Content with capped 1% increase, providers turn focus to quality aspects of pay rule

The rule's proposed functional status measures will "help show the value of rehab therapy," Morton says.
The rule's proposed functional status measures will "help show the value of rehab therapy," Morton says.

Long-term care associations expressed some relief last week after the Centers for Medicare & Medicaid Services announced a federally mandated 1% Medicare pay raise — with no negative adjustments.

That 1% market basket increase was required for all post-acute care providers — including hospices and inpatient rehabilitation facilities — by the Medicare Access and CHIP Reauthorization Act of 2015. While providers may not jump for joy at the $390 million pay boost for Fiscal Year 2018, it also did not come as a surprise, Cynthia Morton, executive vice president at the National Association for the Support of Long Term Care, told McKnight's.

“We would have liked to had a higher payment update,” Morton said. “It's unfortunate but expected.”

Mark Parkinson, president and CEO of the American Health Care Association, said his group was pleased that the MACRA-mandated adjustment came “with no negative adjustments.”

“Skilled nursing providers operate on a 1.6% margin, based on MedPAC's all-payer margin, so any increase is critical,” Parkinson said.

Both AHCA and NASL are looking forward to sounding off on the quality program provisions of the proposed rule, the groups' respective leaders told McKnight's. Morton said the rule's proposal of four new Quality Reporting Program measures addressing functional status is especially exciting.

“Generally speaking those functional change metrics help show the value of the rehab therapy that's been provided to the patient,” Morton said. “We're really excited about those because it shows the progress of the patient. There's been a lot of criticism in this proposed rule and in various reports questioning the value of therapy, so we've been anxious to get these functional change metrics in line.”

Parkinson noted that CMS' choice to publish a proposal to revise the skilled nursing payment system methodology as its own “rulemaking vehicle” was a “more appropriate course of action” than rolling it in with the industry's annual pay change notice.

Morton also said she's pleased the proposed case mix revisions — currently slated for proposal as part of the FY 2019 skilled nursing rule — were released as an advanced notice, since “it's a big change and people need time to understand it.”

The skilled nursing payment rule for FY 2018 is scheduled to be published in the Federal Register on May 4, with comments due by June 26.