Medicare program; prospective payment system and consolidated billing for skilled nursing facilities--update. Final...

Area of Science:

• Health Policy
• Healthcare Economics
• Geriatric Care

Background:

• Annual updates to Medicare prospective payment system (PPS) rates for skilled nursing facilities (SNFs) are statutorily mandated.
• Legislation including the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA) and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) guides these updates.
• The updates pertain to Medicare payments and consolidated billing for SNFs.

Purpose of the Study:

• To update the prospective payment system (PPS) payment rates for skilled nursing facilities (SNFs) for fiscal year (FY) 2002.
• To rebase and revise the SNF market basket using the most recent available cost data (1997).
• To implement the transition of swing-bed facilities to the SNF PPS.

Main Methods:

• Updating annual PPS rates as required by Section 1888(e) of the Social Security Act.
• Rebasing the routine SNF market basket with 1997 total cost data.
• Modifying specific variables within cost categories.
• Implementing the transition for swing-bed facilities to the SNF PPS.

Main Results:

• Updated SNF PPS payment rates for FY 2002 are established.
• The SNF market basket is rebased and revised based on 1997 cost data.
• Modifications to certain cost category variables are implemented.
• A transition plan for swing-bed facilities to the SNF PPS is set to commence from July 1, 2002.

Conclusions:

• The final rule ensures timely updates to SNF PPS rates for FY 2002.
• Rebasing the market basket enhances the accuracy of payment calculations.
• The integration of swing-bed facilities into the SNF PPS streamlines payment processes for these entities.