August 2009

 

FY 10 Medicare Rates for Connecticut SNFs

On August 1, 2009, CMS issued its final rule on Medicare payments to skilled nursing facilities (SNFs), beginning October 1, 2009.  The final rule recalibrates the case-mix adjustments used to establish each of the 53 different payment rates.  As a result, payments to SNFs would be reduced nationally by about $1.05 billion in FY 2010.

Offsetting a portion of the $1.05 billion reduction associated with the recalibration, CMS would apply a market basket adjustment factor of 2.2%. The factor is estimated to increase payment to SNFs by about $690 million.

Consequently, aggregate payments to SNFs during fiscal year 2010 would decrease by approximately $360 million ($690 million -$1.05 billion).

Actual rates to individual facilities would vary because individual SNF payment rates are influenced by geographic wage indices.  While the wage index factors for Connecticut would remain similar to the prior year, the effect of the recalibration would cause most rates to decrease.  Click here for the Connecticut SNF  PPS rates for FY 2010.

The Final rule also establishes a revised case-mix classification methodology for the new RUG IV system, which would include 66 different payment rates.  CMS has indicated that the change would be budget neutral.

In addition, effective with the introduction of the RUG-IV system, CMS proposes to restrict billing for concurrent therapy.  Under the current system, there is no restriction on the time that can be billed for each individual in a concurrent therapy session.  CMS wants to eliminate this perceived incentive and encourage individual therapy.  Thus, the proposal calls for the allocation of concurrent therapy minutes based on the time spent with each individual patient.  The restriction could potentially assign patients to different rehabilitation RUG categories, which in turn may lower payment rates.

If you have any questions, contact Vincent Ruocco, LLC CPA at 203-932-2931.

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