Medicareâs Skilled Nursing Facility Payments (CRS Report for Congress)
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| Release Date |
March 14, 2007 |
| Report Number |
RL33921 |
| Report Type |
Report |
| Authors |
Julie Stone, Domestic Social Policy Division |
| Source Agency |
Congressional Research Service |
Summary:
Medicare pays SNFs using a prospective payment system (PPS). Under SNFPPS, Medicare makes a daily payment that varies depending upon the therapy,nursing, and special care needs of the beneficiary as described by one of 53 differentpayment groups, known as resource utilization groups (RUGs). Payments areupdated annually by the SNF "market basket" increase (the measure of inflation ofgoods and services used by SNFs). For FY2007, the SNF payment update is the fullmarket basket of 3.1 percentage points. Add-on payments are also made for careprovided to persons who are HIV-positive or have Acquired Immune DeficiencySyndrome (AIDS).A refined payment system was implemented through regulation on January 1,2006. The refinements updated and recalibrated the RUGs and added nine newRehabilitation plus Extensive Services groups into the RUG classification system.It is still too soon to know whether the refined case mix system is adequate or willwarrant additional refinements.
