CMS Issues Proposed Rules for Fiscal Year 2020

SNF payment system, advancement of PDPM on the docket

The Centers for Medicare and Medicaid Services (CMS) has issued its Fiscal Year 2020 proposed rules, including its proposal for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).

Among the highlights:

  • CMS is moving forward with implementing the Patient-Driven Payment Model (PDPM)
  • CMS is proposing a new definition of group therapy, while also clarifying the SNF Quality Reporting Program (QRP) and Value-Based Purchasing Program (VBP).

The agency projects an increase of $887 million in aggregate payments to SNFs in 2020 over FY 2019.

CMS currently defines “group therapy” in SNF PPS as therapy provided simultaneously to four patients performing the same or similar activities while supervised by a therapist (or assistant) who is not supervising any other individuals.

To allow more clinical flexibility, CMS is proposing to adopt a new definition of group therapy in the SNF Part A setting as “a qualified rehabilitation therapist or therapy assistant treating 2 to 6 patients at the same time who are performing the same or similar activities.” The new group therapy definition is consistent with the IRF PPS group therapy definition and would be implemented with PDPM.

The agency is also proposing two Transfer of Health Information quality measures to begin collection in October of next year in order to satisfy requirements from the IMPACT Act of 2014.

For more information, view the CMS fact sheet.


About The Author