2023 Medicare Deductibles, Co-Insurance and KX Modifier Thresholds

Effective January 1, 2023, the Medicare Part A co-insurance increased to $200.00/day for Skilled Nursing days 21-100; the Medicare Part B deductible decreased to $226.00; and the KX modifier threshold increased to $2,230 for OT and $2,230 for PT/SLP combined. Medicare is continuing with the Medical Review threshold for therapy provided over the KX modifier threshold. The Medical Review threshold amount is $3,000 for OT and $3,000 for PT/SLP combined and will continue until CY 2028.  Click here for more information about the new 2023 rates. Use this link to read more about the threshold amounts continued from 2022.

Health and Human Services Public Health Emergency 

Effective January 11, 2023, the Public Health Emergency related to COVID-19 was extended another 90 days with a new expiration date of April 11, 2023. The extension of the Public Health Emergency also extends the Qualifying Hospital Stay waiver and the 100-day benefit period waiver for another 90 days. Please note that there is a possibility that the blanket waivers could end prior to the end of the PHE. It is recommended to check the CMS site regularly for updates. The Declaration of the extension can be found here.      

CMS COVID Waiver Updates for Long Term Care Facilities                

In addition to the Public Health Emergency extension effective January 11, 2023, CMS made updates to the COVID Waiver documents for Long Term Care Facilities. Other important Long Term Care Facilities Waiver updates are available here. Any provider with questions may contact Stephanie Kessler or Stefanie Knaub.

CMS Approved 2023 Nursing Facility Minimum Payment Rate SDP 

On December 30, 2022, the PA Department of Human Services (DHS) received approval from the Centers for Medicare and Medicaid Services (CMS) on the Section 438.6(c) Preprint required to implement the new State-Directed Payment (SDP) model which went into effect on January 1, 2023. Under the new model, each Community HealthChoices Managed Care Organization (CHC-MCO) is now required to pay nursing facilities the minimum payment rate established by DHS. DHS will be publishing a FAQ document in the coming weeks on their webpage. Also beginning January 1, 2023, there is a change to the NF Assessment Funds Distribution to NFs. The assessment payments will become a component of the NF’s daily per diem rate paid by each CHC-MCO instead of a lump sum payment. Use this link for additional information on the 2023 proposed rates.    

PCC Helpful Hints

This year, we will be including a new addition to our newsletter, PCC Helpful Hints. Each quarter, we will highlight important changes and updates to PointClickCare. We hope you find this section helpful and welcome your feedback. 

PCC Helpful Hints:
Now is the time for the annual PCC updates to be completed in the database.

For multi-facility databases, the annual updates can be completed at the Management Console Level.

• Update Part A Coinsurance for Medicare A and other payers that follow Medicare coinsurance guidelines using the Multi-Payer Updates. This will allow users to update the coinsurance amount and then save and schedule apply. The schedule apply functionality happens after midnight on the day that the update is done.
  

• If room rates and/or ancillary charge code rates are updated at the beginning of the year, those should be updated. Ancillary charge code updates need to be done at the facility level in Charge Code Amounts Setup where you can enter the 01/01/2023 effective date and the new rate.

• Once charge code amounts have been updated, use the Resident Rate updates functionality at the facility level to update any resident recurring charges for the newly effective rates.

For single facility databases, the following updates should be completed:

• Update Part A Coinsurance for Medicare A and other payers that follow Medicare coinsurance guidelines in Payer Rules and Rate Schedules. Select New to Create a new rate line.

Edit Payer Rules and update the coinsurance amount to $200.00.

• Apply rates. This will create a new rate line effective 01/01/2023 for all residents with Medicare Part A in Census.

Questions about these updates? Need support to meet requirements?

Contact Stefanie Knaub, RKL Senior Living Services Partner, at 717.590.8648.