A Medicare skilled nursing facility (SNF) is an institution, or
distinct part of an institution (e.g., building, floor, wing), that
provides post-acute skilled nursing care and/or skilled rehabilitation services,
has in effect a written agreement to transfer patients between one or more
hospitals and the SNF, and is certified by Medicare. In general, “skilled”
nursing and rehabilitative care are services ordered by a physician that
require the skills of professional personnel (i.e., registered nurse,
physical therapist) and are provided under the supervision of such personnel.
The Medicare SNF benefit has drawn attention due to the rapid increase in SNF
expenditures. In 2011, Medicare Parts A and B payments to SNF providers
totaled $30.1 billion, having grown at an average annual rate of 9.9%
since 2000. SNF payment reductions have been recommended by various
deficit reduction groups. Some of the recommendations have included reducing
the SNF reimbursement rate and reducing or eliminating Medicare bad debt
Given the beneficiary has met certain requirements, a Medicare beneficiary is
entitled to 100 days of SNF care for each Medicare-covered SNF stay. To be
eligible for SNF coverage, a Medicare beneficiary must have been an
inpatient of a hospital for at least 3 consecutive calendar days and transferred
to a participating SNF usually within 30 days after discharge from the
hospital. Beneficiaries must also receive treatment at the SNF for a
condition they were receiving treatment for during their qualifying
hospital stay (or for an additional condition that arose while in the
SNF). For the first 20 days of SNF coverage, Medicare beneficiaries have no
copayment. Medicare beneficiaries have a daily SNF copayment for the 21st through the 100th day indexed annually at
one-eighth (12.5%) of the current Part A deductible. For 2013, the daily copayment
SNFs are reimbursed under a prospective payment system (PPS), which began on
July 1, 1998. The PPS reimbursement is a per diem “per day” amount that
covers most costs of furnishing SNF services to Medicare beneficiaries.
With the exception of certain high-cost ancillary services, the SNF PPS
bundles covered-SNF services into a single per diem reimbursement rather than Medicare
paying for each service individually.
This report describes the Medicare SNF benefit and the reimbursement system for
SNF services. In addition, this report describes recent issues, as well as
congressional and other proposals designed to slow the growth of Medicare
SNF expenditures. .
Date of Report: February 21, 2013
Number of Pages: 19 Order Number: R42401 Price: $29.95
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