FY 2025 Updates to SNF Payment Rates
For FY 2025, CMS has adjusted the payment rates for SNFs, resulting in a net market basket increase of 2.5%. This adjustment includes a 3.3% market basket increase, offset by a productivity adjustment of 0.8%. These changes reflect the ongoing inflationary pressures within the healthcare sector while aiming to balance budgetary constraints. Additionally, CMS has revised the wage index to account for regional cost variations, ensuring fair and equitable payment across different geographic areas.
Skilled Nursing Facility Quality Reporting Program (SNF QRP)
CMS continues to enhance the Skilled Nursing Facility Quality Reporting Program (SNF QRP) to drive quality improvements in patient care. For FY 2025, CMS has introduced three new quality measures:
- Health Equity Measures: These metrics will track disparities in care among different patient populations, encouraging SNFs to address and reduce health inequities.
- Post-Discharge Functionality Assessment: This measure evaluates the functional status of patients 30 days after discharge from the SNF, promoting continuity of care and better long-term outcomes.
- Resident Safety Measure: Focused on reducing preventable harm, this measure will track incidents such as falls and pressure ulcers within SNFs.
- Non-compliance with SNF QRP reporting requirements will result in a 2% reduction in the annual payment update for the facility.
Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program
The SNF Value-Based Purchasing (VBP) Program has been further refined to incentivize better outcomes for residents. For FY 2025, CMS has added two new measures to the program:
- All-Cause Hospital Readmission Measure: This measure assesses the rate of unplanned readmissions within 30 days of discharge from the SNF, encouraging facilities to focus on post-discharge care.
- Discharge to Community Measure: This measure tracks the percentage of residents who return to the community after their SNF stay, emphasizing the importance of successful discharge planning.
- CMS has also increased the percentage of payment adjustments tied to SNF performance, from 2% to 3%, further incentivizing high-quality care.
Changes in PDPM ICD-10 Mappings
The Patient-Driven Payment Model (PDPM) continues to evolve, with significant updates to the ICD-10 mappings for FY 2025. CMS has refined the mappings to ensure more accurate payment classification based on residents’ clinical conditions. Key changes include:
- Reclassification of Certain Codes: Several ICD-10 codes have been reclassified to better align with the clinical needs of residents. This will affect how SNFs categorize and report resident conditions, potentially impacting payment rates.
- Addition of New Codes: New ICD-10 codes reflecting emerging conditions and treatment approaches have been added to the PDPM system. SNFs must stay updated on these changes to ensure accurate coding and reimbursement.
- These adjustments aim to enhance the precision of the PDPM, ensuring that SNFs are compensated fairly based on the complexity of care provided.
Nursing Home Enforcement
In an ongoing effort to improve resident safety and care quality, CMS has strengthened enforcement mechanisms for nursing homes. For FY 2025, key changes include:
- Increased Fines for Non-Compliance: CMS has increased the penalties for facilities that fail to meet federal care standards. This includes higher fines for repeated deficiencies, particularly those related to resident safety.
- Stricter Monitoring for Low-Performing Facilities: Facilities that consistently perform poorly on quality measures will be subject to more frequent inspections and monitoring. CMS is also expanding its use of Special Focus Facilities (SFF) designation to identify and address the worst-performing nursing homes.
- Focus on Infection Control: Given the ongoing challenges posed by infectious diseases, CMS is placing a renewed emphasis on infection control practices, with stricter enforcement of related regulations.
- These measures are designed to ensure that nursing homes maintain high standards of care, protecting the health and well-being of residents.