CMS Proposes Skilled Nursing Facility Payment Rate Update for Fiscal Year 2025

On March 28, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update the payment rates and associated policies for skilled nursing facilities (SNFs). The proposal, which would take effect in fiscal year (FY) 2025, includes several provisions of interest to ASHA members.

Market Basket Update

Payments to SNFs will increase by 4.1% in FY 2025.

Proposed New Assessment Items

CMS proposes adding new assessment items to the SNF Minimum Data Set to capture additional data on social determinants of health (SDOH), including:

• One item to capture information about living situations
• Two items about food insecurity
• One item about the ability to cover utility expenses.

It also proposes to modify an existing SDOH assessment item associated with transportation.

Updates to Civil Monetary Penalty Policies to Strengthen CMS' Enforcement Authority

CMS has taken a variety of actions since 2022 to better protect Medicare beneficiaries in SNFs. In this proposed rule, CMS examined its current policies on civil money penalties (CMPs) for noncompliance with regulatory requirements and proposes to allow for more per-instance and per-day CMPs to be imposed.

Penalties can currently be imposed per day or per instance depending on the health and safety deficiencies identified. Per-day CMPs are applied until the noncompliance is corrected and per-instance CMPs are applied for isolated instances. But per-day and per-instance penalties may not be imposed during the same survey, and per-instance penalties may not be imposed concurrently for the same deficiency.

The proposals in this rule will permit both types of penalties to be applied, not to exceed the statutory daily limits. This change will provide CMS with greater flexibility to impose penalties that more directly reflect the health and safety impact to residents and incentivize permanent correction.

What's Next

The Improving Post-Acute Care Transformation (IMPACT) Act requires standardized items across post-acute care assessment tools. These assessment items will likely be proposed in the home health and long-term care hospital proposed rules, which are expected in the spring or early summer. They were included in the inpatient rehabilitation facility proposed rule issued March 28.

ASHA is reviewing the provisions of the proposed rule and will submit comments to CMS. While we recognize more assessment items create additional administrative burden, ASHA supports collecting SDOH data in order to reduce obstacles Medicare beneficiaries face in accessing care. We are committed to ensuring that SNFs are held accountable for violations that can harm Medicare beneficiaries. And we are considering if the revisions to the CMP policies will support this objective.

If finalized, these policies would impact payment for services provided on or after October 1, 2024 (the beginning of the federal FY 2025).

Questions?

Email reimbursement@asha.org.