MDS 3.0, RUGs IV, RUGs III, Hybrid: A 45 Day Review

Forty- five days past the October 1 conversion to MDS 3.0 and the interim RUGS IV payment groups and I still am getting a great deal of requests for analysis tools, questions on payments, liabilities, dates and rates for the Hybrid (RUGs III) groups, maps between RUGs III and RUGs IV, etc.  While I lost … Read more

As the Home Health and Hospice World Turns: Part II

In Part I, I wrote about my last week’s conversations, etc. regarding the home health industry, specifically Amedysis, the Senate Finance Committee inquiry, the industry impact via the PPACA and the likely consolidation and merger trends that are approaching.  Suffice to say, not all of last week’s news and conversations focused on the home health … Read more

As the Home Health and Hospice World Turns: Part I

Sorry for borrowing (piece of)  a soap opera title for this post but it is rather appropriate given the news that occurred over the past 30 days.  Just this past week, I’ve been interviewed by two business newspapers and on the phone with an investment banking firm I consult with from time to time regarding … Read more

Doc Fix Survives, Medicaid Ehanced Match Doesn’t

In another procedural vote on the revamped Jobs bill in the Senate, Democrats fell short of mustering 60 votes to end a Republican filibuster, effectively ending for now, legislative efforts to extend unemployment benefits.  The vote count was 57 to 41 to continue debate.  Dying with the extension of unemployment benefits are a series of … Read more

Senate Doubles Back on “Doc Fix” Legislation

After a mid-week roadblock was established on a procedural vote all but derailing the American Jobs and Closing Tax Loopholes Act and the integrated provisions that included a “doc fix”, the Senate doubled-back on Friday and passed a separate measure that patches the pending cuts (21%) in the physician fee schedule set for June 1.  … Read more

RUGS-IV Still In Limbo

As the Senate is set this week to take a vote on the American Jobs and Closing Tax Loopholes Act (see my related posts), a key provision within the legislation having to do with implementation of the SNF payment system known as RUGs-IV remains in limbo.  The PPACA (health care reform bill) required implementation of … Read more

American Jobs and Closing Tax Loopholes Update

Prior to the Memorial Day recess (holiday), the House passed its re-shaped version of the bill.  The re-shaping primarily involved spending constraints; reaction to wide-spread criticism (public) of current (and recent) Congressional deficit spending binges as well as a realization that fall elections draw ever closer.  Specifically, what the House did was: Abandoned any additional … Read more

GAO Releases Report on Poor Perfoming Nursing Homes

In 1998, CMS created the Special Focus Facility initiative or program designed to target or focus attention on improving the poorest performing facilities (performance defined by survey/compliance history).  Each state selects up to 15 of the poorest performing facilities until the program reaches its cap or maximum of 136 facilities.  The requirements from CMS to … Read more

Health Reform Implications for Institutional Providers

My last post covered CMS’ proposed rule affecting LTAcHs in fiscal year 2011 (October 1, 2010).  In this post I noted that CMS’ proposed rule included a disclaimer that  any impacts related to the PPACA (health reform) were not included and as a result, CMS would from time to time, release updates providing additional guidance.  … Read more

CMS Proposed Policy and Rate Changes for LTAcHs

Yesterday, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule for rates and other policy changes for FY 2011 (October 1, 2010) as applicable to Medicare inpatient stays within long-term acute care hospitals (LTAcH).  The entire rule can be found at http://www.federalregister.gov/inspection.aspx#special.  In their release, CMS noted that the proposed rule does … Read more