SNF Research Studies and Reports

Report to Congress: Unified Payment for Medicare-Covered Post-Acute Care 

Unified PAC Report to Congress (PDF) | Unified PAC Report to Congress Appendices (ZIP)

Section 2(b)(2)(A) of the Improving Post-Acute Care Transformation (IMPACT) Act of 2014 requires a report to Congress on unified payment for Medicare post-acute care (PAC).  Medicare PAC services are provided to beneficiaries by PAC providers defined as skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), and home health agencies (HHAs).  Each PAC provider setting has a separate Medicare fee-for-service (FFS) prospective payment system (PPS). A goal of unified PAC payment is to base the payment on patient characteristics instead of the PAC setting.  

The Centers for Medicare and Medicaid Services (CMS) and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with Research Triangle Institute (RTI) to provide analysis for this study and report.  RTI convened external technical expert panel meetings to obtain input on the study and report.  In the report, the framework applies a uniform approach to case-mix adjustment across Medicare beneficiaries receiving PAC services for different types of PAC providers while accounting for factors independent of patient need that are important drivers of cost across PAC providers.  The unified approach to case-mix adjustment includes standardized patient assessment data collected by the four PAC providers.  The report does not include legislative recommendations, as additional analyses would need to be done prior to testing or universal implementation of a unified PAC payment system.

Prior SNF Research Studies and Reports

• Observations on Therapy Utilization Trends (PDF) - This memo discusses two notable trends the CMS have observed related to resident classification and therapy utilization by SNF providers for Medicare Part A residents.
• SNF Monitoring - In the FY 2012 SNF PPS final rule, we stated we would monitor the impact of certain FY 2012 policy changes on various aspects of the SNF PPS. Specifically, we have been monitoring the impact of the following FY 2012 policy changes:
  • Recalibration of the FY 2011 SNF parity adjustment to align overall payments under RUG-IV with those under RUG-III,
  • Allocation of group therapy time to pay more appropriately for group therapy services based on resource utilization and cost, and
  • Implementation of changes to the MDS 3.0 patient assessment instrument, most notably the introduction of the Change-of-Therapy (COT) Other Medicare Required Assessment (OMRA).
  • SNF Monitoring (ZIP) includes the latest information from our monitoring efforts.
• SNF Value-Based Purchasing Report to Congress - The Affordable Care Act requires the Secretary of Health and Human Services to develop a plan to implement a value-based purchasing (VBP) program for payments under the Medicare program for  skilled nursing facilities (SNFs). The Secretary shall submit the report containing this plan to Congress.
  
  The Report to Congress describes the current efforts to improve quality and payment efficiency in  SNFs.  In addition, it considers the steps required in designing and implementing a SNF VBP program for payments under the Medicare program.  CMS views VBP as an important step forward in revamping how Medicare pays for health care services; moving the program towards rewarding better value, outcomes, and innovations, instead of merely volume.
  
  The  SNF VBP Report to Congress was authorized under Section 3006(a) of the Patient Protection and Affordable Care Act (Pub. L. 111-148), enacted on March 23, 2010, as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152), enacted on March 30, 2010 (collectively known as the Affordable Care Act) (as added by section 10301(a) of the Affordable Care Act).
  
  Value-Based Purchasing Report to Congress:   SNF Value-Based Purchasing Report to Congress (PDF)
• Post Acute Care Reform Plan
• RUG Refinement
• Time Study (STRIVE)
• Medicare patient days by Resource Utilization Group (RUG) under the RUG-III and RUG-IV (ZIP) payment systems by provider number. Data utilizing FY 2011 first quarter Medicare claims matched to MDS assessments used for the SNF PPS FY 2012 proposed rule and data utilizing the first eight months of FY 2011 Medicare claims matched to MDS assessments used for the SNF PPS FY 2012 final rule
• Medicare patient days by Resource Utilization Group (RUG) under the RUG-III payment system by provider number (ZIP). This data utilizes FY 2010 fourth quarter National Claims History (NCH) Medicare claims data
• SNF Baseline Expenditure Data Used (ZIP) to calculate the impact analysis for the FY 2012 SNF PPS Proposed Rule as well as date used to calculate the impact analysis for the FY 2012 SNF PPS final rule
• Determining RUG-III Group Distribution Based on MDS 3.0 Data (PDF)
• Therapy Minutes by Mode for Different Ownership Status Types (ZIP) utilizing the first quarter of FY 2011 data and utilizing the first eight months of FY 2011
• RUG-III and RUG-IV Distribution of Service Days (ZIP) based on the first quarter of FY 2011 data used for the FY 2012 SNF PPS proposed rule and service days based on the first eight months of FY 2011 used for the FY 2012 SNF PPS final rule
• RUG-III service days for FY 2010 by month data (ZIP) used to evaluate possible seasonality .
• Comparison of Expected versus Actual RUG-IV Utilization (PDF) for the first 8 months of FY 2011