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Skilled Nursing Facility Medicare Rate Calculation Tools Update

by Published On: Jun 18, 2012Updated On: Jul 28, 2015

Medicare Part-A Rate Tools

2016 Medicare Part-A SNF Rate Calculator Update (Final and Proposed)

Last year's transition to new wage index area delineations, with many counties being switched from rural to urban status and vice versa, is complete and the new core-based statistical areas (CBSAs) are now fully implemented.  

Users should remain aware that their rural or urban status may have shifted. When using the rate calculator, the first step will be for providers to look for their county in the drop-down menu on the urban worksheet. If the county is not listed on the urban worksheet, the nursing home is classified as being in a rural area and the rural worksheet would be used.  

2015 Medicare Part-A SNF Rate Calculators (Proposed)  

Significant to this Rule is the change in definition of Metro areas to the new OMB definitions, with areas moving from urban to rural and vice versa.  Some providers accustomed to looking on the rural tab may need to use the urban tab for their county, and some may change from urban to rural. 

CMS is phasing the change in over 2 years.  An extra 'tab' is included in the spreadsheet to show the crosswalk from old to new CBSA.  

2014 Medicare Part-A SNF Rate Calculation Tool (Final)

This tool calculates the SNF Medicare Part-A Final Rates for FY 2014, reflecting provisions of the Bipartisan Budget Act signed into law in December of 2013. The law allowed for a 0.5% average increase in Medicare payment rates and extended the 2% sequestration cut for all health care providers for another two years, through 2023.

The conversion factor has been updated in the model to reflect the 0.5% increase in the Bipartisan Budget Act, rather than the significant decrease that would have gone into effect without the new budget law. There is no sequestration calculation in the spreadsheet.

The calculator calculates the full payment rate and says this about the sequestration: 

“For services provided on or after April 1, 2013, the 20% beneficiary co-pay is calculated as 20% of the full amount in the columns on the left.  But due to the sequester, Medicare will only pay 98% of its share. Thus, the total amount (including the co-pay and Medicare's share) to be paid is .984 of the amounts in the columns on the left."   

RUGs-IV Rate Calculation Tool for FY2013 (final rate)

RUGs-IV Rate Calculation Tool for FY 2012 (final rates)

RUGs-IV Rate Calculation Tool for FY 2011 (final rates)

Medicare Part-B Therapy Rate Tools

Medicare Part-B Therapy Rate Calculation Tools 

Copyright © 2015 LeadingAge. All Rights Reserved. Any reproduction of these calculators or use thereof for commercial purposes without permission from LeadingAge is strictly prohibited.


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