Rehabilitation PPS Highlights
Rehabilitation PPS Highlights
- Rehabilitation facilities would be paid on a per-discharge basis just as acute-care hospitals are paid. Medicare prospective payments will cover all the costs of furnishing covered inpatient rehabilitation services, including routine, ancillary, and capital costs.
- Medicare would pay facilities at relatively higher rates to care for patients with more intensive needs. Payment rates would reflect each patient’s rehabilitation conditions, functional status (both motor and cognitive, age, related illnesses, and other factors that help to explain the intensity of care.
- Facilities would use a comprehensive assessment tool to determine the appropriate payment category. These assessments also would allow HCFA and the facilities to monitor and improve the quality of care.
- The proposal would adjust payments to rehabilitation facilities when a patient is transferred to another hospital or nursing home before completing the full course of care in order to ensure beneficiaries receive adequate care.
- Payment rates for individual facilities would be adjusted to reflect geographic differences in wages and for providing care to a disproportionate number of low-income patients. Rural providers also would receive a payment adjustment to account for their higher costs.
- Medicare would make additional payments for outlier cases involving beneficiaries with extraordinary care needs to ensure appropriate care for the sickest beneficiaries.
As the law requires, the new system would establish payment rates so that estimated payments under the PPS are 2% less than the estimated payments that would have been paid under the existing cost-based system. This provision will result in estimated savings for Medicare beneficiaries and taxpayers of $1.5 billion over seven years.
Source: Health Care Financing Administration, Baltimore.
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