Skilled Nursing Facility Prospective Payment System FINAL RULE FY 2010

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNF), for fiscal year (FY) 2010, effective Oct. 1, 2009.  The final rule reports an increase in market basket of 2.2 percent ($690 Million), a slight increase in from the 2.1 percent that was considered in the proposed rule. The final rule also implements in full the proposed 3.3 percent reduction ($1.05 Billion) resulting from the recalibration of the case-mix adjustment, thereby yielding a net decrease of $360 million (1.1%) in payments to SNFs. In addition to these changes, the wage index used to determine payment for each individual facility has also been updated using most recent data from the hospital wage data.

Below are charts and documents for your reference.  You can also use AAHSA's Rate Calculation Tool to help you figure out your payment changes with this new rule.

FINAL Rule

• Read the FY 2010 SNF PPS FINAL Rule; Released July 31, 2009 
• Summary of the FINAL Rule 
• AAHSA's Comment Letter to CMS, June 30, 2009
• Talking Points

Payment Calculation Tools

• NEW! Payment Rate Calculation Tool for FY 2010
  This Microsoft Excel model calculates your facility's payment rates for each separate Resource Utilization Group (RUG) for FY 2010, effective Oct. 1, 2009. The tool also calculates the overall payment for your facility if Medicare days for each RUG is provided.  Instructions on how to use the Payment Calculation tool is available on the first worksheet.
• Comparison Models for Payment Rates Under Different Proposals
  

  These Microsoft Excel models calculate your facility's total budget change under different proposals. The models vary from comparing changes in rates between the current year and proposed future year, and how your facility's payment will change as a result of recent proposals on health care reform. 

Analysis of the Final Rule

• Changes in Federal Rates
  This table provides information on the changes in the average Federal payment for each separate RUGs, based on the 2010 FINAL rule.
• Comparative Analysis on Payment Components
  This table provides information on the changes for all payment components, including nursing and therapy case-mix, from 2009 to 2010.
• Changes in Urban Wage Indexes
  This table can help facilities determine what is the change in their wage index value from 2009 to 2010. Facilities in urban areas should use this table.
• Changes in Rural Wage Indexes
  This table will help facilities in determining what is the change in their wage index value from 2009 to 2010. Facilities in rural areas should use this table.
• State Average Values of URBAN Wage Indexes for All States 

Note: California RURAL wage index was corrected on September 25, 2009, from 1.2001 to 1.2051.

Contact: Iara Woody, (202) 508-9429.