CMS Overhaul

By on May 30, 2019 in News

The Centers for Medicare and Medicaid Services (CMS) may soon change the way that payments are allotted. The organization hopes that the new payment structure will reflect its renewed commitment to quality care.

Rewarding Performance

In the past, facilities received payments based on the total cost of care provided. The new case-mix CMS model directs Medicare payments to facilities based on the patient’s condition and treatment.

A recent proposal could increase payments to skilled nursing facilities (SNF) by $887 million in fiscal year 2020. That’s about a 2.5 percent increase from the current fiscal year.

Not all SNFs will receive the increased payments. Facilities must meet a list of requirements to receive the funds. If facilities fail to meet the new requirements, payments will be reduced by 2 percentage points. About 60 percent of the funds withheld from under performing SNFs will be upcycled as incentive payments.

The caveat, however, is that under performing SNFs will be expected to improve quality of care with fewer resources.

Additional Payment Increases

Other areas of care may receive a noticeable uptick in payments. CMS has announced that it plans to increase payments to inpatient rehab facilities (IRF) by $195 million for federal fiscal 2020.

Hospice payments may get a $540 million increase in payments, which is roughly a 3 percent boost. Like SNFs, hospice providers will be evaluated based on the services provided to patients. High-performing centers will receive the increase whereas under performing centers will get a 2-percentage point cut.

Influencing Change

There is still time to influence legislation. CMS encourages industry feedback on proposed rule [CMS-1718-P]. The organization will accept comments until June 18, 2019.

The final proposed changes will take effect in October 2019.