All hope is not lost for skilled nursing providers hoping for relief from a planned reduction in reimbursement rates, a top payment expert recently told McKnight’s Long-Term Care News.
The Centers for Medicare & Medicaid Services in early April announced plans to lower nursing home Patient Driven Payment Model (PDPM) rates by 4.6% — a $1.7 billion decrease — to account for unintentional overpayments.
CMS last April originally announced that it intended to recalibrate PDPM’s parity adjustment. The agency had found that aggregate spending under the new model unintentionally increased by $1.7 billion when compared to what it would have paid SNFs under the old Resource Utilization Group model.
The agency is taking comments on the matter through June 10, which could indicate that it’s still considering phasing in the cuts, according to Robin Hillier, a reimbursement expert and president of RLH Consulting.
“I like to be an optimist and CMS did ask for comments. I think if CMS were 100% opposed to a phase-in they would have just announced that they were going to implement the parity adjustment and wouldn’t have asked for comment,” Hillier told McKnight’s on a Newsmakers Podcast.
The American Health Care Association will ask CMS to spread the reductions over three fiscal years rather than one, McKnight’s learned in mid-April. The association argued that the PDPM cuts over three years is a better way for operators to deal with the government’s overpayments.
Hillier added that providers should take this opportunity to hope for the best butl prepare for the worst. She encouraged facilities to look at their average PDPM rates and Medicare utilization to determine how the proposed cut would impact them, and include that in their commenting.
“Do I think there’s a remote possibility [the cuts will be phased in]? I think there is a remote possibility,” she added. “If you asked me if I think it’s highly likely that we won’t take the [full] cut. I wouldn’t go that far.”
