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 House Bill Seeks Changes to Skilled Nursing Value-Based Purchasing Program

A bipartisan proposal by the leaders of the House Ways and Means Committee to, in part, change the way the skilled nursing facility value-based purchasing (SNF VBP) law reads by raising the amount of quality measures in the program, has cleared the panel and awaits further legislative action.

House Ways and Means Chair Richard Neal (D-Mass.) and ranking member Kevin Brady (R-Texas) are the main sponsors of the Beneficiary Education Tools Telehealth Extender Reauthorization (BETTER) Act of 2019, which the lawmakers said will “improve the quality of and access to services for Medicare beneficiaries.”   

For skilled nursing providers, the key points of the legislation would kick in on Oct. 1, 2022, when the bill would permit, but not require, the Centers for Medicare & Medicaid Services (CMS) to expand the SNF VBP program from one to up to 10 measures. At its core, the SNF VBP is built on rewarding SNFs with incentive payments based on the quality of care they provide to Medicare beneficiaries, as measured by the one current measure: the hospital readmissions measure.

But, the Neal-Brady bill wants to allow for more measures to encourage improved quality. These new measures may include functional status, patient safety, care coordination, patient experience, or any other IMPACT Act quality measures (that is, SNF quality reporting program measures reported on Nursing Home Compare), according to the legislation. 

The IMPACT Act (Improving Medicare Post-Acute Care Transformation Act of 2014) quality measures referenced in the legislation are measures from “the following domains: (A) functional status, cognitive function, and changes in function and cognitive function; (B) skin integrity and changes in skin integrity; (C) medication reconciliation; (D) incidence of major falls; and (E) accurately communicating the existence of and providing for the transfer of health information and care preferences of an individual.” 

The addition of new quality measures would go through rulemaking, bill sponsors said.

In response to the proposal, American Health Care Association Senior Vice President of Government Relations Clifton Porter II says the association is reviewing the specific language in the bill “to assure it helps improve quality and outcomes for residents in nursing homes. We look forward to working with Congress on this bill.”

The legislation makes four other changes to the current SNF VBP legislation:

--It excludes facilities from the SNF VBP program that do not meet a minimum number (to be determined by the secretary of the Department of Health and Human Services) of residents or measures;

--It creates a “process to validate such measures and data” in the SNF VBP program similar to the hospital VBP validation process used to improve the measures and program;

--It provides annual funding to CMS to implement the changes; and

--It instructs the Medicare Payment Advisory Commission to develop a report to Congress by March 2021 on establishing a prototype VBP program under a unified prospective payment system for post-acute care services.

Notably, the new legislation does not make changes to the existing 2 percent withhold, to how much of the withhold is returned to the provider, or any of the public reporting requirements. As required by statute, CMS withholds 2 percent of SNFs’ fee-for-service Part A Medicare payments to fund the VBC program. CMS redistributes 60 percent to SNFs as incentive payments.

Beyond SNF VBP, bill sponsors said Neal-Brady also:

--Extends expiring Medicare provisions, including funding for the National Quality Forum and State Health Insurance Programs, makes permanent a demonstration that protects low-income beneficiaries enrolling in Medicare Part D, and extends protections for payments to rural providers;

--Increases funding for counselors who help Medicare beneficiaries with enrollment questions and Medicare plan choices;

--Improves beneficiary education and outreach prior to initial Medicare enrollment by giving beneficiaries better information to avoid a late enrollment penalty;

--Helps rural and community hospitals that have technical barriers preventing them from starting a graduate medical education program to train physicians and reduce the physician shortage; and

--Expands Medicare telehealth benefits to improve access to mental health services for Medicare beneficiaries.

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