CMS Finalizes Skilled Nursing Facility FY 2019 PPS Update

CMS issued a final rule that will update the Resource Utilization Groups, Version IV (RUG IV) payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs), for fiscal year 2019. SNF payments in FY 2019 will increase by 2.4% ($820 million) over FY 2018 levels, as mandated by the Bipartisan Budget Act of 2018. Effective Oct. 1, 2019, the rule finalizes the implementation of a new Patient-Driven Payment Model. This new model represents a complete redesign of the SNF PPS and bases payment on a multi-faceted clinical profile of the patient – a significant departure from the current reliance on therapy volume to set payments. The agency also finalizes updates to the SNF Value-based Purchasing Program, including changes in scoring methodology for low-volume SNFs and an extraordinary circumstances exemption policy. For more details, see today’s second Financial Feature.