CMS suppressed the use of Skilled Nursing Facility readmission measure data for purposes of Fiscal Year (FY) 2023 scoring and payment adjustments in the FY 2023 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program year because the continuing effects of the COVID-19 Public Health Emergency inhibited CMS’s ability to make fair national comparisons of SNF’s performance. CMS adopted the suppression policy in the FY 2023 SNF PPS final rule. The CMS Skilled Nursing Facility Value-Based Purchasing Program Performance Score Report User Guide for FY 2023 Program Year can be found here. You can obtain your individual facility SNF-VBP report located in the CASPER in your SNF’s facility shared folder.
Health and Human Services Extends Public Health Emergency
Effective October 13, 2022, the Public Health Emergency related to COVID-19 was extended another 90 days with a new expiration date of January 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 October 13, 2022, 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.
PA Health & Wellness Nursing Facility Quality Incentive Program
Effective July 1, 2022, PA Health & Wellness rolled out a Quality Incentive Program and all in-network Nursing Facilities received a 3 percent increase to all base per diem rates (Floor or CMI payment levels) that expired on September 30, 2022. In order to maintain the 3 percent increase each quarter, Nursing Facilities need to complete the deliverables found here by September 5, 2022. Notifications of qualifications for the continuing 3 percent increase effective October 1, 2022, to December 31, 2022, are sent by mail and were received prior to September 30, 2022. Facilities not eligible for the continuing 3 percent increase effective October 1, 2022, to December 31, 2022, may qualify for subsequent award quarters as long as they complete the required deliverables for subsequent measurement periods. Measurement Periods and Award Effective Dates are available here. Full reporting instructions for the Quality Incentive Program can be found here and on the PA Health & Wellness website.
Highmark Becoming Episodic Value-Based Payer
Highmark announced their True Performance SNF Episodic Value-Based Bundled Payment Program is coming with an effective date to be determined. Eligible Program Participants must be covered under a True Performance SNF Episodic Value-Based Bundled Payment Program Participation Agreement and Limited Addendum (the “Agreement”). Current participating providers will be issued an amendment to their Participation Agreement to become eligible Program Participants of the True Performance SNF Episodic Value-Based Payment Program.
This methodology will reward credentialed Skilled Nursing Facilities (SNF) with the incentive to earn higher reimbursement (up to 110 percent) for managing their Highmark member patient population toward high value (both quality and efficiency) outcomes of care. The Program will include the following components:
More information can be found in the Highmark True Performance SNF Episodic Value-Based Bundled Payment Program manual located here. All Program Information, including training and education, is located on Navinet in the Highmark Resource Center. Updates on the Program’s effective date will be shared as Highmark releases more information.
Questions about these updates? Need support to meet requirements?
Contact Stefanie Knaub, RKL Senior Living Services Partner, at 717.590.8648.
RKL LLP, 1800 Fruitville Pike, Lancaster, PA 17601
