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Long-Term and Post-Acute Care facilities can expect to see an almost 3 percent increase in payment for both Medicaid and Medicare. And, if a proposal becomes final, Medicare payment could be an additional 3.26 percent higher.
The federal tax package signed May 28, 2003, includes $10 billion for temporary increased Medicaid funding. The general 2.95 percent increase is for the last two calendar quarters of FY 2003 and first three quarters of FY 2004.
The annual Medicare PPS Update for SNFs announced a 2.9 percent increase in Medicare payment rates in FY 2004. The Proposed Rule published May 16, 2003, in the Federal Register also states that the current case mix system will continue for another year.
An additional 3.26 percent above the 2.9 percent SNF market basket increase currently forecast for FY 2004 could be coming, if the proposed supplement (published June 10, 2003) to the Medicare PPS Update becomes final.
The supplement proposes that the payment rate be adjusted beginning with FY 2004 to account for forecast errors in the market basket rate.
From FY 2000 through 2002 the cumulative forecast was 3.26 percent less than the actual change. The major reason for this under-forecast was that wages and benefits for nursing home workers increased more rapidly than expected. The market basket rate is
forecast using historical data, for example, the SNF market basket percent change for FY 2003 was forecast in June 2002.
If this proposal becomes final, it will be applied uniformly-not only when the forecast is lower than the actual change (as has been the case up to now), but also when the forecast is higher than the actual change.
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The caps on rehabilitation therapy covered by Medicare Part B are back in effect, starting with services delivered on and after July 1, 2003. For 2003 the cap covers only half a year, for 2004 and later, the cap applies for a full year.
The 2003 caps are indexed to $1590 for physical therapy and speech-language pathology combined, and $1590 for occupational therapy. Two issues to keep in mind:
- It matters whether residents are in Medicare-certified beds when the caps are reached
- Therapy provided in outpatient hospital settings is exempt from the caps
Although residents in both Medicare-certified and non-certified beds are subject to the cap, those in certified beds may not receive Medicare reimbursement for services after the $1590 limit due to consolidated billing rules.
Beneficiaries in non-certified beds are excluded from those rules and may be reimbursed by Medicare for therapy provided in outpatient hospital settings (when bill types 12x or 13x are used).
Detailed information about implementing the financial caps, including a list of applicable HCPCS codes, is supplied by CMS in Program Memos AB-03-057 and AB-03-073. Points included in the memos:
- The caps do not apply to SNF residents in a covered Part A stay because rehabilitation therapy is included in the global Part A Medicare PPS amount
- CMS will track the total dollar amount of allowed costs reported for payment and will advise beneficiaries on Medicare Summary Notices containing therapy services. The messages will define the caps, state the beneficiary's amount accumulated toward cap/s, advise when cap/s are met and if payment is denied
Accessing beneficiaries' status
Providers may obtain beneficiaries' accrued amounts from the Health Insurance Query Access (HIQA) database. When HIPAA goes into effect (planned for October 2003) the amounts will be available on the ELGA and the ELGB screens. Beneficiaries and providers without access may contact the call center at their intermediary or carrier.
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The CMS Town Hall meeting via telephone on June 2, 2003, was an opportunity for those who use the MDS to give CMS their thoughts about the draft MDS 3.0 assessment. CMS staff began the meeting by reviewing the development process, stakeholder requests, and rationale for changes to specific sections (see CMS Powerpoint).
Professional association representatives and individuals then commented on the MDS generally and on specific sections related to their expertise.
The Quality of Life self report, Section G, received the most attention, both from CMS and commenters. Some comments: only 60 percent of the population being able to respond (as found by CMS) is not adequate, with one commenter estimating that only 25 percent of their population is capable, it would take too long, it could become a survey/QI issue,
and it should exclude new admits.
Other comments included:
- The explosion of purposes for the MDS is at the expense of its clinical value
- More work needs to be done to address individual needs of its populations
- Changes in RAPs are needed to address depression and behavioral symptoms, swallowing scale, and palliative care planning
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Payroll computer systems need to be updated with the new federal income tax withholding tables that are effective for wages paid through December 31, 2004.
The tables show reduced income tax rates under the Jobs and Growth Tax Relief Reconciliation Act of 2003, which was signed into law on May 28, 2003.
Keane Care Payroll software users: click here to view the revised federal income tax tables available in the clients-only Website area.
Please contact your local customer support office if you need any assistance in updating your VistaKEANE Payroll system.
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Do surveyors need authorization to see residents' protected health information under the HIPAA Privacy Rule? No.
Because surveyors' work is required by law and they are considered health oversight agencies, facilities do not need to obtain individual resident's authorization to release protected health information.
Also, facilities do not need a Business Associate agreement with survey agencies. Click here to read the findings that were released in a March 14, 2003, memo from the CMS Director of Survey and Certification Group.
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Your Quality Measures information on the Nursing Home Compare Website is now based on 4th quarter 2002 MDS data. CMS updated the results on May 15, 2003. Consumers can call up the information for each Skilled Nursing Facility in the country.
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Whether and which tasks physicians may delegate were clarified in an April 10, 2003 memo from the CMS Director, Survey and Certification Group. Click here to read the memo.
Regulations specify tasks that must be performed personally by a physician, for example approve in writing a recommendation that an individual be admitted to a LTC facility (CFR 483.40). Another SNF example is that the physician personally must make the initial visit;
other visits may be delegated.
Other tasks may be delegated to a Physician Assistant (PA), Nurse Practitioner (NP), or Clinical Nurse Specialist (CNS) unless prohibited under State law or by a facility's own policies.
The law is more complicated for writing orders and certification, and depends on whether the provider is an employee of the facility. The memo includes this table for SNFs:
| |
Initial visit & orders |
Certification |
Recertification |
Subsequent orders |
| NP & CNS employed by the facility |
May not sign |
May not sign |
May not sign |
May sign |
| NP & CNS not facility employee |
May not sign |
May sign |
May sign |
May sign |
| PA regardless of employment |
May not sign |
May not sign |
May not sign |
May sign |
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The Keane LTC Users' Group invites staff from all facilities using the VistaKEANE system to participate in their organization.
The mission of the Keane LTC Users' Group is to provide input to ensure all the products used by Keane Long-Term Care clients meet the ongoing requirements of the post-acute care community. The Users' Group is a self-governing body, independent of Keane.
Membership in the Users' Group is free and individuals determine their level of involvement.
Sign Up Now
Keane Care customers can visit the VistaKEANE Insider for more information and to sign up for the Keane LTC Users' Group.
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