Financial Update - Courtesy of Steve Jones, Moore Stephens Lovelace

 

Welcome to the Prognostication Zone -- Everybody wants to know what they can expect (besides uncertainty), so here we go with the usual disclaimer that these are challenging financial times for federal and state budgets, and it ain't over till the "markedly obese" woman sings. She's just getting warmed up in Florida, and while it appears that SNF rates have been spared immediate cuts and the Senate and House have stopped playing "chicken" (for now), revenue estimating conferences are still ongoing, and the news isn't good.

 

Medicaid - The current guess is that an increased "Trend Adjustment" will be used to reduce July '08 rates so that the statewide weighted average Medicaid rate remains near its current $174 level. If you're going to have a new cost report become effective, that will be taken into account. That type of methodology will likely be rolled forward unless we have something dramatic happen with funding, like a Provider Tax.

 

Medicare - Thursday night, the House Budget Committee passed a FY 2009 budget resolution removing $150 billion of the $180 billion in Medicare cuts over the next 5 years that President Bush proposed in his budget. Most of the remaining $30 billion will come from improving the efficiency of Part D (so they say) and the bad debt phase-out (although we haven't heard of any changes to the 70% rule yet). There's still a potential freeze on market basket increases and the MMA .4% cuts if general revenues exceed the threshold (45%) of Medicare funding. We've hit the threshold two years running.

Last Tuesday MedPac released their recommendations for FY 09, again advising Congress to eliminate the market basket update to skilled nursing facility (SNF) rates for fiscal year 2009. They also suggested Congress establish a quality incentive payment policy for SNFs. Basically, it looks like Part A payments will remain flat until congress can get the spending under control. MedPac is still pushing for cuts totaling $250 million for FY 09.

 

Bottom line - If I were budgeting for the coming year, I'd use the same Medicare Part A rates I'm getting paid for now or possibly decrease them very slightly to be conservative.

I'd expect a slight decline in average SNF Part B rates starting 1/1/09. There is a serious question about the extension of the exceptions process for Part B limits past 6/30/08, but if I had to guess, I'd say it will be extended (it's an election year), but it probably won't be addressed until the FY 09 budget gets hammered out.

 

Other MedPac funding recommendations include increasing the Physician fee schedule 1.1% and Outpatient services by almost 3%.

 

Unconstrained by the name Payment Advisory Commission, MedPac is venturing into quality measurement for SNFs and recommends that CMS:

1. Add the risk-adjusted rates of potentially avoidable re-hospitalizations and community discharge to its publicly reported post-acute care quality measures;
2. Revise the pain, pressure ulcer, and delirium measures currently reported on CMS' Nursing Home Compare Web site; and
3. Require SNFs to conduct patient assessments at admission and discharge.

Now for Some Good News!

Florida's new Secretary of the Agency for Health Care Administration, Holly Benson, has appointed Dyke Snipes as Medicaid Director. Dyke has been involved with Medicaid for more years than either of us cares to remember, but the best part is he understands the pressure that providers are under and tries to do the right thing. (Of course, he and I don't always agree on what the right thing is!) Unfortunately though, he says he doesn't have a printing press for Medicaid money.

 

Make Sure Your Residents Don't Miss Out on "Recovery Rebates"

Even though your residents might not have a tax liability, individuals can still qualify to receive a $300 economic stimulus payment if they are not claimed (or eligible to be claimed) as a dependent on someone else's return and have at least $3,000 of income from any combination of earned income, including Social Security retirement or disability benefits, most Railroad retirement benefits, disability compensation, disability pension, or survivor benefits paid by Veterans Affairs.

 

The stimulus payments are NOT to be considered in the administration of Federal Programs and Federally-Assisted Programs, and there's also a provision that even if the payment amount puts the beneficiary above the asset limit, they will not be taken into account as resources for the month of receipt and the following two months.

 

To obtain a payment, eligible individuals must file a tax return which provides the IRS their name and address and demonstrates their eligibility. Those who would not otherwise have a filing requirement should file a Form 1040A. Social Security, VA, and Railroad Retirement beneficiaries report their income on line 14a. Supplemental security income (SSI) payments do not count as qualifying income for purposes of the rebate. If the 1099 issued for retirement benefits is not available, individuals can estimate their income by taking the amount of the monthly check and multiplying it by the number of months they received benefits. The IRS is sending out information packets late this month explaining the rebate.

While facilities may not be excited about helping prepare tax returns, these are quite simple; and as long as they don't collect a fee, the IRS won't consider them a "paid preparer" who would be subject to sanctions for certain errors or omissions.

 

For more information contact Steve Jones at sjones@mslcpa.com.

AHCA Holds NH Provider Roundtable on Culture Change - Last Friday, the Agency for Health Care Administration (AHCA) held a roundtable provider discussion on the topic of "innovative projects in nursing homes" intended to support culture change, resident autonomy and choice. There were at least 20 participants attending in person and approximately 20 participating by telephone.  The Agency reported that they will be establishing a Web site with examples of "quality initiatives" that relate to nursing home projects involving cultural change, resident autonomy and resident choice.  

 

When the Agency was questioned about field surveyors welcoming cultural change and innovative ideas or whether providers would be sited for deficiencies, the Agency responded that they hope that the new QI Survey will provide consistency for surveyors' responses throughout the state.  The Agency expressed a commitment to the providers to hold quarterly meetings on the topic and allow for future discussions.