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FY 2009: Prospective Payment System and Consolidated Billing for SNFs
May 2008
The Update
CMS has published a proposed rule which will have an impact on Skilled Nursing Facilities that are participating in the Medicare Program. The proposed rule is available by following the link available from this website: http://www.cms.hhs.gov/center/snf.asp
The modifications documented in this proposed rule outline modifications to the current case mix rates in order to re-establish budget neutrality that had been anticipated with the modifications to the RUG-53 was introduced in January 2006. These modifications are expected to result in a $770-million (-3.3%) decrease in payments to nursing facilities. This decrease would be countered with a 3.1% market basket increase which is anticipated to increase payments to nursing facilities by $710-million. An overall decrease of $60-million (-0.3%) is anticipated – however, not all organizations would be impacted in the same manner by these changes. Other modifications to the Medicare Program in FY2009 are detailed in the proposed rule.
Additionally, the proposed rule discusses changes to the system that are anticipated in FY2010 and beyond. Most significantly are references to the transition to MDS3.0 and the introduction of RUG modifications as a result of the STRIVE project results which are currently planned to be implemented in October 2009.
The comment period for the proposed rule is open until June 30, 2008.
What Momentum is Doing?
Based on the proposed rule, the modifications to the case mix rates in FY2009 will not have a direct impact on the MDS software solution provided by Momentum Healthware. We will continue to monitor the rule as it proceeds through the federal process.
Momentum is already working on a project to address the proposed transition to MDS 3.0 and the possible introduction of a RUG-IV system. This project will proceed as specifications and requirements are made available by CMS.
Last Updated: 5/26/2008
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The EHR system helps us provide better care to what’s often an increasingly complex clientele, for the same money. -Ray Koop, CEO
Luther Home, Winnipeg, Manitoba
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