The CMS is calling it a recalibration, but at least 23 members of Congress are calling it a $770 million cut in funding for skilled-nursing facilities next year and $4 billion less over the next five years.
At issue is a forecasting error stemming from a CMS policy revision begun in 2006 expanding to 53 from 44 the Medicare patient classification categoriesknown as resource utilization groups, or RUGsused to set payment rates. The CMS said it estimated that 19% of SNF patients would fall into the new categories, but the actual number turned out to be closer to 30% and that this triggered higher- than-projected Medicare payments.
The proposed recalibration is necessary to achieve budget neutrality for the new RUGs, but in a letter from lawmakers to HHS Secretary Mike Leavitt, its being called a threat to recent quality-improvement gains.
We believe that if CMS were to finalize its proposed rule, the ability of providers to care for our nations most vulnerable populationthe frail elderly and disabledwould be severely threatened, the letter stated. We urge you not to proceed with the proposed forecast error correction.
A Senate letter was originally signed by Sens. Kent Conrad (D-N.D.) and Norm Coleman (R-Minn.); while a House version was signed by Reps. Earl Pomeroy (D-N.D.), Shelley Moore Capito (R-W.Va.) and Shelley Berkley (D-Nev). At deadline, the American Health Care Association said a total of six senators and 17 representatives have signed the letters.
The CMS, however, is saying that the decrease will be mostly offset by 3.1% market basket update. So, where one action will result in a decrease in funding of $770 million for 2009, a different action will bring in an additional $710 million. -- by Andis Robeznieks
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