Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities: Revisions to Case-Mix Methodology
SUMMARY: We are issuing this advance notice of proposed rulemaking (ANPRM) to solicit public comments on potential options we may consider for revising certain aspects of the existing skilled nursing facility (SNF) prospective payment system (PPS) payment methodology to improve its accuracy, based on the results of our
EFFECTIVE DATE: To be assured consideration, comments must be received at one of the addresses provided below, no later than
ADDRESSES: In commenting, please refer to file code CMS-1686-ANPRM. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.
You may submit comments in one of four ways (please choose only one of the ways listed):
1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Within the search bar, enter the Regulation Identifier Number associated with this regulation, 0938-AT17, and then click on the "Comment Now" box.
2. By regular mail. You may mail written comments to the following address ONLY:
Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By express or overnight mail. You may send written comments to the following address ONLY:
4. By hand or courier. If you prefer, you may deliver (by hand or courier) your written comments before the close of the comment period to either of the following addresses:
a.
(Because access to the interior of the
b.
If you intend to deliver your comments to the
Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.
For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION: Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following Web site as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that Web site to view public comments.
Comments received timely will also be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the
To assist readers in referencing sections contained in this document, we are providing the following Table of Contents.
Table of Contents
I. Executive Summary
A. Purpose
B. Summary of Major Provisions
II. Background
A. Issues Relating to the Current Case Mix System for Payment of Skilled Nursing Facility Services Under Part A of the Medicare Program
B. Summary of the
III. Potential Revisions to SNF PPS Payment Methodology
A. Revisions to SNF PPS Base Federal Payment Rate Components
1. Background on SNF PPS Federal Base Payment Rates and Components
2. Data Sources Utilized for Revision of Federal Base Payment Rate Components
3. Methodology Used for the Calculation of Revised Federal Base Payment Rate Components
4. Updates and Wage Adjustments of Revised Federal Base Payment Rate Components
B. Potential Design and Methodology for Case-Mix Adjustment of Federal Rates
1. Background on Resident Classification System, Version I
2. Data Sources Utilized for Developing RCS-I
a. Medicare Enrollment Data
b. Medicare Claims Data
c. Assessment Data
d. Facility Data
3. Resident Classification Under RCS-I
a. Background
b. Physical and Occupational Therapy Case-Mix Classification
c. Speech-Language Pathology Case-Mix Classification
d. Nursing Case-Mix Classification
e. Non-Therapy Ancillary Case-Mix Classification
f. Payment Classifications under RCS-I
4. Variable Per Diem Adjustment Factors and Payment Schedule
C. Use of the Resident Assessment Instrument--Minimum Data Set, Version 3
1. Potential Revisions to Minimum Data Set (MDS) Completion Schedule
2. Potential Revisions to Therapy Provision Policies Under the SNF PPS
3. Interrupted Stay Policy
D. Relationship of RCS-I to Existing Skilled Nursing Facility Level of Care Criteria
E. Effect of RCS-I on Temporary AIDS Add-on Payment
F. Potential Impacts of Implementing RCS-I
IV. Collection of Information Requirements
V. Response to Comments
Acronyms
In addition, because of the many terms to which we refer by acronym in this ANPRM, we are listing these abbreviations and their corresponding terms in alphabetical order below:
AIDS Acquired Immune Deficiency Syndrome
ARD Assessment reference date
BBRA Medicare,
CASPER Certification and Survey Provider Enhanced Reporting
CCN CMS Certification Number
CFR Code of Federal Regulations
CMI Case-mix index
FY Fiscal year
ICD-10-CM International Classification of Diseases, 10th Revision, Clinical Modification
IPPS Inpatient prospective payment system
IRF Inpatient Rehabilitation Facility
IRF-PAI Inpatient Rehabilitation Facility Patient Assessment Instrument
LTCH Long-term care hospital
MDS Minimum data set
MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108-173
NF Nursing facility
NTA Non-therapy ancillary
OASIS Outcome and Assessment Information Set
PPS Prospective Payment System
QIES Quality Improvement and Evaluation System
QIES ASAP Quality Improvement and Evaluation System Assessment Submission and Processing
RAI Resident assessment instrument
RCS-I Resident Classification System, Version I
RFA Regulatory Flexibility Act, Public Law 96-354
RIA Regulatory impact analysis
RUG-III Resource Utilization Groups, Version 3
RUG-IV Resource Utilization Groups, Version 4
RUG-53 Refined 53-Group RUG-III Case-Mix Classification System
SNF Skilled nursing facility
STM Staff time measurement
STRIVE Staff time and resource intensity verification
TEP Technical expert panel
I. Executive Summary
A. Purpose
--This is a summary of a
Advance notice of proposed rulemaking with comment.
CFR Part: "42 CFR Parts 409 and 488"
RIN Number: "RIN 0938-AT17"
Citation: "82 FR 20980"
Document Number: "CMS-1686-ANPRM"
Federal Register Page Number: "20980"
"Proposed Rules"
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