Nursing Home Abuse News

CMS Announces Nursing Home Payments to Increase in 2006

Medicare payments to nursing homes will increase by $20 million in 2006, an improvement over earlier forecasts that predicted no increase for long-term care providers next year, the Centers for Medicare & Medicaid Services (CMS) announced Thursday. The final regulation implementing the new payment rates is on display today at the offices of the Federal Register.

With today's notice, CMS is refining the payment categories Medicare uses to set daily payment rates for its beneficiaries who are in nursing facilities. These categories are known as Resource Utilization Groups (RUGs). The proposed rule predicting a flat payment rate was published in the May Register.

The new payment plan will more accurately compensate providers for the care of medically complex patients by creating new payment categories that more closely match the kind of services being provided to them.

"Just as we proposed to do in the spring, we are following through on our promise of holding total payments steady while bringing much needed predictability to the nursing home industry," said Mark B. McClellan, M.D., Ph.D., administrator of CMS. "These steps will enable nursing homes and the Medicare program to continue to move forward on providing quality services for patients who need post-acute care."

In the final rule, CMS introduced nine new payment categories to the current system, increasing the number of categories from 44 to 53. While these refinements trigger the elimination of temporary add-on payments as Congress directed in the Balanced Budget Refinement Act of 1999 (BBRA), the final rule includes other changes, which will balance its impact.

CMS is also increasing the rates for all RUG groups to reflect variations in non-therapy ancillary costs not fully captured in the RUG refinements. This adjustment increases the case mix weight that applies to both nursing and non-therapy ancillary costs, and increases aggregate payments by about three percent. This is a permanent payment increase that will be integrated into the base line spending levels and be continued in future years.

The RUG refinements will be implemented on January 1, 2006, which is the second quarter of 2006. Payments for the first quarter, therefore, will reflect the continuation of the temporary add-on payments that increase federal expenditures to facilities by $350 million. Payments for the balance of the year will reflect the new policy. Agency officials expect the cumulative effect of these policies to allow nursing homes to provide a high quality of care while remaining financially sound.

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	Did You Know?
	Anyone can report nursing home abuse and neglect. Anyone can and should report abuse and neglect. It is a violation of state and federal law for any person, including facility staff, volunteers, visitors, family members or guardians, or another resident, to abuse or neglect a resident. If you suspect abuse or neglect, or if a resident tells you they are experiencing this problem, it is important to believe the resident and report the allegation immediately. This will help prevent further suffering by any resident. Many states have laws that require the reporting of abuse and neglect. Find out what your state requires. Put your report in writing, date it, and keep a copy. Convey as much information as you can about the situation. Provide as much background information as possible. A thorough report will help the investigator to address the situation quickly.