Rehabilitation Outcome Reviews-Check out key points to BBA rehab changes
Rehabilitation Outcome Reviews-Check out key points to BBA rehab changes
The Balanced Budget Act (BBA) of 1997 made various provisions for rehabilitation providers, including these:
• Requires the Secretary of Health and Human Services to establish a prospective payment system (PPS) for inpatient rehabilitation hospital or unit services (operating and capital costs) based on patient case mix groups.
• Authorizes a three-day transition period to full PPS implementation. Payment for cost reporting periods on or after Oct. 1, 2000, and before Oct. 1, 2002, is equal to the sum of the TEFRA rate and the PPS rate. The blend is as follows:
— on or after Oct. 1, 2000, and before Oct. 1, 2001, the TEFRA percentage (or, the percentage of the amount that would have been paid if this subsection did not apply) is 66.6%, and the PPS percentage (or, the product of the per unit payment rate and the number of such payment units within a cost reporting period) equals 33.3%.
— on or after Oct. 1, 2001, and before Oct. 1, 2002, the TEFRA percentage is 33.3%, and the PPS percentage is 66.6%.
• Requires the secretary to establish classes of patients (based on factors the secretary deems appropriate) of rehabilitation facilities and a method of classifying specific patients within these groups. The unit of payment will be defined by the secretary. The secretary is authorized to adjust payments according to case mix and to require facilities to submit the needed data to establish/ administer the PPS under this subsection.
• The secretary is required to determine a prospective payment rate for each payment unit for which a rehabilitation facility would be entitled to payment under Medicare. The payment rate will be determined using the most recent cost reporting data and by calculating the average payment for operating and capital costs per facility, adjusted by: (1) updating by the weighted average of the applicable percentage increases for each fiscal year up to FY 2000, and an increase factor specified by the secretary for subsequent fiscal years; (2) reducing such rates by a factor equal to the estimated proportion of payments for Medicare outliers; (3) adjusting by area wage factors; (4) adjusting by case mix; and (5) adjusting for other factors that the secretary deems appropriate.
— The secretary is required to adjust the PPS portion of the rate attributable to wage and wage-related costs by a factor reflecting the relative hospital wage level in the geographic area of the rehabilitation facility. This adjustment will be completed not later than Oct. 1, 2001, and at least every 36 months thereafter.
— The secretary may provide for outlier payments based on unusual length of stay, costs, or other factors specified by the secretary. The amount of the additional payment should approximate the marginal cost of care beyond the cutoff point and may not exceed 5% of the total PPS payments projected or estimated to be made that year. The secretary may make adjustments to payment amounts to take into account the unique circumstances of rehab facilities in Alaska and Hawaii.
• Payments under this section for fiscal years 2001 and 2002 must be budget neutral. For payment units in each FY beginning with FY 2001, the secretary is required to establish an increase factor based on an appropriate percentage increase in the market basket of goods and services comprising the services paid for under this subsection.
• The secretary must publish in the Federal Register, on or before Aug. 1 of each fiscal year (beginning with FY 2001), the classification and weighting factors for case mix group, and a description of the data and methodology used in computing the prospective payment rates.
• There is to be no administrative or judicial review for the establishment of the case mix groups, the prospective payment rates, outlier and special payments, or the area wage adjustments.
The legislation applies to cost reporting periods beginning on or after Oct. 1, 2000. The secretary may require submission of data on or after the date of enactment.
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