CMS Issues FY 2020 Proposed Rule

Carl J. Pucci in Finance & Reimbursement

CMS has issued its FY 2020 Proposed Rule. Attached is the AHCA announcement, which includes a detailed summary of the Rule. 

Specific highlights include:

  • A market basket increase for SNFs of 2.5% (net of all adjustments), effective 10/1/19 (approximately $887 million nationwide).
  • Transition from RUGS IV to PDPM, with few policy changes from last year’s Final Rule. Of note: PDPM remains budget neutral and the Proposed Rule does revise the definition of group therapy (please refer to page 8 of summary), discusses updated ICD-10 diagnosis code mapping (also page 8), clarifies regulatory language related to assessments (page 9 of the summary), and opens further discussion related to potential additional HCPCS codes. 
  • Continues the SNF VBP Program, which establishes a 2% withhold to SNF Part A payments that can be partially earned back based on rehospitalization rate level of improvement. The Rule also finalizes the transition to fiscal year data from calendar year data for baseline and performance year calculations (page 10 of the summary). 
  • Adopts two additional process measures for the SNF QRP related to transfer of health information, effective in FY 2022 (page 12 of the summary). 

AHCA will be preparing additional details related to FY 2020 Proposed Rule. NYSHFA will keep members updated accordingly.


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