Measures

The SNF VBP Program’s Hospital Readmission Measure

The SNF VBP Program currently awards incentive payments to SNFs based on their performance on the SNF 30-Day All-Cause Readmission Measure (SNFRM; National Quality Forum [NQF] #2510). The SNFRM measures the rate of all-cause, unplanned hospital readmissions for SNF residents within 30 days of discharge from a prior hospital stay. The SNFRM is risk adjusted for patient demographics, comorbidities, and other health status variables that affect the probability of a hospital readmission, including diagnoses of COVID-19. Each SNF receives a SNFRM result (i.e., a risk-standardized readmission rate) for a baseline period and a performance period. The following table provides the baseline and performance periods for the Fiscal Year (FY) 2019 through FY 2025 Program years, as finalized through the federal rulemaking process.

Program Year

Baseline Period

Performance Period

FY 2019*

CY 2015 (1/1/2015-12/31/2015)

CY 2017 (1/1/2017-12/31/2017)

FY 2020 FY 2016 (10/1/2015-9/30/2016) FY 2018 (10/1/2017-9/30/2018)

FY 2021

FY 2017 (10/1/2016-9/30/2017)

FY 2019 (10/1/2018-9/30/2019)

FY 2022

FY 2018 (10/1/2017-9/30/2018)

4/1/2019-12/1/2019**

FY 2023 FY 2019 (10/1/2018-9/30/2019) FY 2021 (10/1/2020-9/30/2021)
FY 2024 FY 2019 (10/1/2018-9/30/2019) FY 2022 (10/1/2021-9/30/2022)
FY 2025 FY 2019 (10/1/2018-9/30/2019) FY 2023 (10/1/2022-9/30/2023)

CY = Calendar Year; FY = Fiscal Year.

*The SNF VBP Program shifted from calendar year to fiscal year measurement periods beginning in the FY 2020 Program year to mitigate logistical calculations concerns.

** In response to the COVID-19 public health emergency (PHE), CMS excluded qualifying claims in the first two quarters of Calendar Year (CY) 2020 (January 1, 2020 – June 30, 2020) from use in the SNF VBP Program. Additionally, because the SNFRM assessed hospital readmissions within 30 days of discharge from a prior hospitalization to a SNF and required data from 12 months prior to the start of the SNF stay for risk adjustment, residents that were discharged from the hospital to the SNF after December 1, 2019 and residents with SNF admissions from July 1, 2020 – September 30, 2020 were excluded from the SNFRM calculations due to missing data. Thus, the FY 2022 SNF VBP performance period originally specified in the interim final rule with comment was restricted to April 1, 2019 through December 1, 2019. For further information please see the interim final rule with comment (pages 54835–54837) and the FY 2022 SNF PPS final rule (pages 42503–42516).

Future Expansion of the SNF VBP Program

In Section 111 of the Consolidated Appropriations Act, 2021, Congress amended Section 1888(h) of the Social Security Act to allow the HHS Secretary to apply up to nine additional measures to the SNF VBP Program for payments for services furnished on or after October 1, 2023 (fiscal year [FY] 2024).

In the FY 2023 SNF PPS final rule (pages 47564–47580), CMS adopted two additional measures for use beginning in the FY 2026 SNF VBP Program year, and one additional measure for use beginning in the FY 2027 SNF VBP Program year. The following table lists the measures currently adopted for FY 2023 through FY 2027 Program years, as finalized through the federal rulemaking process.

Measure

FY 2023

 Program Year

FY 2024

 Program Year

FY 2025 

Program Year

FY 2026

 Program Year

FY 2027

 Program Year

SNFRM Yes Yes Yes Yes Yes
Skilled Nursing Facility Healthcare-Associated Infections (SNF HAI) Requiring Hospitalization - - - Yes Yes
Total Nurse Staffing Hours per Resident Day (including Registered Nurse [RN], Licensed Practical Nurse [LPN], and Nurse Aide hours) - - - Yes Yes
Discharge to Community—Post-Acute Care (DTC-PAC) Measure for SNFs (NQF #3481) - - - - Yes

 

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Page Last Modified:
01/12/2023 11:16 AM