The CMS is proposing smaller pay increases to skilled-nursing facilities, inpatient rehabilitation facilities and hospice care in 2018 compared to this year.

The agency on Thursday proposed skilled nursing facilities receive a $390 million increase in federal payments for 2018, representing a roughly 1% increase. This is much less than the $800 million payment hike proposed for skilled nursing facilities last year.

Medicare would pay $80 million a year more to rehabilitation facilities, but that’s $45 million less than what the CMS proposed last year.

Hospices would see payments nearly cut in half year over year. Hospices would receive an additional $180 million, or 1%, more in payments for 2018. In 2017, hospices received a $330 million increase, or 1.1.% raise.

Jonathan Keyserling at the National Hospice and Palliative Care Organization said in a statement that the marginal payment hike “further burdens the community facing ever-increasing costs, and forces hospice providers to do more with less.” He added that the payment increase should be twice as much to about 2.2%.

The agency also proposed new quality measurements within the rules.

Public comment on the proposed changes can be submitted until June 26.


The CMS said in the proposed ruling that the Hospice Compare website will launch sometime in the summer of 2017. The site is intended to make public quality measurement data.

The CMS will allow stakeholders to make recommendations on how the site’s rating system would work and how the ratings are calculated. Hospices will also be given a 30-day period to preview reports before they are made available publicly.

Patients can also be on hospice for longer than six months as long as the individual has a prognosis of six months or less, the CMS proposed. “We have recognized in previous rulings that prognostication is not an exact science,” the agency said.

The number of Medicare beneficiaries receiving hospice services has grown from 513,000 in 2000 to nearly 1.4 million in FY 2016. Medicare hospice expenditures have also grown from $2.8 billion in 2000 to approximately $16.5 billion in 2016.

The CMS projects that hospice expenditures are expected to continue to increase by about 7% annually.

Skilled nursing facilities

The value-based payment program for skilled nursing facilities is set to begin in 2019.

The CMS is asking stakeholders to consider whether the program should tie reimbursement to social risk factors including social support, income and employment.

“One of our core objectives is to improve beneficiary outcomes including reducing health disparities, and we want to ensure that all beneficiaries, including those with social risk factors, receive high quality care,” the CMS said.

In a statement, the American Health Care Association said it appreciated the CMS’ solicitation of input.

Between 2001 and 2013, Medicare post-acute care spending grew at an annual rate of 6.1% and doubled to $59.4 billion, while payments to inpatient hospitals grew at an annual rate of 1.7% over this same period, according to the CMS.

There are more than 16,000 skilled-nursing facilities throughout the country and they admit more than 2 million patients in the traditional Medicare program each year.

Rehabilitation facilities

The CMS proposed removing some claims data requirements on inpatient rehabilitation facilities (IRFs).

A 25% payment penalty for IRFs that fail to submit a Medicare Part A claims form has been removed. The CMS said the penalty is “no longer needed to encourage providers to submit data to the CMS” because submissions are no longer accepted if they lack another form.

The CMS also proposes removing a data metric on whether patients can swallow on their own without supervision. The agency said it duplicated a provision passed last year that included swallowing and nutritional status.

Similar to hospice care, the CMS is asking for stakeholder impute if social risk factors should be included in the IRF Quality Reporting Program.