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3006 - Plans for a Value-Based Purchasing Program for Skilled Nursing Facilities and Home Health Agencies

 
Implementation Status 
Statutory Text 

Summary

As revised by section 10301 of the Senate Manager’s Amendment, stipulates that CMS develop and submit plans to Congress by January 1, 2011, for implementation of VBP programs for SNFs, HHAs and ambulatory surgical centers (ASCs).

On July 8, 2013, CMS released its CY14 hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule in which it contemplates these provisions of the ACA in its proposal.  Comments on the underlying proposed rule are due by September 6, 2013.  A CMS press release is available here.

Implementation Status

 
Summary 
Statutory Text 

See CMS’s Report to Congress regarding the Agency’s plan for implementing VBP for ASCs, its Report to Congress regarding implementation of VBP for SNFs, and its Report to Congress regarding VBP for HHAs.

P.L. 113-93, the Protecting Access to Medicare Act of 2014 (i.e., the “doc fix”), which was signed into law on April 1, contains a provision at section 215 that calls for the establishment of a SNF VBP to be effectuated by FY 2009, among other directives related to the development and oversight of this program, including several measure development-related and formative prior deliverables.

On August 4, CMS issued a final rule updating FY 2015 Medicare payment policies and rates for inpatient stays at general acute care and LTCHs. The final rule also codifies “two interim final rules with comment period relating to criteria for disproportionate share hospital [DSH] uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program.”

Under the final rule, hospitals that participate in the Hospital Inpatient Quality Reporting Program and are ‘meaningful users’ of EHRs would receive a 1.4% payment update – up slightly from the agency’s 1.3% proposed increased. However, the 1.4% rate increase, when coupled with payment policy reductions enumerated further below – including reductions under the Hospital Readmissions Reduction Program, changes to Medicare DSH payments, and so forth – are projected to decrease IPPS operating payments by approximately 0.6%” (compared to the net decrease of 0.8% under the proposed rule) – or by roughly $756 million in FY 2015.

CMS also finalized its proposal to continue its slow phase-in of the ATRA’s coding intensity adjustment, leaving ~$8 billion to be recouped in FYs ‘15 and ‘16.

Gross LTCH payments under the final rule would increase by 1.1%  – up from the 0.8% CMS put forward in its proposed rule, with a delay (pursuant to the statutory mandate) in the full application of the 25% Rule patient threshold, among other key LTCH policy changes denoted further below.

CMS fact sheets are available here and here.  An agency press release is available here.

2014

On July 1, CMS issued its CY15 Medicare HHA PPS proposed rule under which CMS estimates that HHAs will see a -0.3% update – for an aggregate decrease of $58 million in Medicare payments to HHAs in CY 2015. A CMS fact sheet is available here.  These key ACA provisions are addressed in the underlying rule.  Comments on the proposed rule are due by September 2, 2014.

On Apr. 15, CMS issued a proposed rule (fact sheet) updating FY 2016 payments under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). According to the proposals delineated in the rule, Medicare payments to SNFs are expected to increase by 1.4%, or $500 million, over FY 2015 rates.

On July 6, CMS issued a proposed rule (press release; fact sheet) enumerating CY 16 payments under the Medicare Home Health Prospective Payment System (HH PPS). Under the proposed rule, CMS estimates that home health agencies (HHAs) will see a -1.8% update, for an aggregate decrease of roughly $350 million in Medicare payments to HHAs in CY 16.

On July 30, CMS released a final rule (fact sheet) updating the FY 16 Skilled Nursing Facility (SNF) Prospective Payment System (PPS). Under the final rule, Medicare payments to SNFs are expected to increase by 1.2% (versus 1.4% in April’s proposed rule), with aggregate FY16 payments rising by $430M compared with FY 2015.

On Sep. 3 CMS announced an information collection on whether health care facilities meet Medicare and Clinical Laboratory Improvement Amendments participation requirements.

2016

On June 27, CMS released its proposed rule on the calendar year (CY) 2017 home health prospective payment system rate update, which also proposes further policies for implementing a Home Health Value-Based Purchasing (HHVBP) Model beginning in CY 2018.

On July 28, CMS released July quarterly reports for Skilled Nursing Facilities (SNFs) through the Nursing Home Compare reporting system, including information on the SNF Value-Based Purchasing (VBP) Program. The agency also released a fact sheet on reporting requirements for the Skilled Nursing Facility Quality Reporting Program (SNF QRP).

On Sept. 15, CMS posted an article that provides information on the SNF VBP program, including information on program measures, performance scoring, and on quarterly quality feedback reports.

2017

On April 27, CMS released a proposed rule that would update the prospective payment rates for SNFs for FY 2018. This provision of the ACA is addressed in the rule.

On Aug. 1, CMS finalized rulemaking that would update the prospective payment rates for skilled nursing facilities (SNFs) for FY 2018. This provision of the ACA is addressed in the rule.

Statutory Text

 
Implementation Status 
Summary 

SEC. 3006. PLANS FOR A VALUE-BASED PURCHASING PROGRAM FOR SKILLED NURSING FACILITIES AND HOME HEALTH AGENCIES. (a) SKILLED NURSING FACILITIES.— (1) IN GENERAL.—The Secretary of Health and Human Services (in this section referred to as the ‘‘Secretary’’) shall develop a plan to implement a value-based purchasing program for payments under the Medicare program under title XVIII of the Social Security Act for skilled nursing facilities (as defined in section 1819(a) of such Act (42 U.S.C. 1395i–3(a))). (2) DETAILS.—In developing the plan under paragraph (1), the Secretary shall consider the following issues: (A) The ongoing development, selection, and modification process for measures (including under section 1890 of the Social Security Act (42 U.S.C. 1395aaa) and section 1890A such Act, as added by section 3014), to the extent feasible and practicable, of all dimensions of quality and efficiency in skilled nursing facilities. øAs revised by section 10301(b)¿ (B) The reporting, collection, and validation of quality data. (C) The structure of value-based payment adjustments, including the determination of thresholds or improvements in quality that would substantiate a payment adjustment, the size of such payments, and the sources of funding for the value-based bonus payments. (D) Methods for the public disclosure of information on the performance of skilled nursing facilities. (E) Any other issues determined appropriate by the Secretary. (3) CONSULTATION.—In developing the plan under paragraph (1), the Secretary shall— (A) consult with relevant affected parties; and (B) consider experience with such demonstrations that the Secretary determines are relevant to the value-based purchasing program described in paragraph (1). (4) REPORT TO CONGRESS.—Not later than October 1, 2011, the Secretary shall submit to Congress a report containing the plan developed under paragraph (1). (b) HOME HEALTH AGENCIES.— (1) IN GENERAL.—The Secretary of Health and Human Services (in this section referred to as the ‘‘Secretary’’) shall develop a plan to implement a value-based purchasing program for payments under the Medicare program under title XVIII of the Social Security Act for home health agencies (as defined in section 1861(o) of such Act (42 U.S.C. 1395x(o))). (2) DETAILS.—In developing the plan under paragraph (1), the Secretary shall consider the following issues: (A) The ongoing development, selection, and modification process for measures (including under section 1890 of the Social Security Act (42 U.S.C. 1395aaa) and section 1890A such Act, as added by section 3014), to the extent feasible and practicable, of all dimensions of quality and efficiency in home health agencies. (B) The reporting, collection, and validation of quality data. (C) The structure of value-based payment adjustments, including the determination of thresholds or improvements in quality that would substantiate a payment adjustment, the size of such payments, and the sources of funding for the value-based bonus payments. (D) Methods for the public disclosure of information on the performance of home health agencies. (E) Any other issues determined appropriate by the Secretary. (3) CONSULTATION.—In developing the plan under paragraph (1), the Secretary shall— (A) consult with relevant affected parties; and (B) consider experience with such demonstrations that the Secretary determines are relevant to the value-based purchasing program described in paragraph (1). (4) REPORT TO CONGRESS.—Not later than October 1, 2011, the Secretary shall submit to Congress a report containing the plan developed under paragraph (1). øSection 10301 added a new subsection (f) at the end. There are no subsections (c)-(e)¿ (f) AMBULATORY SURGICAL CENTERS.—øAs added by section 10301(a) (1) IN GENERAL.—The Secretary shall develop a plan to implement a value-based purchasing program for payments under the Medicare program under title XVIII of the Social Security Act for ambulatory surgical centers (as described in section 1833(i) of the Social Security Act (42 U.S.C. 1395l(i))). (2) DETAILS.—In developing the plan under paragraph (1), the Secretary shall consider the following issues: (A) The ongoing development, selection, and modification process for measures (including under section 1890 of the Social Security Act (42 U.S.C. 1395aaa) and section 1890A of such Act, as added by section 3014), to the extent feasible and practicable, of all dimensions of quality and efficiency in ambulatory surgical centers. (B) The reporting, collection, and validation of quality data. (C) The structure of value-based payment adjustments, including the determination of thresholds or improvements in quality that would substantiate a payment adjustment, the size of such payments, and the sources of funding for the value-based bonus payments. (D) Methods for the public disclosure of information on the performance of ambulatory surgical centers. (E) Any other issues determined appropriate by the Secretary. (3) CONSULTATION.—In developing the plan under paragraph (1), the Secretary shall— (A) consult with relevant affected parties; and (B) consider experience with such demonstrations that the Secretary determines are relevant to the value-based purchasing program described in paragraph (1). (4) REPORT TO CONGRESS.—Not later than January 1, 2011, the Secretary shall submit to Congress a report containing the plan developed under paragraph (1).

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