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.
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).
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).