BriggsNetNews

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

On September 30, 2021, CMS issued Transmittal R486PR1.  This 267-page transmittal removes those provisions in Chapter 28, relating to low volume prospective payment rates for skilled nursing facilities because they are obsolete.  In also includes revisions to the instructions for the skilled nursing facility (SNF) prospective payment system (PPS).

Section 2820, Low Medicare Volume Prospective Payment Rates for Skilled Nursing Facilities Effective for Cost Reporting Periods Beginning on or after October 1, 1986 and Prior to Cost Reporting Periods Beginning on or After July 1, 1998, is obsolete and is being removed from the manual. For information on low volume PPS for SNFs, see 42 CFR 413.300, Subpart I.

Section 2821, Calculation of the Low Medicare Volume Prospective Payment Rate, is obsolete and is being removed from the manual. For information on low volume PPS for SNFs, see 42 CFR 413.300, Subpart I.

Section 2822, Methodology for Determining Per Diem Low Medicare Volume Prospective Payment Rates Effective for Cost Reporting Periods Beginning on or after October 1, 1997 and Before July 1, 1998, is obsolete and is being removed from the manual. For information on low volume PPS for SNFs, see 42 CFR 413.300, Subpart I.

Section 2831, General Provisions, is clarified and to ensure that the manual reflects current policy with regards to excluded services, we have removed the existing language and inserted a regulatory citation.

Section 2832, Methodology for Determining Per Diem Prospective Payment Rates Effective for Cost Reporting Periods Beginning On or After July 1, 1998, is revised to remove obsolete policy and a citation to the SNF PPS interim final rule has replaced the extensive methodology for the Federal Per Diem and the Facility-Specific per diem previously discussed in this section.

Section 2833, Determination of Facility-Specific Per Diem Rate, is revised to exclude the step-by- step procedures for calculating the facility-specific per diem rates used during the SNF PPS transition for various provider types which appear in successive clauses of section III.A.1. of the May 12, 1998 interim final rule. Instead, we refer the reader to the SNF PPS interim final rule which is available on-line.

Section 2834, Calculating Payment Under SNF PPS, is revised to remove obsolete policy and refer the reader to wage index values now found on the CMS’s SNF PPS website and, the instructions for the application of the short period adjustment factor that are included in the SNF PPS interim final rule.

Section 2835, Use of SNF Pricer, is revised to refer the reader to the description of the SNF Pricer program found in §§30.4ff. of the Medicare Claims Processing Manual, Chapter 6 and on the SNF PC Pricer home page.

Section 2836, Skilled Nursing Facility Prospective Payment System – Payment Requirements and Adjustments, is revised to reflect changes and/or clarifications in policy that have occurred since the inception of the SNF PPS as outlined in either Federal Register Notices related to the SNF PPS published since 1998 or the Medicare Internet Only Manuals (IOM). The reader is referred to the current policy with respect to Assessment Completion Dates and Locking Requirements, formerly Subsection C and Payment Procedures Using the HIPPS Rate Code, formerly Subsection D, now contained exclusively in the Long Term Care Facility Resident Assessment Instrument (RAI) 3.0 User’s Manual. As a result, former subsection D has been entirely deleted, and the existing instructions contained in former subsections E through J have been re-designated as subsections D through I. Each of these re-designated subsections has been revised to refer the reader to related policy set forth in either a Federal Register Notice or various Medicare Internet Only Manuals, such as the Medicare Program Integrity Manual.

Section 2837, Reporting Rehabilitative Therapy Minutes on the MDS for Purposes of Medicare Payment, is obsolete and is being removed from the manual. For current information please refer to the Long Term Care Facility Resident Assessment Instrument 3.0 User’s Manual.

Appendices I, II, 3, IV and Exhibit I, are obsolete and have been removed from the manual. As noted in Section 2834, the wage indexes and short period factors are published in the Federal Register and are available on-line, and use of the HIPPS rate code assessment indicators are discussed in detail in Chapter 6, §30.1, of CMS Internet Only Pub. 100-04, the Medicare Claims Processing Manual, and the Long Term Care Facility Resident Assessment Instrument 3.0 User’s Manual.DISCLAIMER: The revision date and transmittal number apply to the red italicized material only. Any other material was previously published and remains unchanged.