{"abstract":"This final rule updates payment rates; forecast error adjustments; diagnosis code mappings; the Patient Driven Payment Model (PDPM) parity adjustment; the SNF Quality Reporting Program (QRP); and the SNF Value-Based Purchasing (VBP) Program. It also establishes a permanent cap policy to smooth the impact of year-to-year changes in SNF payments related to changes in the SNF wage index. We also announce the application of a risk adjustment for the SNF Readmission Measure for COVID-19 beginning in FY 2023. We are finalizing changes to the long-term care facility fire safety provisions referencing the National Fire Protection Association (NFPA)[supreg] Life Safety Code, and Director of Food and Nutrition Services requirements.","action":"Final rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2022/08/03/2022-16457.html","cfr_references":[{"chapter":null,"citation_url":null,"part":413,"title":42},{"chapter":null,"citation_url":null,"part":483,"title":42}],"citation":"87 FR 47502","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"These regulations are effective on October 1, 2022.","disposition_notes":null,"docket_ids":["CMS-1765-F and CMS-3347-F"],"dockets":[{"supporting_documents":[],"agency_name":"CMS","documents":[{"comment_count":null,"comment_start_date":null,"updated_at":"2023-02-27T21:27:04.849-05:00","comment_url":"https://www.regulations.gov/commenton/CMS-2022-0069-6852","allow_late_comments":null,"id":"CMS-2022-0069-6852","comment_end_date":null,"regulations_dot_gov_open_for_comment":false}],"supporting_documents_count":0,"id":"CMS-2022-0069","title":"Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Quality Reporting Program and Value-Based Purchasing Program; Long-Term Care Facilities to Establish Mandatory Minimum Staffing Levels (CMS-1765-P)"}],"document_number":"2022-16457","effective_on":"2022-10-01","end_page":47619,"executive_order_notes":null,"executive_order_number":null,"explanation":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2022/08/03/2022-16457.xml","html_url":"https://www.federalregister.gov/documents/2022/08/03/2022-16457/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities","images":{"ER03AU22.030":{"large":"https://img.federalregister.gov/ER03AU22.030/ER03AU22.030_large.png","medium":"https://img.federalregister.gov/ER03AU22.030/ER03AU22.030_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.030/ER03AU22.030_original_size.png"},"ER03AU22.031":{"large":"https://img.federalregister.gov/ER03AU22.031/ER03AU22.031_large.png","medium":"https://img.federalregister.gov/ER03AU22.031/ER03AU22.031_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.031/ER03AU22.031_original_size.png"},"ER03AU22.010":{"large":"https://img.federalregister.gov/ER03AU22.010/ER03AU22.010_large.png","medium":"https://img.federalregister.gov/ER03AU22.010/ER03AU22.010_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.010/ER03AU22.010_original_size.png"},"ER03AU22.032":{"large":"https://img.federalregister.gov/ER03AU22.032/ER03AU22.032_large.png","medium":"https://img.federalregister.gov/ER03AU22.032/ER03AU22.032_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.032/ER03AU22.032_original_size.png"},"ER03AU22.011":{"large":"https://img.federalregister.gov/ER03AU22.011/ER03AU22.011_large.png","medium":"https://img.federalregister.gov/ER03AU22.011/ER03AU22.011_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.011/ER03AU22.011_original_size.png"},"ER03AU22.033":{"large":"https://img.federalregister.gov/ER03AU22.033/ER03AU22.033_large.png","medium":"https://img.federalregister.gov/ER03AU22.033/ER03AU22.033_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.033/ER03AU22.033_original_size.png"},"ER03AU22.012":{"large":"https://img.federalregister.gov/ER03AU22.012/ER03AU22.012_large.png","medium":"https://img.federalregister.gov/ER03AU22.012/ER03AU22.012_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.012/ER03AU22.012_original_size.png"},"ER03AU22.013":{"large":"https://img.federalregister.gov/ER03AU22.013/ER03AU22.013_large.png","medium":"https://img.federalregister.gov/ER03AU22.013/ER03AU22.013_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.013/ER03AU22.013_original_size.png"},"ER03AU22.014":{"large":"https://img.federalregister.gov/ER03AU22.014/ER03AU22.014_large.png","medium":"https://img.federalregister.gov/ER03AU22.014/ER03AU22.014_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.014/ER03AU22.014_original_size.png"},"ER03AU22.015":{"large":"https://img.federalregister.gov/ER03AU22.015/ER03AU22.015_large.png","medium":"https://img.federalregister.gov/ER03AU22.015/ER03AU22.015_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.015/ER03AU22.015_original_size.png"},"ER03AU22.016":{"large":"https://img.federalregister.gov/ER03AU22.016/ER03AU22.016_large.png","medium":"https://img.federalregister.gov/ER03AU22.016/ER03AU22.016_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.016/ER03AU22.016_original_size.png"},"ER03AU22.017":{"large":"https://img.federalregister.gov/ER03AU22.017/ER03AU22.017_large.png","medium":"https://img.federalregister.gov/ER03AU22.017/ER03AU22.017_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.017/ER03AU22.017_original_size.png"},"ER03AU22.018":{"large":"https://img.federalregister.gov/ER03AU22.018/ER03AU22.018_large.png","medium":"https://img.federalregister.gov/ER03AU22.018/ER03AU22.018_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.018/ER03AU22.018_original_size.png"},"ER03AU22.019":{"large":"https://img.federalregister.gov/ER03AU22.019/ER03AU22.019_large.png","medium":"https://img.federalregister.gov/ER03AU22.019/ER03AU22.019_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.019/ER03AU22.019_original_size.png"},"ER03AU22.020":{"large":"https://img.federalregister.gov/ER03AU22.020/ER03AU22.020_large.png","medium":"https://img.federalregister.gov/ER03AU22.020/ER03AU22.020_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.020/ER03AU22.020_original_size.png"},"ER03AU22.021":{"large":"https://img.federalregister.gov/ER03AU22.021/ER03AU22.021_large.png","medium":"https://img.federalregister.gov/ER03AU22.021/ER03AU22.021_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.021/ER03AU22.021_original_size.png"},"ER03AU22.022":{"large":"https://img.federalregister.gov/ER03AU22.022/ER03AU22.022_large.png","medium":"https://img.federalregister.gov/ER03AU22.022/ER03AU22.022_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.022/ER03AU22.022_original_size.png"},"ER03AU22.001":{"large":"https://img.federalregister.gov/ER03AU22.001/ER03AU22.001_large.png","medium":"https://img.federalregister.gov/ER03AU22.001/ER03AU22.001_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.001/ER03AU22.001_original_size.png"},"ER03AU22.023":{"large":"https://img.federalregister.gov/ER03AU22.023/ER03AU22.023_large.png","medium":"https://img.federalregister.gov/ER03AU22.023/ER03AU22.023_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.023/ER03AU22.023_original_size.png"},"ER03AU22.002":{"large":"https://img.federalregister.gov/ER03AU22.002/ER03AU22.002_large.png","medium":"https://img.federalregister.gov/ER03AU22.002/ER03AU22.002_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.002/ER03AU22.002_original_size.png"},"ER03AU22.024":{"large":"https://img.federalregister.gov/ER03AU22.024/ER03AU22.024_large.png","medium":"https://img.federalregister.gov/ER03AU22.024/ER03AU22.024_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.024/ER03AU22.024_original_size.png"},"ER03AU22.003":{"large":"https://img.federalregister.gov/ER03AU22.003/ER03AU22.003_large.png","medium":"https://img.federalregister.gov/ER03AU22.003/ER03AU22.003_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.003/ER03AU22.003_original_size.png"},"ER03AU22.025":{"large":"https://img.federalregister.gov/ER03AU22.025/ER03AU22.025_large.png","medium":"https://img.federalregister.gov/ER03AU22.025/ER03AU22.025_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.025/ER03AU22.025_original_size.png"},"ER03AU22.004":{"large":"https://img.federalregister.gov/ER03AU22.004/ER03AU22.004_large.png","medium":"https://img.federalregister.gov/ER03AU22.004/ER03AU22.004_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.004/ER03AU22.004_original_size.png"},"ER03AU22.026":{"large":"https://img.federalregister.gov/ER03AU22.026/ER03AU22.026_large.png","medium":"https://img.federalregister.gov/ER03AU22.026/ER03AU22.026_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.026/ER03AU22.026_original_size.png"},"ER03AU22.005":{"large":"https://img.federalregister.gov/ER03AU22.005/ER03AU22.005_large.png","medium":"https://img.federalregister.gov/ER03AU22.005/ER03AU22.005_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.005/ER03AU22.005_original_size.png"},"ER03AU22.027":{"large":"https://img.federalregister.gov/ER03AU22.027/ER03AU22.027_large.png","medium":"https://img.federalregister.gov/ER03AU22.027/ER03AU22.027_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.027/ER03AU22.027_original_size.png"},"ER03AU22.006":{"large":"https://img.federalregister.gov/ER03AU22.006/ER03AU22.006_large.png","medium":"https://img.federalregister.gov/ER03AU22.006/ER03AU22.006_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.006/ER03AU22.006_original_size.png"},"ER03AU22.028":{"large":"https://img.federalregister.gov/ER03AU22.028/ER03AU22.028_large.png","medium":"https://img.federalregister.gov/ER03AU22.028/ER03AU22.028_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.028/ER03AU22.028_original_size.png"},"ER03AU22.007":{"large":"https://img.federalregister.gov/ER03AU22.007/ER03AU22.007_large.png","medium":"https://img.federalregister.gov/ER03AU22.007/ER03AU22.007_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.007/ER03AU22.007_original_size.png"},"ER03AU22.029":{"large":"https://img.federalregister.gov/ER03AU22.029/ER03AU22.029_large.png","medium":"https://img.federalregister.gov/ER03AU22.029/ER03AU22.029_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.029/ER03AU22.029_original_size.png"},"ER03AU22.008":{"large":"https://img.federalregister.gov/ER03AU22.008/ER03AU22.008_large.png","medium":"https://img.federalregister.gov/ER03AU22.008/ER03AU22.008_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.008/ER03AU22.008_original_size.png"},"ER03AU22.009":{"large":"https://img.federalregister.gov/ER03AU22.009/ER03AU22.009_large.png","medium":"https://img.federalregister.gov/ER03AU22.009/ER03AU22.009_medium.png","original_size":"https://img.federalregister.gov/ER03AU22.009/ER03AU22.009_original_size.png"}},"images_metadata":{"ER03AU22.030":{"large":{"identifier":"ER03AU22.030","content_type":"image/png","size":18580,"width":823,"sha":"ed4cb449c1ead38c66a5f7dbc780b47c","url":"https://img.federalregister.gov/ER03AU22.030/ER03AU22.030_large.png","height":163},"medium":{"identifier":"ER03AU22.030","content_type":"image/png","size":9584,"width":511,"sha":"a0147fb539a0e6372c0069e3965263a9","url":"https://img.federalregister.gov/ER03AU22.030/ER03AU22.030_medium.png","height":101},"original_size":{"identifier":"ER03AU22.030","content_type":"image/png","size":36035,"width":3871,"sha":"b54ab97bf4ca8fdba3c4b2647e965333","url":"https://img.federalregister.gov/ER03AU22.030/ER03AU22.030_original_size.png","height":765}},"ER03AU22.031":{"large":{"identifier":"ER03AU22.031","content_type":"image/png","size":30678,"width":820,"sha":"255cd05d6738a8083d1bb00cd877ed3d","url":"https://img.federalregister.gov/ER03AU22.031/ER03AU22.031_large.png","height":235},"medium":{"identifier":"ER03AU22.031","content_type":"image/png","size":15774,"width":513,"sha":"2ad38d58e8c715ec4cf3d4f7f3e92e07","url":"https://img.federalregister.gov/ER03AU22.031/ER03AU22.031_medium.png","height":147},"original_size":{"identifier":"ER03AU22.031","content_type":"image/png","size":61518,"width":3881,"sha":"0ceb1b539626634fee94db7b8e94a2c6","url":"https://img.federalregister.gov/ER03AU22.031/ER03AU22.031_original_size.png","height":1112}},"ER03AU22.010":{"large":{"identifier":"ER03AU22.010","content_type":"image/png","size":59090,"width":823,"sha":"121fdfb8e01875b73850b2965fc887fe","url":"https://img.federalregister.gov/ER03AU22.010/ER03AU22.010_large.png","height":864},"medium":{"identifier":"ER03AU22.010","content_type":"image/png","size":23697,"width":443,"sha":"629a7b02ada70e49b3258053568db1bd","url":"https://img.federalregister.gov/ER03AU22.010/ER03AU22.010_medium.png","height":465},"original_size":{"identifier":"ER03AU22.010","content_type":"image/png","size":63831,"width":3338,"sha":"d603541bf4ecf2f7dbf487bab2ac20c8","url":"https://img.federalregister.gov/ER03AU22.010/ER03AU22.010_original_size.png","height":3505}},"ER03AU22.032":{"large":{"identifier":"ER03AU22.032","content_type":"image/png","size":12547,"width":823,"sha":"7dbc4e5c711a63cf6256893bea69cb3a","url":"https://img.federalregister.gov/ER03AU22.032/ER03AU22.032_large.png","height":136},"medium":{"identifier":"ER03AU22.032","content_type":"image/png","size":5665,"width":495,"sha":"5569ea4f32402a300eee96c26cfb75d4","url":"https://img.federalregister.gov/ER03AU22.032/ER03AU22.032_medium.png","height":82},"original_size":{"identifier":"ER03AU22.032","content_type":"image/png","size":22146,"width":3732,"sha":"8f831884c655091e1c6e7d143cfe7218","url":"https://img.federalregister.gov/ER03AU22.032/ER03AU22.032_original_size.png","height":615}},"ER03AU22.011":{"large":{"identifier":"ER03AU22.011","content_type":"image/png","size":14276,"width":823,"sha":"9edac479d5378d6bc3200c75ac31b4c7","url":"https://img.federalregister.gov/ER03AU22.011/ER03AU22.011_large.png","height":147},"medium":{"identifier":"ER03AU22.011","content_type":"image/png","size":7257,"width":523,"sha":"c8c258aef1d58329e80d724a37315174","url":"https://img.federalregister.gov/ER03AU22.011/ER03AU22.011_medium.png","height":93},"original_size":{"identifier":"ER03AU22.011","content_type":"image/png","size":25138,"width":3948,"sha":"b2c810dba66ba3f31fb210a86ab6cd06","url":"https://img.federalregister.gov/ER03AU22.011/ER03AU22.011_original_size.png","height":705}},"ER03AU22.033":{"large":{"identifier":"ER03AU22.033","content_type":"image/png","size":18138,"width":823,"sha":"7c0623c6db00ad47acea539b0c21dc9b","url":"https://img.federalregister.gov/ER03AU22.033/ER03AU22.033_large.png","height":188},"medium":{"identifier":"ER03AU22.033","content_type":"image/png","size":8888,"width":517,"sha":"92ad4777afcbc5f2e255ac1dfd8b27b6","url":"https://img.federalregister.gov/ER03AU22.033/ER03AU22.033_medium.png","height":118},"original_size":{"identifier":"ER03AU22.033","content_type":"image/png","size":28075,"width":3901,"sha":"735fede1b06e99e6b7f06c2429fa0216","url":"https://img.federalregister.gov/ER03AU22.033/ER03AU22.033_original_size.png","height":891}},"ER03AU22.012":{"large":{"identifier":"ER03AU22.012","content_type":"image/png","size":20896,"width":823,"sha":"55af1f0d12d75b22654f750dd9a2e126","url":"https://img.federalregister.gov/ER03AU22.012/ER03AU22.012_large.png","height":208},"medium":{"identifier":"ER03AU22.012","content_type":"image/png","size":10724,"width":522,"sha":"485bb3e4c0fc4aa54507c7000f4face6","url":"https://img.federalregister.gov/ER03AU22.012/ER03AU22.012_medium.png","height":132},"original_size":{"identifier":"ER03AU22.012","content_type":"image/png","size":37620,"width":3941,"sha":"09d6e389e08864575a5453747eaa02eb","url":"https://img.federalregister.gov/ER03AU22.012/ER03AU22.012_original_size.png","height":996}},"ER03AU22.013":{"large":{"identifier":"ER03AU22.013","content_type":"image/png","size":21090,"width":823,"sha":"726c99c2e942c41e09f5a2667a354068","url":"https://img.federalregister.gov/ER03AU22.013/ER03AU22.013_large.png","height":255},"medium":{"identifier":"ER03AU22.013","content_type":"image/png","size":8936,"width":469,"sha":"63a3ab6c38d42159c35348565e4d8e7a","url":"https://img.federalregister.gov/ER03AU22.013/ER03AU22.013_medium.png","height":145},"original_size":{"identifier":"ER03AU22.013","content_type":"image/png","size":28340,"width":3538,"sha":"b3305800a201e21ec6fb48fc6a801841","url":"https://img.federalregister.gov/ER03AU22.013/ER03AU22.013_original_size.png","height":1097}},"ER03AU22.014":{"large":{"identifier":"ER03AU22.014","content_type":"image/png","size":59441,"width":823,"sha":"fd4044cd5ec1617e9bc8ff89ed7ee3d7","url":"https://img.federalregister.gov/ER03AU22.014/ER03AU22.014_large.png","height":786},"medium":{"identifier":"ER03AU22.014","content_type":"image/png","size":23212,"width":439,"sha":"4ebbbfe680f001c5152235535fe90bd0","url":"https://img.federalregister.gov/ER03AU22.014/ER03AU22.014_medium.png","height":419},"original_size":{"identifier":"ER03AU22.014","content_type":"image/png","size":58674,"width":3315,"sha":"f819e37e6637e4c949058a58e932d488","url":"https://img.federalregister.gov/ER03AU22.014/ER03AU22.014_original_size.png","height":3166}},"ER03AU22.015":{"large":{"identifier":"ER03AU22.015","content_type":"image/png","size":97086,"width":823,"sha":"fd1639d5296299f598dda3603e4a438a","url":"https://img.federalregister.gov/ER03AU22.015/ER03AU22.015_large.png","height":734},"medium":{"identifier":"ER03AU22.015","content_type":"image/png","size":46968,"width":532,"sha":"860891c47d8d679c31b4b2279279d71d","url":"https://img.federalregister.gov/ER03AU22.015/ER03AU22.015_medium.png","height":475},"original_size":{"identifier":"ER03AU22.015","content_type":"image/png","size":302720,"width":4017,"sha":"eb9bae511afd053c0a6df5715c1cac8e","url":"https://img.federalregister.gov/ER03AU22.015/ER03AU22.015_original_size.png","height":3583}},"ER03AU22.016":{"large":{"identifier":"ER03AU22.016","content_type":"image/png","size":10950,"width":820,"sha":"a300a4394592950e37d08286e0d8ea38","url":"https://img.federalregister.gov/ER03AU22.016/ER03AU22.016_large.png","height":126},"medium":{"identifier":"ER03AU22.016","content_type":"image/png","size":5615,"width":525,"sha":"eb645e6efb4f159773f0f221a818df2e","url":"https://img.federalregister.gov/ER03AU22.016/ER03AU22.016_medium.png","height":81},"original_size":{"identifier":"ER03AU22.016","content_type":"image/png","size":38972,"width":3963,"sha":"0b1c6e5c7cf57b03bdc8dd8a6fc5b06d","url":"https://img.federalregister.gov/ER03AU22.016/ER03AU22.016_original_size.png","height":609}},"ER03AU22.017":{"large":{"identifier":"ER03AU22.017","content_type":"image/png","size":10537,"width":823,"sha":"64e34cb392d789e01c04920aba034397","url":"https://img.federalregister.gov/ER03AU22.017/ER03AU22.017_large.png","height":107},"medium":{"identifier":"ER03AU22.017","content_type":"image/png","size":5414,"width":517,"sha":"bbe838c98bfa2fc42c9202596c83c126","url":"https://img.federalregister.gov/ER03AU22.017/ER03AU22.017_medium.png","height":67},"original_size":{"identifier":"ER03AU22.017","content_type":"image/png","size":18294,"width":3901,"sha":"e9030fc79a8e6f2e0fc09227ceac157e","url":"https://img.federalregister.gov/ER03AU22.017/ER03AU22.017_original_size.png","height":505}},"ER03AU22.018":{"large":{"identifier":"ER03AU22.018","content_type":"image/png","size":7606,"width":823,"sha":"ea6dcf3fbc67a073c419c55bb0c9b18e","url":"https://img.federalregister.gov/ER03AU22.018/ER03AU22.018_large.png","height":96},"medium":{"identifier":"ER03AU22.018","content_type":"image/png","size":3884,"width":499,"sha":"e0475ab017efa56bd17b35069058bba1","url":"https://img.federalregister.gov/ER03AU22.018/ER03AU22.018_medium.png","height":58},"original_size":{"identifier":"ER03AU22.018","content_type":"image/png","size":13996,"width":3766,"sha":"1fd8c5d70831bdb5f9c20f5a9e0f0a91","url":"https://img.federalregister.gov/ER03AU22.018/ER03AU22.018_original_size.png","height":440}},"ER03AU22.019":{"large":{"identifier":"ER03AU22.019","content_type":"image/png","size":7559,"width":823,"sha":"8fbe5abdd8b481a36f466de495967bf6","url":"https://img.federalregister.gov/ER03AU22.019/ER03AU22.019_large.png","height":97},"medium":{"identifier":"ER03AU22.019","content_type":"image/png","size":3739,"width":490,"sha":"55caccbba8d5c6a1379a9ec5f74b35a5","url":"https://img.federalregister.gov/ER03AU22.019/ER03AU22.019_medium.png","height":58},"original_size":{"identifier":"ER03AU22.019","content_type":"image/png","size":13493,"width":3702,"sha":"8a86c17c61c7d6b2893b5d4a7fc854ba","url":"https://img.federalregister.gov/ER03AU22.019/ER03AU22.019_original_size.png","height":438}},"ER03AU22.020":{"large":{"identifier":"ER03AU22.020","content_type":"image/png","size":16791,"width":819,"sha":"1501231c15617b00c25bb61cad49efba","url":"https://img.federalregister.gov/ER03AU22.020/ER03AU22.020_large.png","height":193},"medium":{"identifier":"ER03AU22.020","content_type":"image/png","size":9400,"width":517,"sha":"38b6f6a1840fddcb0082d62c93e378b4","url":"https://img.federalregister.gov/ER03AU22.020/ER03AU22.020_medium.png","height":122},"original_size":{"identifier":"ER03AU22.020","content_type":"image/png","size":28652,"width":3901,"sha":"b091c592ed26842f11fc4a2d047366e4","url":"https://img.federalregister.gov/ER03AU22.020/ER03AU22.020_original_size.png","height":919}},"ER03AU22.021":{"large":{"identifier":"ER03AU22.021","content_type":"image/png","size":65938,"width":823,"sha":"21d265add83af0eda88cacf33d3f1bcf","url":"https://img.federalregister.gov/ER03AU22.021/ER03AU22.021_large.png","height":719},"medium":{"identifier":"ER03AU22.021","content_type":"image/png","size":40108,"width":573,"sha":"89854a13afac9be86594b0db54361d1e","url":"https://img.federalregister.gov/ER03AU22.021/ER03AU22.021_medium.png","height":501},"original_size":{"identifier":"ER03AU22.021","content_type":"image/png","size":238599,"width":4333,"sha":"86f645053129884c16eed5cd2ca117a7","url":"https://img.federalregister.gov/ER03AU22.021/ER03AU22.021_original_size.png","height":3787}},"ER03AU22.022":{"large":{"identifier":"ER03AU22.022","content_type":"image/png","size":14536,"width":823,"sha":"fa4cf7098ae575c5147db5ec39e32045","url":"https://img.federalregister.gov/ER03AU22.022/ER03AU22.022_large.png","height":151},"medium":{"identifier":"ER03AU22.022","content_type":"image/png","size":7359,"width":517,"sha":"4bc6d27d8ddc503bfbc3d34d4f34c5df","url":"https://img.federalregister.gov/ER03AU22.022/ER03AU22.022_medium.png","height":95},"original_size":{"identifier":"ER03AU22.022","content_type":"image/png","size":25441,"width":3901,"sha":"30df0198ea8f2106c52dfc82e360b787","url":"https://img.federalregister.gov/ER03AU22.022/ER03AU22.022_original_size.png","height":715}},"ER03AU22.001":{"large":{"identifier":"ER03AU22.001","content_type":"image/png","size":21549,"width":822,"sha":"fcc26794c2f160a6270de6bef1577649","url":"https://img.federalregister.gov/ER03AU22.001/ER03AU22.001_large.png","height":209},"medium":{"identifier":"ER03AU22.001","content_type":"image/png","size":10794,"width":515,"sha":"0896bc529ce3e33bd705b513e8b44f55","url":"https://img.federalregister.gov/ER03AU22.001/ER03AU22.001_medium.png","height":131},"original_size":{"identifier":"ER03AU22.001","content_type":"image/png","size":41370,"width":3901,"sha":"d18ab74f8d5e90559e68e541514ce54f","url":"https://img.federalregister.gov/ER03AU22.001/ER03AU22.001_original_size.png","height":992}},"ER03AU22.023":{"large":{"identifier":"ER03AU22.023","content_type":"image/png","size":17440,"width":821,"sha":"842c5f958d26ab05bf528809dc2567c3","url":"https://img.federalregister.gov/ER03AU22.023/ER03AU22.023_large.png","height":190},"medium":{"identifier":"ER03AU22.023","content_type":"image/png","size":9121,"width":514,"sha":"2d7be648e5ecc1ac920cc1102dffed11","url":"https://img.federalregister.gov/ER03AU22.023/ER03AU22.023_medium.png","height":119},"original_size":{"identifier":"ER03AU22.023","content_type":"image/png","size":30714,"width":3901,"sha":"6267a322fc5ccc4e1a28e4adf671ad39","url":"https://img.federalregister.gov/ER03AU22.023/ER03AU22.023_original_size.png","height":903}},"ER03AU22.002":{"large":{"identifier":"ER03AU22.002","content_type":"image/png","size":13314,"width":820,"sha":"bf40307614cf465dda0d90d927569114","url":"https://img.federalregister.gov/ER03AU22.002/ER03AU22.002_large.png","height":141},"medium":{"identifier":"ER03AU22.002","content_type":"image/png","size":7944,"width":541,"sha":"fbf3ec72bf44746c5431eb6e6dab0bdb","url":"https://img.federalregister.gov/ER03AU22.002/ER03AU22.002_medium.png","height":93},"original_size":{"identifier":"ER03AU22.002","content_type":"image/png","size":26928,"width":4083,"sha":"43c665fcee2dd66eccaa58dbf0ad1642","url":"https://img.federalregister.gov/ER03AU22.002/ER03AU22.002_original_size.png","height":702}},"ER03AU22.024":{"large":{"identifier":"ER03AU22.024","content_type":"image/png","size":109630,"width":823,"sha":"659d7c7ad4fdf83403c3450de7ae2756","url":"https://img.federalregister.gov/ER03AU22.024/ER03AU22.024_large.png","height":992},"medium":{"identifier":"ER03AU22.024","content_type":"image/png","size":46350,"width":489,"sha":"8d735fafbffb07fddd711599f4dec08f","url":"https://img.federalregister.gov/ER03AU22.024/ER03AU22.024_medium.png","height":589},"original_size":{"identifier":"ER03AU22.024","content_type":"image/png","size":126000,"width":3692,"sha":"4d0bda72c3d7af6b4832f75951b24a45","url":"https://img.federalregister.gov/ER03AU22.024/ER03AU22.024_original_size.png","height":4448}},"ER03AU22.003":{"large":{"identifier":"ER03AU22.003","content_type":"image/png","size":11500,"width":823,"sha":"48b28d9bbf80e8ac27478f6993a464ac","url":"https://img.federalregister.gov/ER03AU22.003/ER03AU22.003_large.png","height":130},"medium":{"identifier":"ER03AU22.003","content_type":"image/png","size":4822,"width":417,"sha":"7888e5f40c6a28f5c38a58dcd4a5021a","url":"https://img.federalregister.gov/ER03AU22.003/ER03AU22.003_medium.png","height":66},"original_size":{"identifier":"ER03AU22.003","content_type":"image/png","size":15429,"width":3151,"sha":"fddd1f3562a46038da65e9d21690b8f5","url":"https://img.federalregister.gov/ER03AU22.003/ER03AU22.003_original_size.png","height":498}},"ER03AU22.025":{"large":{"identifier":"ER03AU22.025","content_type":"image/png","size":102280,"width":822,"sha":"eaf0a824a30f5e68f2e8a8f82c8a69e7","url":"https://img.federalregister.gov/ER03AU22.025/ER03AU22.025_large.png","height":886},"medium":{"identifier":"ER03AU22.025","content_type":"image/png","size":64062,"width":574,"sha":"5a569198c79b1292024fd3411461d797","url":"https://img.federalregister.gov/ER03AU22.025/ER03AU22.025_medium.png","height":618},"original_size":{"identifier":"ER03AU22.025","content_type":"image/png","size":371829,"width":4333,"sha":"8dc269d8295dad6f0e6ffd87c1c6bcbe","url":"https://img.federalregister.gov/ER03AU22.025/ER03AU22.025_original_size.png","height":4669}},"ER03AU22.004":{"large":{"identifier":"ER03AU22.004","content_type":"image/png","size":12089,"width":819,"sha":"fcbd42ad261052d90cce48fba0581e83","url":"https://img.federalregister.gov/ER03AU22.004/ER03AU22.004_large.png","height":139},"medium":{"identifier":"ER03AU22.004","content_type":"image/png","size":4841,"width":417,"sha":"049ea7692143d003d451ffe154bd29b9","url":"https://img.federalregister.gov/ER03AU22.004/ER03AU22.004_medium.png","height":71},"original_size":{"identifier":"ER03AU22.004","content_type":"image/png","size":15096,"width":3151,"sha":"7019783c3476e7b69b0fc34acdb9309e","url":"https://img.federalregister.gov/ER03AU22.004/ER03AU22.004_original_size.png","height":535}},"ER03AU22.026":{"large":{"identifier":"ER03AU22.026","content_type":"image/png","size":140722,"width":823,"sha":"f0d11392dbf55395ce536b78f0f215cf","url":"https://img.federalregister.gov/ER03AU22.026/ER03AU22.026_large.png","height":1099},"medium":{"identifier":"ER03AU22.026","content_type":"image/png","size":75176,"width":529,"sha":"0a4cfd24037aea6841f4c44bc3a79268","url":"https://img.federalregister.gov/ER03AU22.026/ER03AU22.026_medium.png","height":706},"original_size":{"identifier":"ER03AU22.026","content_type":"image/png","size":482634,"width":3995,"sha":"64336d41d9f7edae1d2ca48dbdccea92","url":"https://img.federalregister.gov/ER03AU22.026/ER03AU22.026_original_size.png","height":5333}},"ER03AU22.005":{"large":{"identifier":"ER03AU22.005","content_type":"image/png","size":72381,"width":823,"sha":"59446c9de7a234480e671c144b60ef82","url":"https://img.federalregister.gov/ER03AU22.005/ER03AU22.005_large.png","height":649},"medium":{"identifier":"ER03AU22.005","content_type":"image/png","size":41375,"width":548,"sha":"80cc110b4620d42f87970465a3ac695e","url":"https://img.federalregister.gov/ER03AU22.005/ER03AU22.005_medium.png","height":432},"original_size":{"identifier":"ER03AU22.005","content_type":"image/png","size":120289,"width":4130,"sha":"f38c8ecd6a6db8408b67c1c137fd560f","url":"https://img.federalregister.gov/ER03AU22.005/ER03AU22.005_original_size.png","height":3258}},"ER03AU22.027":{"large":{"identifier":"ER03AU22.027","content_type":"image/png","size":46747,"width":230,"sha":"ba7354fdc7c71ac894565e2c738d2ae2","url":"https://img.federalregister.gov/ER03AU22.027/ER03AU22.027_large.png","height":1498},"medium":{"identifier":"ER03AU22.027","content_type":"image/png","size":14343,"width":108,"sha":"77b28d639e22e4548c6c95bcf22fdae0","url":"https://img.federalregister.gov/ER03AU22.027/ER03AU22.027_medium.png","height":703},"original_size":{"identifier":"ER03AU22.027","content_type":"image/png","size":56294,"width":819,"sha":"5be82c9b44cb7fe6073c6184ccd582f5","url":"https://img.federalregister.gov/ER03AU22.027/ER03AU22.027_original_size.png","height":5333}},"ER03AU22.006":{"large":{"identifier":"ER03AU22.006","content_type":"image/png","size":68502,"width":823,"sha":"660649dfe0f91d427d433da8c213ed7d","url":"https://img.federalregister.gov/ER03AU22.006/ER03AU22.006_large.png","height":605},"medium":{"identifier":"ER03AU22.006","content_type":"image/png","size":41319,"width":552,"sha":"c7eb3444f41d50c503ad42a6320760ed","url":"https://img.federalregister.gov/ER03AU22.006/ER03AU22.006_medium.png","height":406},"original_size":{"identifier":"ER03AU22.006","content_type":"image/png","size":118692,"width":4168,"sha":"766b05326e34c03ddfeada1ca71b3f59","url":"https://img.federalregister.gov/ER03AU22.006/ER03AU22.006_original_size.png","height":3066}},"ER03AU22.028":{"large":{"identifier":"ER03AU22.028","content_type":"image/png","size":30797,"width":820,"sha":"c41561095a521bf92ca28633999ca38b","url":"https://img.federalregister.gov/ER03AU22.028/ER03AU22.028_large.png","height":242},"medium":{"identifier":"ER03AU22.028","content_type":"image/png","size":13106,"width":501,"sha":"43067822cf4d93ec326bab6867091d73","url":"https://img.federalregister.gov/ER03AU22.028/ER03AU22.028_medium.png","height":148},"original_size":{"identifier":"ER03AU22.028","content_type":"image/png","size":55980,"width":3790,"sha":"cb53afc6a54082b8e190f4162de67318","url":"https://img.federalregister.gov/ER03AU22.028/ER03AU22.028_original_size.png","height":1119}},"ER03AU22.007":{"large":{"identifier":"ER03AU22.007","content_type":"image/png","size":34537,"width":823,"sha":"5d545b4cbeb68aeba469dcdd940fc4af","url":"https://img.federalregister.gov/ER03AU22.007/ER03AU22.007_large.png","height":419},"medium":{"identifier":"ER03AU22.007","content_type":"image/png","size":16071,"width":489,"sha":"76000be2a33751bb65f0197d77e1d212","url":"https://img.federalregister.gov/ER03AU22.007/ER03AU22.007_medium.png","height":249},"original_size":{"identifier":"ER03AU22.007","content_type":"image/png","size":54944,"width":3696,"sha":"eee4cff1dcaea8763e2f3238bfc670f3","url":"https://img.federalregister.gov/ER03AU22.007/ER03AU22.007_original_size.png","height":1882}},"ER03AU22.029":{"large":{"identifier":"ER03AU22.029","content_type":"image/png","size":16905,"width":823,"sha":"bc9fff68d1e8bc8e32cc98d207d8c5ac","url":"https://img.federalregister.gov/ER03AU22.029/ER03AU22.029_large.png","height":179},"medium":{"identifier":"ER03AU22.029","content_type":"image/png","size":8688,"width":501,"sha":"bc7c5fab3afd9d2f4da8d2f20e398de1","url":"https://img.federalregister.gov/ER03AU22.029/ER03AU22.029_medium.png","height":109},"original_size":{"identifier":"ER03AU22.029","content_type":"image/png","size":30959,"width":3785,"sha":"0f7b80eb1edbb5483b3dad60e7b5d9f3","url":"https://img.federalregister.gov/ER03AU22.029/ER03AU22.029_original_size.png","height":823}},"ER03AU22.008":{"large":{"identifier":"ER03AU22.008","content_type":"image/png","size":21846,"width":823,"sha":"7143ca541bdee1cd9a07995afc862dbc","url":"https://img.federalregister.gov/ER03AU22.008/ER03AU22.008_large.png","height":241},"medium":{"identifier":"ER03AU22.008","content_type":"image/png","size":10610,"width":502,"sha":"bc3c6cbf56efb386bc059d06de0bb445","url":"https://img.federalregister.gov/ER03AU22.008/ER03AU22.008_medium.png","height":147},"original_size":{"identifier":"ER03AU22.008","content_type":"image/png","size":32969,"width":3788,"sha":"5f4af8d89b6f09362682d64f1e41a8fc","url":"https://img.federalregister.gov/ER03AU22.008/ER03AU22.008_original_size.png","height":1109}},"ER03AU22.009":{"large":{"identifier":"ER03AU22.009","content_type":"image/png","size":15192,"width":821,"sha":"0e0dc6b3ceb79cff161398914d4bb933","url":"https://img.federalregister.gov/ER03AU22.009/ER03AU22.009_large.png","height":151},"medium":{"identifier":"ER03AU22.009","content_type":"image/png","size":8362,"width":571,"sha":"8882b15194392d6ce2c2ef7ee48fcd6f","url":"https://img.federalregister.gov/ER03AU22.009/ER03AU22.009_medium.png","height":105},"original_size":{"identifier":"ER03AU22.009","content_type":"image/png","size":26486,"width":4305,"sha":"9aa0dd7b443c9e94474cda1b80355e65","url":"https://img.federalregister.gov/ER03AU22.009/ER03AU22.009_original_size.png","height":792}}},"json_url":"https://www.federalregister.gov/api/v1/documents/2022-16457?publication_date=2022-08-03","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2022-08-03/2022-16457/mods.xml","not_received_for_publication":null,"page_length":118,"page_views":{"count":28432,"last_updated":"2026-04-04 12:15:04 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2022-08-03/pdf/2022-16457.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2022-16457.pdf?1659125715","publication_date":"2022-08-03","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2022/08/03/2022-16457.txt","regulation_id_number_info":{"0938-AT36":{"issue":"201904","html_url":"https://www.federalregister.gov/regulations/0938-AT36/requirements-for-long-term-care-facilities-regulatory-provisions-to-promote-program-efficiency-trans","title":"Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction (CMS-3347-P)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201904&RIN=0938-AT36&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"},"0938-AU76":{"issue":"202204","html_url":"https://www.federalregister.gov/regulations/0938-AU76/fy-2023-skilled-nursing-facility-snfs-prospective-payment-system-and-consolidated-billing-and-update","title":"FY 2023 Skilled Nursing Facility (SNFs) Prospective Payment System and Consolidated Billing and Updates to the Value-Based Purchasing and Quality Reporting Programs (CMS-1765)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=202204&RIN=0938-AU76&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"}},"regulation_id_numbers":["0938-AT36","0938-AU76"],"regulations_dot_gov_info":{"supporting_documents":[],"regulatory_plan":{"html_url":"https://www.federalregister.gov/regulations/0938-AU76/fy-2023-skilled-nursing-facility-snfs-prospective-payment-system-and-consolidated-billing-and-update","title":"FY 2023 Skilled Nursing Facility (SNFs) Prospective Payment System and Consolidated Billing and Updates to the Value-Based Purchasing and Quality Reporting Programs (CMS-1765)"},"comments_count":0,"agency_id":"CMS","comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=CMS-2022-0069","supporting_documents_count":0,"docket_id":"CMS-2022-0069","document_id":"CMS-2022-0069-6852","regulation_id_number":"0938-AU76","title":"Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Quality Reporting Program and Value-Based Purchasing Program; Long-Term Care Facilities to Establish Mandatory Minimum Staffing Levels (CMS-1765-P)","checked_regulationsdotgov_at":"2023-02-28T02:27:04Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":47502,"subtype":null,"title":"Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2023; Changes to the Requirements for the Director of Food and Nutrition Services and Physical Environment Requirements in Long-Term Care Facilities","toc_doc":"Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2023; etc.","toc_subject":"Medicare Program:\n","topics":["Diseases","Grant programs-health","Health facilities","Health professions","Health records","Medicaid","Medicare","Nursing homes","Nutrition","Puerto Rico","Reporting and recordkeeping requirements","Safety"],"type":"Rule","volume":87}