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SNF Rate Calculator UpdateRULE: FY 2019 PROPOSEDFederal Register May 8, 2018 (CMS-1696-P)Display copy page #sSpreadsheet ReferenceRule page/ tableAmountLabor/ Non-labor shareJ3:J4Table 8, p 360.707Nursing case-mixB4Tables 4 and 5, p 22Urban$181.50Rural$173.39Therapy Case-mixC4$136.71$157.65Therapy Non-case-mixD4$18.01$19.23Non-case-mix componentE4$92.63$94.34Market Basket UpdateA1:D1p 14 - 22Mandated 2.4% in place of the otherwise calculated: 2.7% market basket - 0.0% forecast error - 0.8% MFP adjustment = 1.9%. See Notes below.Wage Index TableUrban Columns R - SRuralColumns S - TThe FY 2019P SNF PPS wage index file is available on the SNF PPS website at: Index, Therapy IndexColumns B and DTables 6 and 7, p 27 - 30Various, no changeCopay (days 21-100)P5:6$167.50 for 2018Not updated yet for 2019AIDS add-onM82p 25128% add-onNOTES: The Bipartisan Budget Act of 2018 (BBA 2018) added section 1888(e)(5)(B)(iv) to the Social Security Act to set the FY 2019 market basket percentage to 2.4 percent, after the application of the productivity adjustment. Absent this new mandate, the traditionally calculated market basket update factor would have been 1.9%, calculated from the IHS Global Insight Inc. first quarter 2018 with historical data forecast of 2.7% less a 0.8% multifactor productivity adjustment. There would not have been a forecast error correction since the difference in the FY 2017 estimated and actual market basket percentages did not exceed the 0.5 percentage point threshold for adjustment.FY 2019 Proposed: Per BBA 2018, the market basket update factor will be 2.4%, otherwise the normally calculated percentage would have been 2.7% - 0.00 forecast error – 0.8% multifactor productivity adjustment = 1.9%FY 2018 Final: Per MACRA section 411(a), the market basket update factor will be 1.0, otherwise the normally calculated percentage would have been 2.6% - 0.00 forecast error – 0.6% multifactor productivity adjustment = 2.0%FY 2018 Proposed: Per MACRA section 411(a), the market basket update factor will be 1.0, otherwise the normally calculated percentage would have been 2.7% - 0.00 forecast error – 0.4% multifactor productivity adjustment = 2.3%FY 2017 Final net SNF market basket update factor: 2.7% market basket update change - 0.0% forecast error - 0.3% multifactor productivity adjustment = 2.4%FY 2017 Proposed net SNF market basket update factor: 2.6% market basket update change - 0.0% forecast error - 0.5% multifactor productivity adjustment = 2.1%FY 2016 Final net SNF market basket update factor: 2.3% market basket update change - 0.6% forecast error - 0.5% multifactor productivity adjustment = 1.2%FY 2016 Proposed net SNF market basket update factor: 2.6% market basket update change - 0.6% forecast error - 0.6% multifactor productivity adjustment = 1.4%FY 2015 Final net market basket update factor: 2.5% market basket update change - 0.0% forecast error - 0.5% MFP adjustment = 2.0%2019 Copay: The 2019 snf copay for days 21-100 has not been updated yet and the 2018 rate is used in the calculator for 2019 as a proxy. The 2019 rate will likely be released in November 2018.SNF Quality Reporting Program (QRP): Beginning with FY 2019 payments (10/1/18), SNFs that don’t meet QRP requirements will be subject to a 2.0 percentage point reduction to the SNF market basket percentage update for that fiscal year.SNF Value-Based Purchasing Program (VBP): Beginning with FY 2019, the SNF VBP Program will apply positive or negative incentive payment adjustments to SNFs based on their performance on the program’s readmissions measure. “At the time of the publication of this proposed rule, we will not have completed SNF performance score calculations for the FY 2019 program year. However, we intend to provide the range of value-based incentive payment adjustment factors applicable to the FY 2019 program year in the FY 2019 SNF PPS final rule.” (p 224)SNF Patient-Driven Payment Model (PDPM): New payment methodology proposed to be effective October 1, 2019. This is a new case-mix model based on the patient’s condition and care needs. A summary is available here: ................
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