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CMS has always been clear about its intention for the PDPM reimbursement model to be “budget neutral,” so the 4.6% parity adjustment outlined in FY 2023 Proposed Rule comes as no surprise. For the second consecutive year, CMS is proposing a downward adjustment to SNFs’ Medicare A rates to offset ~5% increased spending created by the implementation of PDPM reimbursement in October 2019. Last year’s Proposed Rule (April 2021) outlined a 5% parity adjustment which was ultimately not included in the Final Rule for FY 2022.

Read on as our experts summarize FY 2023 Proposed Rule’s financial implications + offer guidance for our valued HealthPRO Heritage partners, as well as SNF providers, contracted with other therapy companies, too!

Questions Worth Asking

Now, more than ever, it is critical that providers achieve excellent patient outcomes for their short-term rehab patients. This includes both an excellent patient experience for “consumers,” as well as efficient and effective stays that translate to competitive lengths of stay, episodic cost, and rehospitalization rates. Short-term rehab is likely your organization’s most well-recognized deliverable, and, as such, it is judged by referral sources and your consumer market as representative of the quality of your enterprise. Successful operators reap the benefits of these excellent outcomes with improved standing in their markets, resulting in increased census. They also reap the rewards of value-based purchasing incentives which can amount to as much as 2% of their total Medicare Part A reimbursement.

As senior living organizations work toward overcoming today’s challenges, many are finding success with partnering with consulting experts from RISE Senior Living. 

In December, HealthPRO Heritage shared a white paper entitled “Four Questions to Evaluate Your Business Partners,” which provided practical considerations when reviewing current or potential vendor partnerships within the Aging Services industry. As a follow-up, we provide some of HealthPRO Heritage’s solutions to challenges facing long-term care providers today.

Since the RCS-1 Proposed Rule was released in Spring 2017, through the PDPM Final Rule and up to today, we’ve spent hundreds of hours thinking and pressure testing different ideas. We’ve had ongoing conversations with customers, colleagues, and consultants about PDPM therapy pricing. Our goal was simple: Develop a pricing approach which equally addresses and ensures the success of our patients, customers, and employees under PDPM. 

On Friday, January 14, 2022, the Secretary of Health and Human Services, Xavier Becerra, declared a renewal of the Public Health Emergency declaration, effective January 16, 2022. For an additional 90 days, this allows for access to waiver or modification of requirements under Section 1135 of the Social Security Act. The new expiration date is set for April 16, 2022. CMS has committed to provide notice of the PHE end prior to the expiration date, with a 60-day notice promised. The link to view this declaration: https://aspr.hhs.gov/legal/PHE/Pages/COVID19-14Jan2022.aspx  

The past two years pressure-tested the Senior Living industry in unprecedented ways. Have your partners (or those you may be considering) helped see you through the unique challenges? Are they still the best fit in today's environment to help you weather the storm in 2022 & beyond?