AHCA Clarifies 2018/19 PPS Rate Questions

Carl J Pucci

AHCA has clarified numerous questions related to the release of the 2018/19 SNF Medicare PPS rates (see NYSHFA member mailing 8/23/18.)  

Below is the AHCA Bulletin, including a detailed document and video explaining their responses. In addition they have updated the SNF PPS Rate Calculator.


Dear AHCA Member:

After the release of the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) FY 2019 Final Rule, AHCA has received many questions about the order in which adjustments are made to payment rates and how the SNF Value-Based Purchasing (VBP) incentive payment multiplier (IPM) is applied. 

Payment adjustments are made in the order of:

1)         Market basket adjustment
2)         QRP adjustment (if any)
3)         VBP adjustment
4)         Sequestration

We have provided an updated SNF-PPS Rate Calculator if you would like to see how these adjustments impact your SNF PPS rates for FY 2019. 

The IPM is applied directly to your facility's adjusted federal per diem rate on each claim at step three from above. It is NOT applied after a 2% cut as it already contains the cut. An IPM of 1.00000 means you will NOT see a cut, an IPM >1 means you will see a payment increase, and an IPM of

Click here to access a document providing a more detailed explanation of our responses. 

Visit ahcancalED to view a short video on how to understand the SNF VBP Performance Score Reports and your payment adjustment.  

Additionally, AHCA will host a Preventing Hospital Readmissions session on Monday, October 8 at its 69th Convention & Expo in San Diego. Learn more and register here.

Please contact research@ahca.org with any questions.

NYSHFA/NYSCAL CONTACT: 

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