A congressional advisory panel last week recommended that the government develop new interim Medicare payment policies for home health and skilled-nursing care as they move from cost-based reimbursement to prospectively based systems.
The Prospective Payment Assessment Commission said home health agencies should receive a prospectively determined per-visit rate subject to monthly per-beneficiary expenditure limits. Medicare now pays home-care agencies a capped per-visit rate based on average costs.
In 1994, the average national per-visit cost was $63.09, ProPAC said.
ProPAC also said skilled-nursing facilities should be subject to a per-day rate, based on resource utilization. The recommendation also would cap reimbursement for therapy, laboratory tests and other ancillary services.
Routine costs at skilled-nursing facilities, such as room and board, now are reimbursed based on the costs specific to that facility but subject to per-day limits. Ancillary services have no cost limits.
Under the ProPAC recommendation, the transitional payment systems would be in place until HCFA and Congress have the data to implement fully prospective pay for both post-acute services.
Under current payment policies, skilled-nursing facilities and home health agencies represent some of the fastest-growing components of Medi-care expenditures.
The Congressional Budget Office projects that Medicare will spend $20.1 billion for home health services in fiscal 1997, which began Oct. 1, 1996. The CBO projects expenditures of $12.4 billion on skilled-nursing care in fiscal 1997.