CMS Issues Proposed Payment Rules for Acute and Post-Acute Care Settings

April 18, 2023

The Centers for Medicare & Medicaid Services (CMS) sprang into action in April with three proposed payment rules impacting payment rates and other policies for inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and acute care hospitals. Each setting is paid under a prospective payment system (PPS) and the policies finalized this summer will apply to services delivered on or after October 1, 2023―the beginning of federal fiscal year (FY) 2024.

Skilled Nursing Facilities

CMS proposed an annual update of 3.7% for FY 2024, which includes a 2.3% parity adjustment reduction. This reduction was imposed to address the increased spending in SNFs under the patient-driven payment model (PDPM)―a new payment model implemented in FY 2020―that exceeded CMS’s projections. CMS did not propose any additional parity adjustment reductions beyond FY 2024.

CMS also requested recommendations to modify the comorbidities lists that help drive payment under PDPM. ASHA is reviewing the speech-language pathology comorbidities list to determine if it will recommend changes.

Adjustments were also proposed to the quality reporting and value-based purchasing programs (QRP and VBP, respectively) including the development of a health equity adjustment for the SNF VBP.

Finally, CMS did not include an expected nursing staffing minimums proposal in this rule. Instead, it signaled this policy will be included in a separate rule to be issued sometime this Spring. ASHA is monitoring this proposal to help identify key issues associated with the development of staffing minimums in the event CMS proposes a similar policy for therapy services in the future.

Comments on the proposed rule are due June 5, 2023, and can be submitted via regulations.gov (search CMS-1779-P).

Inpatient Rehabilitation Facilities

CMS proposed a 3.0% increase to IRF payments. It also made changes to the measures for the IRF QRP. Finally, the agency proposed to allow hospitals to open a new IRF unit and begin being paid under the IRF PPS at any time during the cost reporting period, provided the hospital notifies the CMS Regional Office and the Medicare Administrative Contractor in writing at least 30 days before the date of the change and maintains the information needed to accurately determine the costs attributable to the IRF unit. Such a change would also remain in effect for the rest of the cost reporting period. CMS believes this will alleviate unnecessary burden and administrative complexity placed upon hospitals and increase access to care.

Comments on the proposed rule are due June 2, 2023, and can be submitted via regulations.gov (search CMS-1781-P).

Inpatient Acute Care Hospitals

Inpatient services provided in acute care hospitals are paid under the inpatient prospective payment system (IPPS). In FY 2024, CMS proposes to increase payments by 2.8%. As with the SNF VBP, CMS proposed to apply a health equity adjustment in future years of the program. However, most of the proposals included in the IPPS do not have a direct impact on the delivery of audiology and speech-language pathology services.

Comments on the proposed rule are due June 9, 2023, and can be submitted via regulations.gov (search CMS-1785-P).