CMS has released proposed payment rules for hospices and inpatient rehabilitation, psychiatric and skilled nursing facilities in fiscal year 2025.
Fifteen things to know:
1. CMS has proposed a 2.8% increase in payments for inpatient rehab facilities in 2025.
2. The payment update includes a 3.2% market basket update, which is reduced by a 0.4% productivity adjustment. Additionally, CMS aims to update the outlier threshold to maintain outlier payments at 3% of total payments.
3. The proposed rule would equate to an estimated $255 million increase in IRF payments in 2025.
4. The agency also plans to modify assessment items associated with health-related social needs. Under the proposed rule, beginning Oct. 1, 2026, inpatient rehab facilities would be required to report specific data related to living situations and food and utilities.
5. In 2025, CMS aims to increase hospice payments by 2.6%, which would be about a $705 million increase over 2024.
6. The proposed payment increase stems from the 3% market basket increase reduced by a 0.4 percentage point productivity adjustment.
7. The 2025 rates for hospices that do not submit required quality data would be updated by the proposed hospice payment update percentage of 2.6% minus four percentage points, which results in a -1.4% update.
8. Beginning in 2028, CMS plans to add two new process measures to the Hospice Quality Reporting Program: Timely Reassessment of Pain Impact and Timely Reassessment of Non-Pain Symptom Impact.
9. CMS proposed a 4.1% pay increase for SNFs in 2025, based on the proposed SNY market basket of 2.8%, plus a 1.7% market basket forecast error adjustment and a negative 0.4% productivity adjustment.
10. The adjustments are projected to total $196.5 million in 2025.
11. The proposed rule would update the SNF market basket update base year from the current base year of 2018 to a new base year of 2022. It would also update the pay rates used based on the 2025 SNF market basket increase factor, as adjusted by the productivity adjustment and forecast error correction.
12. CMS also plans to add four new social determinants of health items and modify one SDOH assessment item for the SNF quality reporting program.
Inpatient psychiatric facilities
13. CMS plans to increase payments to inpatient psychiatric facilities by 2.7% in 2025, based on the proposed 2021-based market basket increase of 3.1% less a proposed 0.4 percentage point productivity adjustment.
14. The agency also aims to update the outlier threshold so that estimated outlier payments remain at 2% of total payments, which would lead to an estimated 0.1% decrease in aggregate payments.
15. Total estimated payments to inpatient psychiatric facilities are projected to increase by 2.6% (about $70 million) in 2025.