Not only was the report mistimed, as it turned out, but its findings were controversial. As it turned out, the GAO did not release its report until after the expiration of the BIPA increase, when Congress had been expected to have already "resolved" the reimbursement problem with permanently higher rates. Most congressmen at the time assumed that the economy would still be generating large budget surpluses that would easily support higher nursing-staff reimbursement and other Medicare reforms. Even under the best of circumstances, the GAO could not have completed its study until the early fall of 2002. In 2000, few stakeholders seriously expected that the GAO study might influence the outcome of sustaining legislation in 2002. During that time, the GAO would study how increased reimbursement affected patient care. However, rather than "protecting" even this increase, BIPA provided a temporary solution: The new rate would be in effect only from April 1, 2001, until October 31, 2002. The nursing component varied at the time from 26 to 74% of the total daily reimbursement, depending on patient RUG classification, so that the actual increase in reimbursement could be anything between 4 and 12.3% per Medicare patient. One argument offered to Congress in support of raising other reimbursement rates was that they were too low to permit sufficient staffing to deliver quality care.Ĭongress responded to this argument with a provision of the Benefits Improvement and Protection Act (BIPA) that authorized a 16.6% increase in the nursing component of the SNF Medicare reimbursement rate. The industry had already enjoyed some success in lobbying Congress to raise reimbursement levels for the most expensive care-patients classified in "high-cost" Resource Utilization Groups (RUGs). In 2000, the long-term care industry was fighting to reverse the devastating cuts in Medicare reimbursement levels imposed by the Balanced Budget Act of 1997. In reality, it reflects the often irrational way that policies are sold to Congress.
The dispute over the GAO report has been described as a debate over research methods. Restoration of the reimbursement rates has again become a controversial issue with a doubtful outcome. The American Health Care Association (AHCA) responded immediately with its own analysis casting doubt on the accuracy of the GAO's conclusions, but the damage had been done. The report, accessible online at can be interpreted as implying that SNFs squander increased reimbursements authorized by Congress. Some of that optimism evaporated in November when the General Accounting Office (GAO), a congressional agency that exists to audit and evaluate the effects of legislation, released a report entitled Skilled Nursing Facilities: Available Data Show Average Nursing Staff Time Changed Little after Medicare Payment Increase. With such a broad-based effort, it seemed that reason would prevail and a quick fix would emerge from Congress, despite the victory of budget-conscious Republicans in the midterm elections. Every member of the Massachusetts delegations to the House and Senate signed a letter petitioning their congressional colleagues to act quickly to save their SNFs.
Nursing homes were mobilized to educate their legislators. There was a lot of hope last fall that the sudden drop in Medicare reimbursement rates in October would be only a temporary setback for long-term care providers. Retrieved from (View+on+Washington).-a098033868 (View on Washington)." Retrieved from (View+on+Washington).-a098033868 2003 Medquest Communications, LLC 12 Sep.
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