The Centers for Medicare & Medicaid Services will implement “interim” payments that reflect the MDS 3.0 and RUG-IV system this October only if Congress does not pass legislation repealing the delay of RUG-IV until 2011, the agency emphasized Tuesday.
“The interim payment system using MDS 3.0 and RUG IV that will be implemented on Oct. 1, 2010, is only an INTERIM measure until an integrated payment system can be developed,” Sheila Lambowitz, director of the Division of Institutional Post Acute Care, clarified in an e-mail to McKnight’s. “Once that payment system is in place, any claims paid at the interim RUG-IV rates will be reprocessed to using the RUG III system as modified by ACA [the Patient Protection and Affordable Care Act].”
Under the new payment system, new claims will be paid at the modified RUG-III rate through Sept. 30, 2011, she continued. Effective Oct. 1, 2011, the full RUG-IV will be implemented on a permanent basis.
Lambowitz was responding to a story McKnight’s wrote Tuesday about new details from CMS about the RUG-IV case mix classification system. CMS said in an update it issued Monday that as it builds a payment infrastructure complying with ACA, it “will apply interim payment rates, effective October 1, 2010 that reflect not only the use of MDS 3.0 but also the new RUG-IV system in its entirety.”
The American Association of Homes and Services for the Aging, a major industry group, told McKnight’s that CMS did not introduce new information in the notification pertaining to a time line for RUG-IV. Instead, the agency presented its plans for an interim payment plan in the event that Congress does not act on legislation to move implementation of RUG-IV to Oct. 1.
Members should continue to lobby their lawmakers to repeal the delay of RUG-IV, AAHSA’s Barbara Manard told McKnight’s. Congress is set to vote this week on the American Jobs and Closing Tax Loopholes Act bill, which would move the start date of RUG-IV to this October.
CMS spokeswoman Mary Kahn reiterated that unless Congress passes such legislation, it will apply this interim payment fix.
“It’s not a permanent implementation and the fact it is temporary is key,” Kahn said.
