New Report Shows Care Centers If They Are at Risk of a 2% Rate Penalty

Posted on March 6, 2019 by Julie Apold

The Centers for Medicare & Medicaid Services (CMS) has released the Provider Threshold Report (PTR). This new report for the Skilled Nursing Facility Quality Reporting Program (SNF QRP) shows care centers if they are at risk of a 2 percent rate penalty for failure to meet the 80 percent reporting threshold requirement on the quality reporting measures during a calendar year.   

Failure to meet the threshold can result in a care center having its Medicare Fee-For-Service rate reduced 2 percent in the forthcoming fiscal year. Care centers should review the PTR now to see if they are below the 80 percent threshold on any of the measures, as they have until May 15 to make updates or corrections to their current MDS submissions for, at least, Oct. 1, 2018 – Dec. 31, 2018.    

LeadingAge had advocated for this report because the existing SNF QRP Provider Preview Reports did not offer any indication of whether SNFs were reporting sufficiently to avoid the 2 percent penalty on their Medicare FFS rates. 

CMS has also begun tracking performance on five new quality measures in the fourth quarter of 2018 related to Drug Regimen Review (DRR), as well as Self Care and Mobility scores. The reporting on these measures, even though only for the fourth quarter, is taken into account when determining if a care center has met the 80 percent reporting threshold on all measures. Failure to meet the threshold will see a 2 percent reduction in the FY2020 Medicare FFS rates. Care centers should review their PTR and especially their reporting performance on these new measures, as you can still make updates or corrections to you Oct. 1 – Dec. 31, 2018 MDS submissions until May 15, 2019.

CMS calculates a SNFs performance based on certain QRP measures using data from key sections of the MDS that SNFs submit on their admissions and discharges. Typically, when a SNF fails to meet the SNF QRP reporting requirement, it isn’t that the SNF did not submit MDS data; it is more likely that the relevant MDS sections were not completed at least 80 percent of the time. For example, last year the majority of noncompliant SNFs (penalized 2 percent beginning Oct. 1, 2018) often entered dashes in section GG of the MDS and therefore, were deemed to not have reported adequately.    

For more information about which MDS items tie to the SNF QRP measures, click here.  

The QIES Technical Support Office recently sent an email to providers about the availability of the PTR noting that providers can also access their reporting statistics for CY2019 data submission. The PTR can be found in the "SNF Quality Reporting Program" category in the CASPER Reporting system. It is in the same folder as other items for the SNF QRP, such as the Provider Preview Reports that that just show a SNF’s performance on the quality measure. For more information, see the CASPER Reporting User`s Guide.