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We appreciate the recommendation on creating a floor of ( negative payment adjustments once ASM participants collectively improve outcomes but do not believe that this would be appropriate for ASM as it could lead to a reduction in the magnitude of upside payment adjustments, which could lead to less meaningful incentives to improve quality and reduce unnecessary spending

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The interrupted stay policy doesn’t apply and we consider the subsequent stay a new stay if the patient readmits to either: The same SNF outside the interruption window A different SNF (regardless of the length of time between stays) In these cases, the VPD schedule resets to day 1 payment rates, and the assessment schedule also resets to day 1, requiring a new 5-day assessment

especially those with exocrine pancreatic insufficiency