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.
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Skilled Nursing Facilities To Receive 1.4% Medicare Increase October 1
Due to sequestration, skilled nursing facilities (SNF) saw a 2% reduction in Medicare payments for services provided on or after April 1, 2013. But, SNF Medicare rates will (on average) increase 1.43% on October 1, 2013, according to proposed rules recently issued by the Centers for Medicare and Medicaid Services. Rates for individual facilities will vary by geographic location and case-mix. Because of sequestration, rates beginning October 1, 2013 (FY 2014) will be 0.6% lower than rates that were paid from October 1, 2012-March 31, 2013 (FY 2013, before sequestration). More
HCBS: Proposed Rule Allows Veterans Affairs Agreements
"Use of Medicare Procedures To Enter Into Provider Agreements for Extended Care Services" is a proposed rule published in the Federal Register by the U.S. Department of Veterans Affairs (VA) on Feb. 13 that authorizes the VA to enter into agreements with adult day health care as well as other community-based extended care services and nursing homes. Comments must be received by the VA on or before March 15. More
Jimmo vs. Sebelius: No More Improvement Standard for Home Health, SNF Medicare Coverage
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 But in the meantime, the previous "improvement standard" is no longer in effect.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. More
Skilled Nursing Facility Medicare Rate Calculation Tools
We have updated the skilled nursing facility Medicare rate calculation tool for rates beginning October 1, 2012. We have provided a calculation tool that members may use to estimate (conservatively) Medicare Part B therapy rates for January 1, 2013. More