Resource Utilization Group (RUG) statistics are reported for a facility's five most recent cost reporting periods. The most current status of each period is reported (i.e. as submitted, settled, reopened, etc.). Note that some reporting periods may be for other than twelve months. A "view" button is provided to link the corresponding cost report for each period.
NOTE: RUG statistics are reported for Medicare patients only.
Patient days by RUG category are from worksheet S-7. Percentages of total are calculated.
The Balanced Budget Act of 1997 mandates the implementation of a per diem prospective payment system (PPS) for skilled nursing facilities (SNFs) covering all costs (routine, ancillary and capital) related to the services furnished to beneficiaries under Part A of the Medicare program. Major elements of the system include:
Federal rates are set using allowable costs from FY 1995 cost reports. The rates also include an estimate of the cost of services which, prior to July 1, 1998, had been paid under Part B but furnished to SNF residents during a Part A covered stay. FY 1995 costs are updated to FY 1998 by a SNF market basket minus 1 percentage point for each of fiscal years 1996, 1997 and 1998. Providers which received new provider exemptions in FY 1995 are excluded from the data base. Routine cost limit exceptions payments are also excluded. The data is aggregated nationally by urban and rural area to determine standardized federal per diem rates to which case mix and wage adjustments apply.
Per diem payments for each admission are case-mix adjusted using a resident classification system (Resource Utilization Groups IV) based on data from resident assessments (MDS 3.0) and relative weights developed from staff time data.
The labor portion of the federal rates is adjusted for geographic variation in wages using the facility wage index.
Payment rates are increased each Federal fiscal year using a SNF market basket index.
A three-year transition that blends a facility-specific payment rate with the federal case mix adjusted rate is used. The facility-specific rate includes allowable costs (from FY 1995 cost reports) including exceptions payments. Payments associated with 'new provider' exemptions are included but limited to 150 percent of the routine cost limit. It also includes an add-on for related Part B costs similar to the federal rate.
The PPS system is effective for cost reporting periods beginning on or after July 1, 1998.