Education event

FFY 2021 Skilled Nursing Facility PPS Proposed Rule




In late April, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for the skilled nursing facility prospective payment system.  If finalized, provisions of the rule will go into effect October 1, 2020.    

CMS notes that this year’s proposed rule is limited to essential policies including payment policies and proposals to reduce provider burden, due to the currently limited capacity of health care providers to review and comment, secondary to the COVID-19 public health emergency.   

In the current proposed rule, CMS proposes several substantive changes to ICD-10 mapping.  The reimbursement system for SNFs, the patient-driven payment model (PDPM) utilizes ICD-10 codes to assign patients to clinical categories and to assign certain co-morbidities. CMS previously finalized a policy that provides for non-substantive changes to ICD-10 codes to be applied via a subregulatory process and for substantive revisions to be proposed and finalized through rulemaking.  

This brief video includes an overview of the major provisions of the proposed rule.  Members are asked to review and to provide input to inform CHA’s continued work on this issue.  A provider forum for additional discussion will be held on May 28 (call information below) and is open to all CHA member organizations.  Members are also invited to submit comments at the “questions” tab on this website.  

Recommended for:

Leaders of skilled nursing facilities, health information system specialists, chief financial officers and reimbursement personnel, as well as chief nursing officers, and leaders in quality management and compliance. 


Download Presentation
Summary of Proposed Final Rule


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