Three categories — rehospitalizations, quality measurements and interoperability — are expected to be major challenges for providers under a new Skilled Nursing Facility Prospective Payment System proposed rule, according to one long-term care expert.

The Centers for Medicare & Medicaid Services is expected to release its notice on the rule by May 1, said David Gifford, M.D., senior vice president of quality and regulatory affairs at the American Health Care Association, on Monday. Far more than just the usual market basket update (inflationary pay adjustment) worries should concern providers, Gifford explained.

The new rule could contain a “wildcard” piece related to electronic records interoperability, Gifford said.

“We’re the most anxious about that,” he noted about the nation’s largest association of nursing home and long-term care operators.

Long-term care was long ago left out of stimulus money for electronic medical records, and the IMPACT Act contained only a vague requirement that providers need to exchange certain data elements in fiscal year 2018. But Gifford said he suspects CMS will create a “backdoor requirement” under which providers will have to have more robust interoperable electronic records systems in order to participate in incentive programs such as accountable care organizations.

Also, if the estimates are correct, skilled nursing facility Medicare Part A payments could be correlated to 30-day rehospitalization rates under the rule, Gifford said. Those with poor rates may be hit with a 2% cut by late 2018.

The rule also is expected to specify quality requirements. CMS is evaluating 11 modified quality measurements under its reporting program, and Gifford said he expects most will be added in. Of top concern is the 90-day Payment Standardized Medicare Spending Per Beneficiary, which Gifford warned could create confusion related to comparability across settings.

More testing is needed to see if measurements for an inpatient rehabilitation setting, for example, and the data from those measurements, should be stretched to a different setting.

There’s also concern about drug regimen review and follow-up, which is a review of all medications to identify potential adverse effects, duplicate drug therapy or noncompliance with drug therapy. That also needs more testing, Gifford said.

In early April, Gifford’s LeadingAge counterpart, Senior Vice President Cheryl Phillips, M.D., said she expected that the final rule would include Quality Assurement Performance Improvement rules, and updated regulations on ethics, compliance and infection control.

The final rule is expected to be released in August or September so that it can be put into effect for fiscal 2017 (starting Oct. 1, 2016).