Prospective Payment System for Nursing Facilities

Summary

Prospective Payment System for Nursing Facilities - Makes this Act applicable to the payment for services of nursing facilities under federally funded long-term care programs. (Sec. 102) Sets forth as payment objectives to: (1) maintain an equitable and fair balance between cost containment and quality of care in nursing facilities; (2) maintain administrative simplicity for such facilities and the Secretary of Health and Human Services; (3) encourage nursing facilities to admit residents without regard to their source of payment; (4) encourage investment in buildings and improvements to nursing facilities as necessary to maintain quality and access; and (5) provide an incentive to nursing facilities to admit and provide care to persons in need of comparatively greater care. (Sec. 103) Sets forth provisions regarding: (1) powers and duties of the Secretary; and (2) the relationship of this Act to title XVIII (Medicare) of the Social Security Act. (Sec. 105) Directs the Secretary to: (1) establish a system which groups residents into classes according to similarity of their assessed condition and required services; (2) assign relative weights for resident classes based on the relative value of the resources required for each resident class, performed for each geographic region; and (3) designate no fewer than eight geographic regions. (Sec. 106) Requires the Secretary to determine payment rates for nursing facilities using the following cost-service groupings: (1) nursing service costs; (2) administrative and general costs; (3) fee-for-service ancillary services; (4) selected ancillary services and other costs; and (5) property costs. Directs that nursing facilities be: (1) paid a prospective, facility-specific, per diem rate based on the sum of the per diem rates established for the nursing service, administrative and general, and property cost centers and a facility-specific prospective rate for each unit of the fee-for-service ancillary services; and (2) reimbursed for selected ancillary services and other costs on a retrospective basis. (Sec. 107) Requires the nursing facility to perform periodic resident assessments to determine the resident class of each resident in the facility. (Sec. 108) Sets forth provisions regarding: (1) determination of the per diem rates for nursing service, administrative and general, and property costs; (2) payment for fee-for-service ancillary services; (3) reimbursement of selected ancillary services and other costs; (4) mid-year rate adjustments; and (5) exceptions to payment methods for new and low volume nursing facilities. (Sec. 114) Grants any person or legal entity aggrieved by a decision of the Secretary under this Act, which results in an amount in controversy of $10,000 or more, the right to appeal directly to the Provider Reimbursement Review Board.

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Documents

3 official files

• Introduced in Senate (text)

  Introduced in Senate · EN · 19 September 1994

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• Introduced in Senate (PDF)

  Introduced in Senate · EN · 19 September 1994

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• Introduced in Senate

  summary · EN · 19 September 1994

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