CMS Issues FY 2021 SNF Final Payment Rule

Carl J. Pucci in Finance & Reimbursement

CMS has released the FY 2021 SNF PPS final payment rule, which includes the following: 

  • Net Market Basket increase of 2.2%, effective 10/1/20 (approximately $750M nationwide)
  • Nominal changes to the Patient-Driven Payment Model (PDPM)
  • No impact upon the Public Health Emergency (PHE) or the related Section 1135 Waiver (currently set to expire on 10/26/20)
  • Does not address AHCA recommended PDPM COVID-related payment policy changes (AHCA is pursuing legislative action) 

Below is the AHCA announcement with a detailed summary of the final rule: 

The Centers for Medicare & Medicaid Services (CMS) today issued the final rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2021 update.   

We are pleased to report that the final rule includes a net market basket increase of 2.2 percent. The final market basket is one tenth lower than the proposed market basket of 2.3 percent due to updated data reflecting substantial changes in the macroeconomic forecast due to COVID-19 CMS estimates that the net market basket update would increase Medicare SNF payments by approximately $750 million in FY 2021.

As we predicted, CMS issued the final rule with few changes in the Patient-Driven Payment Model (PDPM) payment policy section. Updates were limited to nominal additions/deletions of ICD-10 codes used to map the primary reason for SNF stay diagnosis to appropriate PDPM clinical categories from the lists included in the proposed rule. 

The team at AHCA team has developed a summary (member login required) of the payment updates, the SNF value-based purchasing program, and the IMPACT Act quality reporting additions.  

We appreciate your continued support, especially during this challenging time. Please do not hesitate to reach me directly with any questions or comments.  

Michael W Cheek
Senior Vice President
Reimbursement Policy


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