Nursing Home Payment and Finance
We advocate for Medicare and Medicaid payment systems for nursing homes that will appropriately account for essential costs of high quality care. We work with the Centers for Medicare and Medicaid Services (CMS) to obtain the most up-to-date information on payment policies and updates.
On January 24, the U.S. District Court for the District of Vermont approved the settlement of Jimmo vs. Sebelius, a class-action lawsuit against the so-called "improvement standard" for Medicare coverage of skilled maintenance services in home health, nursing home and outpatient therapy settings. According to the terms of the settlement, a beneficiary will continue to have Medicare coverage for these services even if the beneficiary's condition does not improve. The Centers for Medicare and Medicaid Services (CMS) is revising its payment manual and plans extensive education to Medicare contractors, providers and others. But in the meantime, the previous "improvement standard" is no longer in effect. More information is available from the Center for Medicare Advocacy, one of the original parties in the Jimmo vs. Sebelius lawsuit.
Dr. Cheryl Phillips, our senior vice president for advocacy and public policy, discusses accountable care organizations and what LeadingAge members will need to do to engage with them in the future.
We have updated the skilled nursing facility Medicare rate calculation tool for final rates beginning Oct. 1, 2013.
The Centers for Medicare and Medicaid Services (CMS) has issued a Survey and Certification Letter announcing changes to the required Office of Civil Rights (OCR) Clearance Process for providers applying for participation in the Medicare Part A program. Effective July 15, State Survey Agencies (SA) must include the OCR Certification Information Request Packet with the initial enrollment package sent to potential providers or to providers undergoing a change in ownership (CHOW). SAs must now also offer potential providers the option to submit the entire civil rights package online.
A slowing rate of growth in Medicare spending has extended the projected solvency of the Medicare Trust Fund for an additional 2 years, to 2026, according to the annual report released by the Medicare Trustees on May 31. The Centers for Medicare and Medicaid Services (CMS) attributes the positive trend to provisions of the Affordable Care Act that have held the growth in Medicare spending per beneficiary to below the per-person rate of growth in the nation's economy.