Federal Register. Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities Proposed Rule for FY 2. SNF Value- Based Purchasing Program, SNF Quality Reporting Program, and SNF Payment Models Research. Start Preamble. Start Printed Page 2. AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: This proposed rule would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2. In addition, it includes a proposal to specify a potentially preventable readmission measure for the Skilled Nursing Facility Value- Based Purchasing Program (SNF VBP), and other proposals for that program aimed at implementing value- based purchasing for SNFs. Additionally, this proposed rule proposes additional polices and measures in the Skilled Nursing Facility Quality Reporting Program (SNF QRP). This proposed rule also includes an update on the SNF Payment Models Research (PMR) project. DATES: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p. 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. You may submit electronic comments on this regulation to http: //www. Within the search bar, enter the Regulation Identifier Number associated with this regulation, 0. AS4. 4, and then click on the “Comment Now” box. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS- 1. P, P. O. Box 8. 01. Baltimore, MD 2. 12. Please allow sufficient time for mailed comments to be received before the close of the comment period. By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS- 1. P, Mail Stop C4- 2. Security Boulevard, Baltimore, MD 2. 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. Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 4. G, Hubert H. Humphrey Building, 2. Independence Avenue SW., Washington, DC 2. Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp- in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)b. 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Safety & Relief Valve Experts -sales, testing, certification and service. Our safety valve experts provide our customers with the right information and maintain a large inventory of valves and parts. Safety valves are used in. National Debt Relief is a BBB accredited business that helps consumers get out of debt without loans or bankruptcy. Lower your credit card debt payments. Debt relief is better than debt consolidation. Eradicate your debt with our 100% legitimate debt relief program. Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7. Security Boulevard, Baltimore, MD 2. If you intend to deliver your comments to the Baltimore address, please call telephone number (4. 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. Start Further Info. FOR FURTHER INFORMATION CONTACT: Penny Gershman, (4. SNF PPS clinical issues. John Kane, (4. 10) 7. Kia Sidbury, (4. 10) 7. Bill Ullman, (4. 10) 7. Stephanie Frilling, (4. Charlayne Van, (4. End Further Info. End Preamble. Start Supplemental Information. 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. 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 Centers for Medicare & Medicaid Services, 7. Security Boulevard, Baltimore, Maryland 2. Monday through Friday of each week from 8: 3. To schedule an appointment to view public comments, phone 1- 8. Availability of Certain Tables Exclusively Through the Internet on the CMS Web Site. As discussed in the FY 2. SNF PPS final rule (8. FR 4. 63. 90), tables setting forth the Wage Index for Urban Areas Based on CBSA Labor Market Areas and the Wage Index Based on CBSA Labor Market Areas for Rural Areas are no longer published in the Federal Register. Instead, these tables are available exclusively through the Internet on the CMS Web site. The wage index tables for this proposed rule can be accessed on the SNF PPS Wage Index home page, at http: //www. Summary of Major Provisions. C. Summary of Cost and Benefits. II. Background on SNF PPSA. Statutory Basis and Scope. B. Initial Transition for the SNF PPSC. Required Annual Rate Updates. III. SNF PPS Rate Setting Methodology and FY 2. Update. A. Federal Base Rates. Start Printed Page 2. B. SNF Market Basket Update. C. Wage Index Adjustment. E. Adjusted Rate Computation Example. IV. Additional Aspects of the SNF PPSA. SNF Level of Care—Administrative Presumption. B. Consolidated Billing. C. Payment for SNF- Level Swing- Bed Services. V. Skilled Nursing Facility Value- Based Purchasing Program (SNF VBP)B. Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)C. SNF Payment Models Research. VI. Collection of Information Requirements. VII. Response to Comments. VIII. Economic Analyses. Regulation Text. Acronyms. In addition, because of the many terms to which we refer by acronym in this proposed rule, we are listing these abbreviations and their corresponding terms in alphabetical order below: AIDS Acquired Immune Deficiency Syndrome. ARD Assessment reference date. BBA Balanced Budget Act of 1. Pub. 1. 05- 3. 3BBRA Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1. Pub. 1. 06- 1. 13. BIPA Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2. Pub. 1. 06- 5. 54. CAH Critical access hospital. CASPER Certification and Survey Provider Enhanced Reporting. CBSA Core- based statistical area. CCN CMS Certification Number. CFR Code of Federal Regulations. CMI Case- mix index. CMS Centers for Medicare & Medicaid Services. FFS Fee- for- service. FR Federal Register. FY Fiscal year. HCPCS Healthcare Common Procedure Coding System. HIQR Hospital Inpatient Quality Reporting. HOQR Hospital Outpatient Quality Reporting. HRRP Hospital Readmissions Reduction Program. HVBP Hospital Value- Based Purchasing. IGI IHS (Information Handling Services) Global Insight, Inc. IMPACT Improving Medicare Post- Acute Care Transformation Act of 2. Pub. 1. 13- 1. 85. IPPS Inpatient prospective payment system. IRF Inpatient Rehabilitation Facility. LTC Long- term care. LTCH Long- term care hospital. MAP Measures Application Partnership. MDS Minimum data set. MFP Multifactor productivity. MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2. Pub. 1. 08- 1. 73. MSA Metropolitan statistical area. NF Nursing facility. NQF National Quality Forum. OMB Office of Management and Budget. PAC Post- acute care. PAMA Protecting Access to Medicare Act of 2. Pub. L 1. 13- 9. 3PMR Payment Models Research. PPS Prospective Payment System. PQRS Physician Quality Reporting System. QIES Quality Improvement Evaluation System. QIES ASAP Quality Improvement and Evaluation System Assessment Submission and Processing. QRP Quality Reporting Program. RAI Resident assessment instrument. RAVEN Resident assessment validation entry. RFA Regulatory Flexibility Act, Pub. RIA Regulatory impact analysis. RUG- III Resource Utilization Groups, Version 3. RUG- IV Resource Utilization Groups, Version 4. RUG- 5. 3 Refined 5. Group RUG- III Case- Mix Classification System. SCHIP State Children's Health Insurance Programs. DTI Suspected deep tissue injuries. SNF Skilled nursing facility. SNF QRP Skill nursing facility quality reporting program. SNFRM Skilled Nursing Facility 3. Day All- Cause Readmission Measure. STM Staff time measurement. STRIVE Staff time and resource intensity verification. TEP Technical expert panel. UMRA Unfunded Mandates Reform Act, Pub. VBP Value- based purchasing. I. Purpose. This proposed rule would update the SNF prospective payment rates for FY 2. E) of the Social Security Act (the Act). It would also respond to section 1. H) of the Act, which requires the Secretary to provide for publication in the Federal Register before the August 1 that precedes the start of each fiscal year (FY), certain specified information relating to the payment update (see section II. C.). This proposed rule also includes an update on the SNF PMR project. In addition, it proposes to specify a potentially preventable readmission measure for the Skilled Nursing Facility (SNF) Value- Based Purchasing (VBP) Program, and makes other proposals related to that Program's implementation for FY 2. We are also proposing four new quality and resource use measures for the SNF QRP and are proposing new SNF review and correction procedures for performance data that is to be publicly reported. B. Summary of Major Provisions. In accordance with sections 1. E)(ii)(IV) and 1. Act, the federal rates in this proposed rule would reflect an update to the rates that we published in the SNF PPS final rule for FY 2. FR 4. 63. 90) which reflects the SNF market basket index, as adjusted by the multifactor productivity (MFP) adjustment for FY 2. We also propose for the SNF VBP Program to specify a potentially preventable readmission measure, define performance standards, and adopt a scoring methodology, among other policies.
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