On July 31, 2020 the Centers for Medicare and Medicaid Services (CMS) issued the FY 2021 Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule. This updates the Medicare payment rates and Value-Based Purchasing program for Skilled Nursing Facilities effective October 1, 2020.


These updates include routine technical rate-setting updates to the SNF PPS payment rates, along with finalizing adoption of the most recent Office of Management and Budget (OMB) statistical area delineations.  These delineations will result in wage index values being more representative of the actual costs of labor in a given area and apply a 5% cap on wage index decreases from FY 2020 to FY 2021. CMS projects aggregate payments to SNFs will increase by $750 million, or 2.2 percent, for FY 2021 compared to FY 2020.


While they made no changes to the measures, SNF VBP scoring policies, or payment policies, CMS is finalizing updates to the SNF VBP Program Regulation so that it reflects previously finalized policies, and they are also updating the 30-day Phase One Review and Correction deadline for the baseline period quality measure quarterly report. CMS is also announcing performance periods and performance standards for the FY 2023 program year.


In response to stakeholder recommendations, CMS is also finalizing changes to the ICD-10 code mappings, effective October 1, 2020, and they encourage stakeholders to continue to provide feedback on the ICD-10 code mappings so that they may continue to improve and refine the payment methodology.


The FY 2021 SNF PPS Final Rule will be published in the August 5th version of edition of the Federal Register. Federal Register

The Final Rule Fact Sheet Fact Sheet


Blog by Janine Lehman, RN, RAC-CT, CLNC, Proactive Medical Review

Learn more about Janine and the rest of the Proactive team.