111-148), enacted on March 23, 2010, as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152), enacted on March 30, 2010 (collectively known as the Affordable Care Act) (as added by section 10301(a) of the Affordable Care Act).

See the SNF Value-Based Purchasing Report to Congress in the Downloads section below.

Attention:  SNF Swing Bed Providers 

The conversion from AT&T to Verizon is currently underway. If you have not yet converted to Verizon, please access the QTSO CMSNet Information website (See Related Links Outside CMS) for the detailed Installation Guide and FAQ document. The Submission Access link is also at this site. CMS has urged all SNF SB providers to transition during the month of December 2011. The AT&T connection is scheduled to be unavailable after January 15, 2012, so it is extremely urgent that you act now if you have not already converted. You will use your current AT&T login ID (example: IRF1234/SWB1234/CAH1234) to access the Verizon client install. Your password will equal your login id. 

You do not need to apply for a new ID – use your existing AT&T login ID. Be sure that you have administrative rights on the PC before beginning the client install. Consult the FAQ document if you are not sure. 

The install is fairly quick and easy. CMS is sure you will find the new Verizon method faster and easier to use. If you are having problems installing the Verizon client after reading the detailed Installation Guide, you may contact the Verizon Help Desk at 888-238-2122. 

The conversion deadline is January 15th, 2012.

Thank you for your cooperation.

The August 23, 2011 National Provider Call follow-up and clarifications are available on the FY 2012 RUG-IV Education & Training web page.

The transcript to the Special Open Door Forum (September 1, 2011), a follow-up to the August 23, 2011 National Provider Call, is available on the FY 2012 RUG-IV Education & Training web page.

The training slides and audio and written transcripts to the August 23, 2011 National Provider Call are found on the FY 2012 RUG-IV Education & Training web page.

Therapy Minutes by Mode for Different Ownership Status Types utilizing the first quarter of FY 2011 data and utilizing the first eight months of FY 2011 is available in the Downloads section below.

National Provider Call on Skilled Nursing Facility Prospective Payment System Fiscal Year 2012 Policy Changes Relating to the Minimum Data Set Version 3.0 The Centers for Medicare & Medicaid Services (CMS) will host a National Provider Call on "Skilled Nursing Facility (SNF) Prospective Payment System (PPS) FY2012 Policy Changes Relating to the Minimum Data Set (MDS) 3.0".  Subject matter experts will discuss new MDS 3.0 policies that will be implemented on October 1, 2011.  A question and answer session will follow the presentations.

When:  August 23, 2011
Time: 1:30 p.m. – 3:00 p.m. ET
Target Audience: SNF providers, RAI coordinators, State RAI coordinators, therapists
The following topics will be discussed:

  • Allocation of group therapy
  • Student supervision
  • Changes to the MDS Assessment Schedule
  • End of Therapy (EOT) Other Medicare Required Assessment (OMRA) Clarifications
  • End Of Therapy with Resumption (EOT-R)
  • COT OMRA
  • Transition timeline for new policies

Fiscal Year 2012

  • CMS 1351-CN (Publication Date: September 23, 2011):  Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2012; Correction  is available for download from the List of SNF Federal Regulations web page
  • Wage Index tables as published in the SNF PPS FY 2012 final rule are available for download from the Wage Index web page.
  • Medicare patient days by Resource Utilization Group (RUG) under the RUG-III and RUG-IV payment systems by provider number. Data utilizing FY 2011 first quarter Medicare claims matched to MDS assessments used for the SNF PPS FY 2012 proposed rule and data utilizing the first eight months of FY 2011 Medicare claims matched to MDS assessments used for the SNF PPS FY 2012 final rule are available in the Downloads section below.
  • Medicare patient days by Resource Utilization Group (RUG) under the RUG-III payment system by provider number. This data utilizes FY 2010 fourth quarter National Claims History (NCH) Medicare claims data and is available in the Downloads section below.
  • SNF Baseline Expenditure Data Used to calculate the impact analysis for the FY 2012 SNF PPS Proposed Rule as well as date used to calculate the impact analysis for the FY 2012 SNF PPS final rule is available in the Downloads section below.
  • Determining RUG-III Group Distribution Based on MDS 3.0 Data is available in the Downloads section below.
  • Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2012 (CMS 1351-F) is available for download from the List of SNF Federal Regulations web page.
  • RUG-III and RUG-IV Distribution of Service Days based on the first quarter of FY 2011 data used for the FY 2012 SNF PPS proposed rule and service days based on the first eight months of FY 2011 used for the FY 2012 SNF PPS final rule are available for download from the Downloads section below.
  • RUG-III service days for FY 2010 by month data used to evaluate possible seasonality is available for download from the Downloads section below.
  • National Therapy Associations' SNF Student Supervision Guidelines are available in the Downloads section below.
  • Comparison of Expected versus Actual RUG-IV Utilization for the first 8 months of FY 2011 is available in the Downloads section below.