Among the many provisions in the final version of the omnibus health and human services bill were several changes to reimbursement for nursing facilities, most of which were included in prior versions of the HHS bill, with the exception of the rebasing repeal:

Payment restrictions on leave days. Limits payments for leave days in a nursing facility to 30 percent of that nursing facility’s total payment rate for the involved resident and allows this payment only when the occupancy of the nursing facility, inclusive of bed hold days, is equal to or greater than 96 percent.

Payment limitation. Beginning January 1, 2012, resident reimbursement classifications are updated from RUG-III to RUG-IV case mix. Effective January 1, 2012, this law requires the commissioner to determine payment rates to account for the transition to RUG-IV, in a facility-specific, revenue-neutral manner.

Alternate rates for nursing facilities. Suspends automatic property rate adjustments for the rate years beginning on October 1, 2011, and October 1, 2012.

Planned closure rate adjustment. Prohibits the commissioner from accepting applications for planned closure rate adjustments as of July 16, 2011.

Rate increase for low-rate facilities. Increases certain low-rate nursing facility reimbursement rates by up to 2.45 percent effective October 1, 2011—there are about 70 facilities eligible for this increase, with amounts ranging from .01% to 2.45%.

Repeal of rebased operating payment rates. Prohibits any further steps toward phase-in of nursing facility rebased operating payment rates.

Patti Cullen, CAE
952.851.2487
pcullen@careproviders.org

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