Skilled care companies seek site-neutral Medicare rates

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House panel hears testimony on site-neutral payments, potential for Medicaid cuts to providers
House panel hears testimony on site-neutral payments, potential for Medicaid cuts to providers

Proposed Medicare payment changes have put the nation's skilled care companies at odds with inpatient rehabilitation providers, and the two sides were making strident arguments in front of lawmakers at press time.

Federal lawmakers should take necessary steps so that skilled nursing facilities and inpatient rehabilitation centers are reimbursed at the same level for some services, the American Health Care Association/National Center for Assisted Living urged in written testimony to the House Committee on Ways and Means. The committee held a hearing in June.

MedPAC offered a framework for implementing “site-neutral” post-acute payments in its report. Legislators should implement the proposal, which would equalize payments for certain orthopedic conditions, AHCA/NCAL stated in prepared remarks. The association also urged Congress to pass a drafted bill that would lead to a standardized assessment tool for post-acute providers, allowing for the cross-setting comparisons needed to expand site-neutral payments. 

AHCA says site-neutral payments would improve care and efficiency by tying reimbursement to patient needs rather than setting. A trade organization representing inpatient rehabilitation facilities — whose reimbursements would shrink under a site-neutral policy — disagrees.

MedPAC's proposal would hurt patients by pushing them into the “less capable” SNF setting because it is the “cheapest option,” stated Bruce M. Gans, M.D., chairman of the American Medical Rehabilitation Providers Association. IRFs must meet higher staffing standards than nursing facilities and admit patients who can sustain a high level of therapy, AMRPA noted. 

MedPAC has not issued a formal recommendation regarding site-neutral payments, despite presenting a case for it in the June report. 


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