Medicare Payments for Nursing Homes Stay Healthy in 2006 The Centers for Medicare and Medicaid Services (CMS) released 2006 updates for skilled nursing facility (SNF) per diem payment rates for Part A stays that include an overall annualized increase of 3% in Medicare aggregate spending (Federal Register, Aug. 4, 2005). The rate change is effective Jan. 1, 2006 instead ... Bottom Line
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Bottom Line  |   September 01, 2005
Medicare Payments for Nursing Homes Stay Healthy in 2006
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Special Populations / Older Adults & Aging / Healthcare Settings / Practice Management / Bottom Line
Bottom Line   |   September 01, 2005
Medicare Payments for Nursing Homes Stay Healthy in 2006
The ASHA Leader, September 2005, Vol. 10, 3. doi:10.1044/leader.BML.10132005.3
The ASHA Leader, September 2005, Vol. 10, 3. doi:10.1044/leader.BML.10132005.3
The Centers for Medicare and Medicaid Services (CMS) released 2006 updates for skilled nursing facility (SNF) per diem payment rates for Part A stays that include an overall annualized increase of 3% in Medicare aggregate spending (Federal Register, Aug. 4, 2005). The rate change is effective Jan. 1, 2006 instead of the usual Oct. 1 to allow ample time for the facilities to adjust to a refined Resource Utilization Group (RUG) case-mix classification system.
The current 14 rehabilitation-intensive RUGs-each of which has three payment levels-experience rate increases of 3% to 8% for urban settings. For rural settings the rehabilitation RUG increase is a consistent 3.2%. A resident who requires at least 500 minutes of treatment per week will yield a daily payment ranging from $329 to $385 in an urban setting, depending on the resident’s activities of daily living (ADL) rating. The increase in value of the rehabilitation-intensive RUGs is due to moderate increases in the therapy component and greater increases in the nursing component. However, the SNF is free to allocate the total per diem amount as it sees fit for direct patient services and overhead.
The 2006 rates expand the number of RUG categories from 44 to 53, establishing nine new categories that describe residents needing rehabilitation services in combination with extensive medical services. The “extensive services” category is determined by the need for intravenous medication, suctioning, tracheostomy care, or use of a ventilator/respirator.
In comments to CMS, ASHA supported the retention of the current allowance of three grace days added to a SNF resident’s five-day assessment period. Grace days allow rehabilitation professionals to more accurately estimate the amount of therapy required and maintain efficiency in staffing by not requiring rehabilitation staff to be on call for weekend assessments. CMS agreed to delay the decision regarding grace days and include the issue as part of the design process for the revised Minimum Data Set and revision of the case-mix classification system.
CMS continues to raise the issue of concurrent therapy. This involves a single clinician treating more than one Medicare patient at a time, rendering unrelated services, unlike group therapy. CMS reports that management pressures some clinicians to render concurrent services when clinically inappropriate. CMS agreed to collaborate with professional organizations to establish guidelines and develop educational materials to better define appropriate concurrent therapy.
For more information contact Mark Kander, director of health care regulatory analysis, at mkander@asha.org or by phone at 800-498-2071, ext. 4139.
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September 2005
Volume 10, Issue 13