In the
FY 2025 SNF Prospective Payment System (PPS) Final Rule, the Centers for Medicare and Medicaid Services (CMS) finalized a policy for Skilled Nursing Facilities (SNFs) who participate in the SNF Quality Reporting Program, a validation process beginning in the fall of 2025 for the FY 2027 SNF QRP. This process is a similar one adopted for the SNF Value-Based Purchasing Program (SNF VBP).
Beginning in September, CMS’ contractor Healthcare Management Solutions, LLC (HCMS) will randomly select up to 1,500 SNF each FY to submit MDS records for review. HCMS has provided more information on the following key component to the program:
- Selected SNFs will be notified through their iQIES MDS 3.0 Provider Preview Report folder. The initial selection notification that will be uploaded to a selected SNFs iQIES 3.0 MDS Provider Previews Report folder will be titled Skilled Nursing Facility Data Validation Process - Initial Selection Notification. SNFs selected for the data validation process will be notified through their Internet Quality Improvement and Evaluation System (iQIES) Provider folder only.
- SNFs will receive notifications throughout the year. There is no formal timeline at this time.
- SNFs are encouraged to begin checking their iQIES folders weekly starting in September 2025.
- Selected SNFs are required to submit requested medical chart documentation to support validation of 10 MDS assessment records.
- Any selected SNF that fails to submit requested medical chart documentation within 45 calendar days of the audit notification will be considered noncompliant, resulting in the SNF losing 2% of Medicare reimbursement for the applicable fiscal year.
- SNFs may file for reconsideration if they believe the finding of noncompliance is in error through that process. Please keep in mind that the FY2025 data validation process is only penalizing SNFs for not submitting requested documentation within 45 days of the selection notification.
If after reviewing the available resources, you are still seeking additional information, you may contact the SNF Validation Help Desk at
snfvalidation@hcmsllc.com.