Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2025

<RULE> DEPARTMENT OF HEALTH AND HUMAN SERVICES <SUBAGY>Centers for Medicare & Medicaid Services</SUBAGY> <CFR>42 CFR Parts 413 and 488</CFR> <DEPDOC>[CMS-1802-F]</DEPDOC> <RIN>RIN 0938-AV30</RIN> <SUBJECT>Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2025</SUBJECT> <HD SOURCE="HED">AGENCY:</HD> Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS). <HD SOURCE="HED">ACTION:</HD> Final rule. <SUM> <HD SOURCE="HED">SUMMARY:</HD> This final rule finalizes changes and updates to the policies and payment rates used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for fiscal year (FY) 2025. First, we are rebasing and revising the SNF market basket to reflect a 2022 base year. Next, we update the wage index used under the SNF PPS to reflect data collected during the most recent decennial census. Additionally, we finalize several technical revisions to the code mappings used to classify patients under the Patient Driven Payment Model (PDPM) to improve payment and coding accuracy. This final rule also updates the requirements for the SNF Quality Reporting Program and the SNF Value-Based Purchasing Program. Finally, we also are revising CMS' enforcement authority for imposing civil money penalties (CMPs) and including revisions to strengthen nursing home enforcement regulations. </SUM> <EFFDATE> <HD SOURCE="HED">DATES:</HD> These regulations are effective on October 1, 2024. </EFFDATE> <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> <E T="03">PDPM@cms.hhs.gov</E> for issues related to the SNF PPS. Heidi Magladry, (410) 786-6034, for information related to the skilled nursing facility quality reporting program. Christopher Palmer, (410) 786-8025, for information related to the skilled nursing facility value-based purchasing program. Celeste Saunders, (410) 786-5603, for information related to Nursing Home Enforcement. </FURINF> <SUPLINF> <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD> <HD SOURCE="HD1">Availability of Certain Tables Exclusively Through the Internet on the CMS Website</HD> As discussed in the FY 2014 SNF PPS final rule (78 FR 47936), tables setting forth the Wage Index for Urban Areas Based on Core-Based Statistical Area (CBSA) Labor Market Areas and the Wage Index Based on CBSA Labor Market Areas for Rural Areas are no longer published in the <E T="04">Federal Register</E> . Instead, these tables are available exclusively through the internet on the CMS website. The wage index tables for this final rule can be accessed on the SNF PPS Wage Index home page, at <E T="03">https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html.</E> Readers who experience any problems accessing any of these online SNF PPS wage index tables should contact Kia Burwell at (410) 786-7816. To assist readers in referencing sections contained in this document, we are providing the following Table of Contents. <HD SOURCE="HD1">Table of Contents</HD> <EXTRACT> <FP SOURCE="FP-2">I. Executive Summary</FP> <FP SOURCE="FP1-2">A. Purpose</FP> <FP SOURCE="FP1-2">B. Summary of Major Provisions</FP> <FP SOURCE="FP1-2">C. Summary of Cost and Benefits</FP> <FP SOURCE="FP-2">II. Background on SNF PPS</FP> <FP SOURCE="FP1-2">A. Statutory Basis and Scope</FP> <FP SOURCE="FP1-2">B. Initial Transition for the SNF PPS</FP> <FP SOURCE="FP1-2">C. Required Annual Rate Updates</FP> <FP SOURCE="FP-2">III. Analysis and Responses to Public Comments on the FY 2025 SNF PPS Proposed Rule</FP> <FP SOURCE="FP1-2">A. General Comments on the FY 2025 SNF PPS Proposed Rule</FP> <FP SOURCE="FP-2">IV. SNF PPS Rate Setting Methodology and FY 2025 Update</FP> <FP SOURCE="FP1-2">A. Federal Base Rates</FP> <FP SOURCE="FP1-2">B. SNF Market Basket Update</FP> <FP SOURCE="FP1-2">C. Case-Mix Adjustment</FP> <FP SOURCE="FP1-2">D. Wage Index Adjustment</FP> <FP SOURCE="FP1-2">E. SNF Value-Based Purchasing Program</FP> <FP SOURCE="FP1-2">F. Adjusted Rate Computation Example</FP> <FP SOURCE="FP-2">V. Additional Aspects of the SNF PPS</FP> <FP SOURCE="FP1-2">A. SNF Level of Care—Administrative Presumption</FP> <FP SOURCE="FP1-2">B. Consolidated Billing</FP> <FP SOURCE="FP1-2">C. Payment for SNF-Level Swing-Bed Services</FP> <FP SOURCE="FP-2">VI. Other SNF PPS Issues</FP> <FP SOURCE="FP1-2">A. Rebasing and Revising the SNF Market Basket</FP> <FP SOURCE="FP1-2">B. Changes to SNF PPS Wage Index</FP> <FP SOURCE="FP1-2">C. Technical Updates to PDPM ICD-10 Mappings</FP> <FP SOURCE="FP1-2">D. Request for Information: Update to PDPM Non-Therapy Ancillary Component</FP> <FP SOURCE="FP-2">VII. Skilled Nursing Facility Quality Reporting Program (SNF QRP)</FP> <FP SOURCE="FP1-2">A. Background and Statutory Authority</FP> <FP SOURCE="FP1-2">B. General Considerations Used for the Selection of Measures for the SNF QRP</FP> <FP SOURCE="FP1-2">C. Collection of Four Additional Items as Standardized Patient Assessment Data Elements and Modification of One Item Collected as a Standardized Patient Assessment Data Element Beginning With the FY 2027 SNF QRP</FP> <FP SOURCE="FP1-2">D. SNF QRP Quality Measure Concepts Under Consideration for Future Years—Request for Information (RFI)</FP> <FP SOURCE="FP1-2">E. Form, Manner, and Timing of Data Submission Under the SNF QRP</FP> <FP SOURCE="FP1-2">F. Policies Regarding Public Display of Measure Data for the SNF QRP</FP> <FP SOURCE="FP-2">VIII. Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program</FP> <FP SOURCE="FP1-2">A. Statutory Background</FP> <FP SOURCE="FP1-2">B. Regulation Text Technical Updates</FP> <FP SOURCE="FP1-2">C. SNF VBP Program Measures</FP> <FP SOURCE="FP1-2">D. SNF VBP Performance Standards</FP> <FP SOURCE="FP1-2">E. SNF VBP Performance Scoring Methodology</FP> <FP SOURCE="FP1-2">F. Updates to the SNF VBP Review and Correction Process</FP> <FP SOURCE="FP1-2">G. Updates to the SNF VBP Extraordinary Circumstances Exception Policy</FP> <FP SOURCE="FP-2">IX. Nursing Home Enforcement</FP> <FP SOURCE="FP1-2">A. Background</FP> <FP SOURCE="FP1-2">B. Analysis of the Provisions of the Proposed Regulations</FP> <FP SOURCE="FP-2">X. Collection of Information Requirements</FP> <FP SOURCE="FP-2">XI. Economic Analyses</FP> <FP SOURCE="FP1-2">A. Regulatory Impact Analysis</FP> <FP SOURCE="FP1-2">B. Regulatory Flexibility Act Analysis</FP> <FP SOURCE="FP1-2">C. Unfunded Mandates Reform Act Analysis</FP> <FP SOURCE="FP1-2">D. Federalism Analysis</FP> <FP SOURCE="FP1-2">E. Regulatory Review Costs</FP> </EXTRACT> <HD SOURCE="HD1">I. Executive Summary</HD> <HD SOURCE="HD2">A. Purpose</HD> This final rule will update the SNF prospective payment rates for fiscal year (FY) 2025, as required under section 1888(e)(4)(E) of the Social Security Act (the Act). It also responds to section 1888(e)(4)(H) of the Act, which requires the Secretary to provide for publication of certain specified information relating to the payment update (see section II.C. of this final rule) in the <E T="04">Federal Register</E> before the August 1 that precedes the start of each FY. Additionally, in this final rule, we are finalizing the rebasing and revising of the SNF market basket to reflect a 2022 base year. Next, we are finalizing the update to the wage index used under the SNF PPS to reflect data collected during the most recent decennial census. We also finalize several technical revisions to the code mappings used to classify patients under the PDPM to improve payment and coding accuracy. This final rule updates the requirements for the SNF QRP, including the collection of four new items as standardized patient assessment data elements, and the modification of one item collected and submitted using the Minimum Data Set (MDS) beginning with the FY 2027 SNF QRP. We also finalize a policy that SNFs, which participate in the SNF QRP, participate in a validation process beginning with the FY 2027 SNF QRP. We also provide a summary of the comments received on the request for information on quality measure concepts under consideration for future SNF QRP program years. This final rule also includes requirements for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program, including adopting a measure selection, retention, and removal policy, a technical measure updates policy, a measure minimum for FY 2028 and subsequent years, updates to the review and correction policy to accommodate new measure data sources, updates to the Extraordinary Circumstances Exception policy, and updates to the SNF VBP regulation text. We also proposed revisions to existing long-term care (LTC) enforcement regulations that would enable CMS and the States to impose CMPs to better reflect amounts that are more consistent with the type of noncompliance that occurred. <HD SOURCE="HD2">B. Summary of Major Provisions</HD> In accordance with sections 1888(e)(4)(E)(ii)(IV) and (e)(5) of the Act, this final rule updates the annual rates that we published in the SNF PPS final rule for FY 2024 (88 FR 53200, August 7, 2023). In addition, this final rule includes a forecast error adjustment for FY 2025. We are also finalizing the rebasing and revising of the SNF market basket to reflect a 2022 base year. Next, we are finalizing the update of the wage index used under the SNF PPS to reflect data collected during the most recent decennial census. We are also finalizing several technical revisions to the code mappings used to classify patients under the PDPM to improve payment and coding accuracy. We are finalizing several updates for the SNF VBP Program. We are adopting a measure selection, retention, and removal policy that aligns with policies we have adopted in other CMS quality programs. We are ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Preview showing 10k of 652k characters. Full document text is stored and available for version comparison. ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━