2018/19 SNF Medicare PPS Rates / AHCA Rate Calculator Posted

Carl J. Pucci in Finance & Reimbursement

As announced in NYSHFA member mailing of August 1, 2018, CMS has issued the 2019 SNF PPS Final Rule. The regional Medicare PPS rates have been calculated and are now posted on the NYSHFA website. Nationally, the average increase in the 2018/19 rates over the 2017/18 rates is approximately 2.4%, but will vary depending on each regions’ final wage index. The rates, effective 10/1/18, are found in the “What’s New” section on the home page, as well as archived in the “Reimbursement/Medicare” section under the Facilities Resources” header (see attached). Note: certain regions are identified by a different county in the AHCA calculator link below (i.e., Kingston region is identified by AHCA as Ulster). Both descriptions are now shown in each region’s header for cross-reference. 

In addition, AHCA has developed a 2019 Medicare SNF-PPS rate calculator which will enable members to compute the applicable State/County/RUG mix/QRP Penalty/VBP Payment Incentive Multiplier/Sequester calculations comparing FY 18 and FY 19. 

Under the SNF QRP, CMS reduces by 2 percentage points the annual market basket percentage update in the case of a SNF that does not submit specified quality data for that fiscal year. In addition, the first financial impact related to VBP begins October 1, 2018. CMS will apply either a positive or negative incentive payment to Medicare Part A (FFS) services provided by SNFs. Providers may see up to a 2 percent reduction in rates. Either the improvement from 2015 to 2017 or the performance in 2017 will determine the payment. SNFs will be notified of their VBP incentive payment 60 days prior to October 1 through Performance Score Reports accessible using the QIES-CASPER system. Please refer to the above member mailing from 8/1/18 for additional details on these initiatives. 

Here is the link to the AHCA calculator:

  • The first tab includes the user inputs (State/County/QRP Penalty/VBP Payment Incentive Multiplier)
  • The second tab is Wage Index and RUG summary data
  • The third tab is the facility rate and revenue calculator comparing FY 18 with FY 19 and shows the exact impact of the SNF QRP penalty, the SNF VBP Incentive Multiplier, and the Sequester impact on PPD. 

AHCA Disclaimer:  This FY 2019 Medicare SNF PPS Rate Calculator is not an official CMS calculator. This calculator, with your facility-specific inputs, provides estimated SNF PPS rates and revenues based on tables from the final rule. We anticipate some technical correction updates from CMS, and possible minor calculation or rounding errors for some situations, but overall this tool should provide a close estimate on the revenue impact of all the payment adjustments that go into effect in FY 2019. This tool includes the 2.4% market basket rate increase, the SNF QRP adjustment (for affected facilities), the SNF VBP incentive payment multiplier, and sequester adjustment.


Carl J. Pucci
Chief Financial Officer
518-462-4800 x36