About Us

Quality Assurance Assessment Bill

                                                                                                                                                                                                                               Printable Version

Background 
Over the past few years, decline in the economy has resulted in state tax revenue shortfalls and strain on funds available for reimbursement to nursing facilities for services to residents covered by Medicaid.  The result is a growing gap between the cost of services and reimbursement levels.  The current projected average underfunding is $27.48 for each patient day for 2011.  This amount has tripled in the past five years.

Nursing facilities are experiencing unprecedented and damaging losses.  Some facilities have closed and others have had to turn away Medicaid residents. 

LB600 is a way to generate additional dollars for nursing facilities.  Forty-six states have already imposed assessments on a variety of Medicaid providers, including nursing facilities that can off-set some of the growing cuts.

Here’s how LB600 works
1. Tabitha, along with all Nebraska nursing facilities, will pay a provider assessment to the State of Nebraska.
2. The State qualifies for a federal match which is added to the provider assessment (60% federal, 40% state).
3. Administrative expenses are deducted from the total and the remainder is distributed back to the providers based on the number of Medicaid clients each serves.  (In 2010, 51% of Elders served at Tabitha Nursing & Rehabilitation Center were Medicaid recipients.)

In 2009, Tabitha and other state providers examined this option which originally came from a Nebraska Department of Health and Human Services consultant study.  At that time, with appropriation growth at 2.5%, the workgroup voted to not move forward with an assessment program, but to keep it under consideration in the event the bottom fell out of the funding for future appropriation increases.  Now, it seems, the bottom has fallen out.  Tabitha and other providers are facing a 4-5% Medicaid reimbursement cut which will be effective July 1, 2011. 

Impact on Tabitha
Without the assessment, TNRC  will lose between $275,000 and $344,000 in annual Medicaid funding.

Tabitha’s modeling shows that Tabitha Nursing and Rehabilitation Center (TNRC) and Tabitha Nursing Center at Crete (TNCC) would both benefit from the assessment.  If the 2011 Medicaid rate cut is 4-5%, an assessment would defray nearly all of the decrease in reimbursement.

Downside/Risks
A downside to the assessment is that, under federal regulations (42 CFO 433.68), the assessment is made against days of service to Medicaid and private-pay residents (Medicare days may be excluded).  However, it is reimbursed as supplements based on Medicaid days only. 

This  puts providers with higher percentages of Medicaid residents at an advantage over providers whose percentage of Medicaid residents is low or none.  To determine how the assessment would impact all of Nebraska facilities, the Nebraska Health Care Association hired Joseph Lubarsky, CPA of Eljay LLC in Louisville, Kentucky.  Lubarsky’s modeling demonstrates that less than 10 facilities out of 224 would pay more in assessments than they would be reimbursed.

Should the federal government discontinue the provision for the assessment match, the assessment to Providers and this supplemental funding stream would end.

Click Here to access a more detailed presentation on LB600 from the Nebraska Health Care Association.
 

In Summary
The intent of LB600 is to prevent devastating outcomes that will likely result under the proposed cuts to Medicaid.  The proposed cuts create an unprecedented level of under-funding which will surely jeopardize Tabitha’s ability to care for some of Nebraska’s most vulnerable citizens. 

LB600 provides a mechanism for securing additional Federal dollars and match them with dollars contributed by the providers themselves who care deeply about protecting and sustaining essential services for the elderly.

This bill does not create an additional tax burden to the citizenry of Nebraska.

Tabitha’s Position
Tabitha supports the passage of LB600.