Provider comments will be vital in determining the fate of potential pay adjustments to the Patient Driven Payment Model, federal health officials said Thursday. 

The Centers for Medicare & Medicaid Services recently received more than 200 entries from industry stakeholders on the agency’s April proposal to recalibrate PDPM’s parity adjustment. They came in response to the agency’s announcement that there had been an unintentional 5.3% unintentional spending increase, or $1.7 billion, for skilled nursing facilities under the new model. This, while PDPM is supposed to be budget neutral. 

CMS staffers on Thursday said those comments will play a big role in determining the next steps after the agency decided to hold off making any final decisions until fiscal year 2023, which starts Oct. 1, 2022. This is good news for providers, who became worried in April after a proposed rule brought speculation that cuts would come as soon as this Oct. 1.

McKnight's Long-Term Care News, May 2019, Page 4, John Kane
CMS’ John Kane

“We received a significant number of comments on this methodology, which we greatly appreciate[d],” John Kane, technical advisor and SNF payment lead for CMS, said during a SNF/Long-Term Care Open Door Forum call Thursday.  

“We are going to be taking all of those comments into consideration and reviewing those comments as we look forward to future rule making and the FY23 SNF PPS proposed rule,” he explained. 

Most comments asked for a delay in implementing any cutbacks. Many also called on the agency to reconsider trimming any payments, given the harsh financial impact that COVID-19 has caused many operators. Commenters also stressed that higher-need patients had justified the need for higher reimbursements and spending. 

PBJ reminder

CMS officials on Thursday also reminded providers that staffing data from April 1, 2021, through June 30, 2021 must be submitted by Aug. 14 to satisfy Payroll-Based Journal requirements. 

“Only data successfully submitted by the deadline will be considered timely and used on the Care Compare website and in the Five-Star rating calculation,” one staffer explained. 

“Once a facility uploads their data files, they need to check their final validation report, which can be accessed in the Certification and Survey Provider Enhanced Reporting, or CASPER folder, to verify if the data was successfully submitted,” they added.