News Releases

CMS Terminates Blanket Waivers, Issues Proposed Payment Rule for Nursing Homes, Skilled Nursing

A pair of actions this month from the Centers for Medicare and Medicaid Services (CMS) add up to forthcoming changes for nursing homes and skilled nursing facilities. On April 7, CMS announced it will be lifting some of the emergency blanket waivers it issued for nursing homes, skilled nursing facilities and certain other providers at the start of the COVID-19 pandemic. This was followed on April 11 by the filing of the fiscal year (FY) 2023 Skilled Nursing Facilities Prospective Payment System (SNF PPS) proposed rule.

Waiver Termination

The temporary emergency blanket waivers were designed to provide facilities with the flexibilities needed to respond to the COVID-19 pandemic. However, with steadily increasing vaccination rates for nursing home residents and staff, and with overall improvements seen in nursing homes’ abilities to respond to COVID-19 outbreaks, CMS is taking steps to phase out certain flexibilities it says are generally no longer needed. Affected organizations include nursing homes, skilled nursing facilities, inpatient hospices, intermediate care facilities for individuals with intellectual disabilities, and end-stage renal disease facilities.

CMS is ending specific waivers in two groups: one group of waivers will terminate 30 days from the issuance on April 7 of this new guidance, and the other group will terminate 60 days from issuance. Details on which waivers meet each of these timeframes can be found in a CMS Quality, Safety, and Oversight memo.

Proposed SNF PPS

The proposed FY23 SNF PPS, which is scheduled for publication in the Federal Register on April 15, updates Medicare payment rates for skilled nursing facilities and includes proposals for the SNF Quality Reporting Program (QRP) and the SNF Value-Based Program (VBP) for FY 2023 and future years.

CMS estimates that the aggregate impact of the payment policies in this proposed rule would result in a decrease of approximately $320 million in Medicare Part A payments to SNFs in FY 2023 compared to FY 2022.

In the proposed rule, CMS is soliciting input to help the agency establish minimum staffing requirements for nursing homes, which it intends to issue a proposed rule on within a year. CMS is also requesting stakeholder input on a measure that would examine staff turnover levels in nursing homes for possible inclusion in CMS’ SNF Value-Based Purchasing (VBP) Program.

In January, CMS began posting nursing home staff turnover rates on the Medicare.gov Care Compare website, and CMS will be including this information in the star rating system starting in July 2022. CMS will use the stakeholder feedback on the proposed PPS to inform a proposal of this measure for inclusion in the SNF VBP Program in the future.

Comments on the proposed rule will be accepted through June 10.

For more on this and other reimbursement policies, contact us.