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CMS Publishes FY 2014 Proposed Payment Guidance

May 7, 2013
by Charlene Marietti
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The Centers for Medicare & Medicaid Services (CMS) has issued proposed updates to payment rates, quality data collection and reporting and qualification criteria for long-term care providers including those used in skilled nursing (SNF) and inpatient rehabilitation (IRF) facilities, acute care and long-term care hospitals (LTCH) and hospice. The proposed changes are being published in the Federal Register over a week-long period, according to industry segment.

Skilled Nursing Facilities. Under the proposed rule, CMS estimates that aggregate payments to SNFs would increase 1.4% in FY 2014 over FY 2013 under the prospective payment system (PPS) affecting Medicare Part A providers and beneficiaries. CMS also proposes to revise and update the SNF market basket using data from FY 2010. (Calculations currently rely on market basket data from FY 2004.) The proposal also would add specificity and qualification criteria to the Minimum Data Set, Version 3.0 that would identify calendar days of therapy (00420) and clarify conditions that qualify for certain Rehabilitation Resource Utilization Group (RUG) categories.

The proposed rule was published in the Federal Register on May 6, is available for comments until July 1, 2013. See the CMS Fact Sheet for more information on the SNF proposed rule. 

Inpatient Rehabilitation Facilities. The proposed rule would increase IRF payments by 2%. It also proposes to “revise the diagnosis codes used to determine presumptive compliance under the existing “60 percent rule;” update the IRF facility-level adjustment factors; revise sections of the Inpatient Rehabilitation Facility-Patient Assessment Instrument; revise requirements for acute care hospitals that have IRF units; clarify the IRF regulation text regarding limitation of review; update references to previously changed sections in the regulations text; and revise and update quality measures and reporting requirements under the IRF quality reporting program.”

The proposed rule is scheduled for publication in the Federal Register on May 8, and is available for comments until July 1, 2013. See the CMS Fact Sheet for more information on the proposed IRF rule. 

Acute Care and Long-Term Care Hospitals. CMS estimates Total Inpatient Prospective Payment System (IPPS) payments to LTCHs will increase by 1.1%. Other proposed revisions include the “Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals [and implements] certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation.” Also included is an update to the rate-of-increase limits for certain hospitals excluded from the IPPS.

The proposed rule is scheduled for publication in the Federal Register on May 10. See the CMS Fact Sheet for more information on the proposed hospital quality of care provisions. 

Hospice. CMS estimates an increase in hospice Medicare payments of 1.1% and proposes the addition of standardized data collection and reporting. The agency proposes implementation of the Hospice Item Set (HIS), a standardized patient data set, and required submissions of the HIS beginning July 1, 2014, as well as required use of a quality of care survey for informal caregivers in 2015.

The proposed rule is scheduled for publication in the Federal Register on May 10. See the CMS Fact Sheet for more information about the proposed rule.

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