On Monday, April 11th, CMS released the proposed rule, FY 2023 Skilled Nursing Facility (SNFs) Prospective Payment System Rate Update and Quality Reporting Requirements (CMS-1765).

The proposed rule provides for a net market basket increase for SNFs of 3.9 percent beginning October 1, 2022, but for a proposed parity adjustment of 4.6 percent. Due to the proposed parity adjustment, CMS estimates that the net market basket update would decrease Medicare SNF payments by approximately $320 million (a 0.7% decrease) in FY 2023.

AHCA/NCAL has developed a summary of the payment rule and the greatest impacts on members.

ACTION NEEDED

WHCA/WiCAL urges all SNF member providers to submit public comment via the Voter Voice portal to share your concerns with the proposed rule.

WHCA/WiCAL emphasizes three things:

1. The deadline for submitting public comment is June 10. HOWEVER, CMS is already reviewing comments, and so by submitting now, your comments will be more impactful than waiting till a deluge of comments are submitted closer to the deadline. Consider submitting your public comment as soon as possible.
2. To be effective, the provider community needs a high volume of personalized comments to be submitted. We ask each member facility to submit comments, and within each facility, we encourage separate comments from multiple people – NHA, DON, HR, etc. The more, the better!
3. Make a concise, compelling argument using the below framework. Please note – your public comment does not need to be long, you can keep it to 2-3 paragraphs, up to a page at most. What is most important is that you make a convincing case of your concerns.

What should be in your public comment?

In your public comment, use this subject line: CMS SNF Proposed Rule – FY 2023 Skilled Nursing Facility (SNFs) Prospective Payment System Rate Update and Quality Reporting Requirements (CMS-1765)

Your public comment should address two issues:

1. How the proposed Medicare payment reduction set forth in the proposed payment rule will negatively impact your facility, staff, and residents
   • Explain from your own perspective how a payment reduction will exacerbate the workforce shortage and impact patient care.
   • Request that the parity adjustment be removed from the rule, but alternatively if the parity adjustment is to be implemented, it be phased in over a 3-year period to ease the negative impact over time.
2. How a proposed minimum staffing requirement would negatively impact your facility, staff, and residents.
   • Explain the impact of the ongoing workforce shortage and how a minimum staffing standard will not aid providers in addressing the workforce shortage, but rather will likely exacerbate the current workforce shortage crisis that you continue to experience; include details on how your residents are impacted by workforce shortages.
   • If appropriate, explain how the ongoing workforce shortage has forced you to take beds out of service because you could not staff them, and how doing so has reduced community access to post-acute care, including for patients ready for discharge from the hospital.

The more personalized you can make your comment, the better. Use your own circumstances and your own examples to drive home your message.

Submit public comment via the Voter Voice portal to share your concerns with the proposed rule as soon as possible!

AHCA/NCAL WEBINAR RECORDINGS

• AHCA/NCAL held a webinar on April 14 that provided an overview of the proposed rule and a briefing to the membership on submitting comments to CMS.
  • The webinar recording is available here. AHCA/NCAL member login required.
  • Webinar slides are available here.
• AHCA/NCAL held a subsequent webinar on April 21 titled, Tips for Submitting Comments to CMS on the FY23 Payment Rule.
  • The webinar recording is available here. AHCA/NCAL member login required.
  • Webinar slides are available here.

Please direct any questions to Director of Reimbursement Policy Kate Dickson. For assistance with public comment submission, contact Director of Government Relations and Regulatory Affairs Jim Stoa.