CMS Update for FY 2015: SNF Payment

staff orange and blueChanges YOU need to know

On July 31, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1605-F] outlining Fiscal Year (FY) 2015 Medicare payment rates for skilled nursing facilities (SNFs). The FY 2015 SNF payment rates and other issues discussed in the final rule are summarized below.

  • Overall payment increase to SNF’s of 2% or $750 million from FY payments in 2014
  • The wage index has been updated which contained a number of significant changes which will be used to identify a providers urban or rural status.  To help diminish the potential negative wage index impacts  to certain providers there will be a one year transition with a blended rate.  This will consist of a 50% current and 50% revised FY 2015 wage index. 
  • CMS is revising the current COT OMRA policy which would permit providers to use the COT OMRA to reclassify a resident into a therapy RUG from a non-therapy RUG, but only in certain limited circumstances.

Article Digest

Here are a couple articles we thought you might find interesting…

Doctors flunk test on skilled nursing facilities, raising concerns about care transitions, UCLA researchers say

Early career physicians have extremely poor knowledge of skilled nursing facilities, showing that more robust training is needed to ensure that physicians can oversee effective transitions into SNFs, according to investigators at the University of California, Los Angeles.

The UCLA team created a 10-item, multiple choice pre-test that was given to 67 internal medicine residents prior to their mandatory SNF rotation. The mean number of correct answers was 4.9, the investigators found. Even after training, some residents still consistently answered certain questions incorrectly. The questions were about what a skilled nursing facility is, how it is staffed and what services it provides.

Medical residents have insufficient knowledge about the type of care that can be provided at a SNF and efforts to improve this knowledge are needed to assure proper triage of patients and safe transitions to the SNF, the authors wrote in the study abstract.

Full findings have been published online in JAMDA-The Journal of Post-Acute and Long-Term Care Medicine.


Medicare should pay skilled nursing facilities and rehab facilities equally for certain treatments, MedPAC tells Congress

Skilled nursing facilities and inpatient rehabilitation facilities should receive the same payments for treating certain conditions, the Medicare Payment Advisory Commission recommended in its latest report to Congress. The site-neutral payment proposal won praise from the nation’s largest long-term care association.

A site-neutral payment system would focus on the patient and their needs, regardless of setting, and encourage all settings to provide efficient, high-quality care, said Mark Parkinson, CEO and president of the American Health Care Association/National Center for Assisted Living.

MedPAC has long shown support for equalizing IRF and SNF payments, and the group provided an in-depth consideration of the potential policy in the report released Friday. While IRFs must meet more stringent guidelines than SNFs in areas such as staffing, the two settings treat similar patient populations and achieve similar outcomes, the analysis determined.

The panel examined the possible effects of site-neutral payments for three conditions: rehab after stroke, major joint replacement and hip/femur procedures (such as for hip fractures). Patient characteristics and outcomes were very similar for the orthopedic conditions, but more variable for stroke rehab. For instance, SNFs tend to treat stroke patients at risk for falls, while IRFs see more individuals with swallowing issues.

More study should be conducted on stroke-related conditions, but the orthopedic conditions are a strong starting point for a site-neutral policy, the report concluded.

Leveling these post-acute payments would potentially save the Medicare program money, because IRF reimbursements exceed SNF payments by as much as 50%, MedPAC has noted. Rehab facilities have protested the proposed changes, but they might not take a substantial hit to their bottom lines, according to Friday’s report. This is because the site-neutral policy would not affect add-on payments, such as monetary reimbursement around having a teaching program, which many IRFs receive.

IRFs also should have regulations loosened to increase their competitiveness with nursing facilities if the site-neutral payments are implemented, MedPAC recommended. For example, regulators could waive the requirement that IRFs treat only patients who can tolerate aggressive therapy.

Click here to access the complete report.


Therapy Center strives to stay ahead of the game when it comes to new regulations and changes in the healthcare industry. We consider ourselves to be more than just a therapy provider, we are a business partner who cares about educating our staff and our partners on issues that affect business and mostly importantly their patients. Contact Kristi Fredieu for more information on our comprehensive services, which include patient care, marketing, compliance, education and management.

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