Advocate: ‘Makes no sense’ that skilled nursing was left out of final physician rule

The skilled nursing field will not be a part of the Merit-Based Incentive Payment system under a new federal final rule issued Thursday, leaving some advocates perplexed.

The Centers for Medicare & Medicaid Services released its Physician Fee Schedule, which includes provisions for everything from telehealth to physician evaluation. But Cynthia Morton, executive vice president of the National Association for the Support of Long Term Care, expressed dismay nursing homes were left out of the incentive program.

“We are very concerned about the curt statement CMS makes in the rule that SNFs won’t be eligible for MIPS,” Morton said in an email.

Excluding skilled nursing “makes no sense,” she added, because their omission would keep the field from receiving a Part B payment update each year. MIPS is one of the two pathways for providers to be paid under Part B, as governed by the Medicare Access and CHIP Reauthorization Act. CMS had asked in the proposed rule for ways that facility-based outpatient therapy could be treated under MIPS, Morton said.

“Instead of taking our ideas under advisement, CMS very briefly states in the Final Rule that SNFs won’t be eligible for MIPS because of claim limitations,” she added.

An official with the American Health Care Association expressed similar concerns tied to MIPS back in July, but did not have a comment on the final rule as of late Friday.

But Morton added there is one bright note for providers under the rule: On Jan. 1, CMS will remove functional status reporting requirements for outpatient therapy, which date back to 2013. Such reporting has been a “burden” to the field for years, with no standardization in the process. The NASL has been advocating for its repeal since its inception five years ago.

The final rule also opens up the door for further use of telemedicine, and improving interoperability among providers, moves that industry advocates applauded on Friday.

“While much work remains to ensure that Medicare catches up with private payers in its coverage of telehealth services, this final rule marks progress,” Joel White, executive director of the Health IT Now said in a statement.

CMS has also issued a fact sheet on the rule.