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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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2015 Therapy Payment Calculator Update

The Centers for Medicare & Medicaid Services recently finalized their physician fee schedule final rule for 2015. The rule includes updates to overall payment of physician services, including therapy services. LeadingAge’s Part B Therapy Rate Calculation Tool has been revised to reflect changes made in the final rule. This tool automatically calculates your facilities Medicare Reimbursement for CY 2015 rates, effective January 1, 2015. 

MedPAC Holds 3 Sessions of Interest to Long-Term Care Community

Recently, MedPAC held 3 sessions of interest to the long-term care community. The first was on short hospital stays, the second was on site neutral payments for skilled nursing facilities and inpatient rehabilitation facilities (IRFs), and the third on issues in Medicare Advantage. During the short hospital stay policies session, Chairman Glenn Hackbarth noted that the commission would not have recommendations on short hospital stay policies for their March 2015 report to Congress.

CMS Rejects Advanced Care Planning Codes in Physician Fee Schedule Final Rule

The American Medical Association (AMA) recommendation to include 2 newly created advance care planning codes in the physician fee schedule final rule was rejected by the Centers for Medicare and Medicaid Services.

Breakdown of State Medicaid Nursing Facility Payment Policies Released by MACPAC

On Oct. 29, the Medicaid and CHIP Payment and Access Commission (MACPAC) released data on Medicaid nursing facility payment policies in each of the 50 states and Washington, DC. Since state Medicaid payment policies vary greatly across states, this tool may be helpful to members as they advocate to their state officials on Medicaid skilled nursing facility payment policy.

MedPAC Considers Allowing Hospitals to Recommend Post-Acute Care Providers

At a recent meeting, the Medicare Payment Advisory Commission (MedPAC) discussed proposals to allow hospitals to recommend post-acute care providers to Medicare beneficiaries on discharge. Current law does not permit this kind of recommendation. The commission did not reach a conclusion on any changes in current policy. However, this discussion shows why it is important for nursing homes and other post-acute care providers to focus on quality measure performance and the development of relationships with hospitals and physician organizations.