SKILLED NURSING FACILITY

Medicare Skilled Nursing Facility payments are based on a prospective payment system (SNF-PPS), under which SNFs are paid an all-inclusive per-diem rate for routine and ancillary services, and into which most services provided by other facilities and general practitioners are bundled.

Medicare pays SNFs on the basis of a standard federal rate, adjusted by a Resource Utilization Group (RUG), which is assigned using data from a regulated series of patient assessments in the Minimum Data Set Resident Assessment Instrument (MDS-RAI). Payment for individual SNF admissions will vary based on the acuity of the diagnoses and the length-of-stay. Additional payments are available only for a specific list of non-SNF tests, items and professional services.

Medicare SNF coverage is also dependent on the Medicare beneficiary’s meeting a qualified hospital stay within 30 days prior to the SNF admission.

NEWS

5/07/2008 :: The 2009 proposed rule for the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) was released today. While it technically includes a full 3.1% marketbasket update, CMS states it is decreasing payments by 3.3% to account for much higher coding creep in 2008 than was anticipated. The net result is expected to be a slight reduction in SNF PPS base payments in 2009. Additional bullet points on the proposed rule are available to OHA members.