Quality Measures and Administrative Procedures for the Skilled Nursing Facility Value-Based Purchasing Program and Quality Reporting Program for the FY 2025 SNF PPS Proposed Rule (CMS-10895)

Abstract (2000 characters maximum) The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program is authorized by section 1888(h) of the Social Security Act (the Act), and it applies to freestanding SNFs, SNFs affiliated with acute care facilities, and all non-Critical Access Hospital (CAH) swing-bed rural hospitals. Beginning with payment for services furnished on October 1, 2018, section 1888(h) of the Act requires the Secretary to reduce the adjusted Federal per diem rate determined under section 1888(e)(4)(G) of the Act otherwise applicable to a SNF for services furnished during a fiscal year (FY) by 2 percent, and to adjust the resulting rate for a SNF by the value-based incentive payment amount earned by the SNF based on the SNF’s Performance Score for that FY under the SNF VBP Program. Through the SNF VBP Program, incentive payments are awarded to SNFs to encourage improvements in the quality of care provided to Medicare beneficiaries. The Skilled Nursing Facility Quality Reporting Program (SNF QRP) is authorized by section 1888(e)(6) of the Act, and it applies to freestanding SNFs, SNFs affiliated with acute care facilities, and all non-CAH swing-bed rural hospitals. Section 1888(e)(6)(A)(i) of the Act requires the Secretary to reduce by 2 percentage points the otherwise applicable Annual Payment Update (APU) to a SNF for a FY if the SNF does not comply with the requirements of the SNF QRP for that FY. Section 1888(e)(6)(B)(i)(II) of the Act requires that each SNF submit data on quality measures specified under section 1899B(c)(1) of the Act and data on resource use and other measures specified under section 1899B(d)(1) of the Act in a manner and within the timeframes specified by the Secretary. In addition, section 1888(e)(6)(B)(i)(III) of the Act requires, for FYs beginning on or after October 1, 2018, that each SNF submit standardized patient assessment data required under section 1899B(b)(1) of the Act in a manner and within the timeframes specified by the Secretary. Section 1888(h)(12)(A) of the Act (as added by section 111(a)(4) of Division CC of the Consolidated Appropriations Act, 2021 (Pub. L. 116–260)), requires the Secretary to apply a process to validate data submitted under the SNF VBP Program and the SNF QRP.

The latest form for Quality Measures and Administrative Procedures for the Skilled Nursing Facility Value-Based Purchasing Program and Quality Reporting Program for the FY 2025 SNF PPS Proposed Rule (CMS-10895) expires 2027-12-31 and can be found here.