MedPAC Report Discusses Lowering IRF Payment RatesThe Medicare Payment Advisory Commission (MedPAC) released its congressionally mandated June 2024 Report to the Congress: Medicare and the Health Care Delivery System. This year’s report included a chapter that considered ways to lower Medicare payment rates for select conditions in inpatient rehabilitation facilities. Specifically, the chapter explored alternative approaches to lower fee-for-service (FFS) payment rates for beneficiaries admitted to IRFs with select conditions, in lieu of an across-the-board reduction to IRF payment rates, to “better align payments with costs.” It’s important to note that the Commission has recommended since 2009 that the Congress reduce the aggregate level of FFS payments to IRFs. The Commission is concerned that Medicare’s high payment rates encourage IRFs to treat cases that do not require this level of care and unnecessarily increase Medicare spending. Consequently, the Commission recommended several steps for Congress to minimize how frequently Medicare pays for inappropriate IRF stays, including directing CMS to (1) regularly evaluate the list of conditions that count toward compliance and the compliance threshold, (2) clarify existing coverage rules, (3) continue to educate providers about appropriate admissions and documentation, and (4) expand its monitoring and review of claims.
Nursing Shortage Impacting Staffing MandateFollowing CMS’ final rule on Minimum Staffing Standards for Long-Term Care Facilities, several nursing home operators express concern over meeting the new staffing mandate due to the nursing shortage. The mandate, which requires 24/7 registered nurse presence and specific staffing ratios, faces opposition and a federal lawsuit, with facilities expressing concerns over finding sufficient staff amidst high costs and burnout exacerbated by the pandemic.
Yvette M. Salas MSN, CRRN, FSARN Health Policy Chair