Payments for claims made under the skilled nursing facilities (SNFs) prospective payment system (PPS) will decrease by 0.3 percent during fiscal year (FY) 2009, according to an advance release of a Proposed rule issued by CMS. Although the market basked increase for FY 2009 is 3.1 percent, adjustment to the payment system are being proposed that will result in a 3.3 percent reduction in overall payments resulting in the 0.3 percent decrease for FY 2009. As a result, SNF payments are expected to decline $60 million.
Recalibration of the case-mix adjustment
In 2006, the case mix indices (CMIs) were refined to include two adjustments based on forecasted utilization. Although the refinements were not suppose to affect the budget, the expanded resource utilitization groups (RUG) model caused a 30 percent increase in Medicare expenditures and caused reimbursements to rise much higher than the 19 percent initially projected.
CMS' now proposes to recalibrate the case-mix weights so as to re-establish a budget neutral position on a prospective basis and to recalibrate the part that accounted for the use of non-therapy ancillary services. The payments to SNFs will more accurately reflect the service needs of Medicare beneficiaries. Also, it would give CMS a baseline to anticipate future program enhancements, such as quality of care incentives and updates to the case-mix model that will reflect changes in patient needs and industry practices.
Acting CMS Administrator, Kerry Weems, stated these proposed changes are to reflect CMS' policy of providing a high level of quality care for those in skilled nursing facilities and to compensate the facilities properly for providing such care.
Source: CMS Release, May 2, 2008.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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