Tabitha

Skilled Nursing Facility Prospective Payment System 2012 Rule Produces Devastating Cuts to Medicare Reimbursement

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ASK
We are asking Congress to act so the Centers for Medicare and Medicaid’s 2012 Prospective Payment rule, which creates an 11.1% cut in reimbursement to Skilled Nursing Facility Providers, is adjusted to prevent an unmanageable jolt to the sector, preserve our ability to provide quality care and maintain jobs.

ISSUE SUMMARY
Each year, the Centers for Medicare and Medicaid (CMS) issue an updated payment plan for Medicare services. The 2012 rule for Skilled Nursing Facility (SNF) Providers was issued Saturday, July 30, and is scheduled to go into effect October 1, 2011.

This new payment plan will cut Tabitha’s reimbursement for rehabilitation services by 11.1%.

We estimate this change will reduce Tabitha Nursing & Rehabilitation Center’s (TNRC) revenue by almost $1.0 million/year.

In addition, effective July 1, 2011, Nebraska Medicaid rates for Tabitha’s services were reduced by $517,000/year. If the state’s Medicaid Plan for the LB600 Provider Assessment is approved, this loss would be reduced to $46,000.

More cuts are expected. The message from Washington on the debt deal was that Medicare was spared, this is far from true. Between now and November 23, the ‘Super Committee’ must find at least an additional $1.2 trillion in debt reduction. That group can change any part of the budget, including Medicare and Medicaid funding.

BACKGROUND
The matrix used by CMS to pay Skilled Nursing Facilities for providing post-acute skilled nursing and rehabilitation services (Medicare A benefits) is based on 66 Resource Utilization Groups (RUGs).

The most recent RUG matrix issued by CMS (RUG-IV) was implemented in 2010 and was expected to be budget neutral. However, RUG-IV created an unexpected increase in reimbursement expense to CMS. Now CMS is required to recalibrate/fix RUG-IV and achieve the original goal of budget neutrality.

PARALLELS WITH RECENT HOME HEALTH CARE CUTS
Home Health Care Providers recently experienced a similar dilemma which was created by their CMS reimbursement structure.

• In this case, CMS recognized the dire impact of a single year ‘claw back’. In that case, they spread the adjustment over several years, giving Home Health Care Providers time to react to the reduced rates.
• The Home Health Care reduction this year was 5%, offset by a Market Basket adjustment.

We have been asking, and continue to ask for a similar adjustment strategy so Elders’ access to services and caregivers’ access to jobs will not be jeopardized by this RUG-IV ‘claw-back’.

THREATS TO ELDERS & THE ECONOMY
A loss of up to $1.5 million/year will reduce Tabitha’s capacity for service.

First and foremost we intend to protect Tabitha’s Mission and our high standard of service to Elders.

It is our work to discern and implement the most humane and effective response to the Centers for
Medicare and Medicaid Services’ drastic cut and this work is underway.

CALL TO ACTION
Please email, fax or phone members of Nebraska’s Congressional delegation to express your concern for the proposed cut to Medicare funding and share the message of Tabitha’s dedication to quality programming for Elders who rely on these programs to regain their independence and health.

PRIMARY ACTION
Compose a short email and send it to Nebraska’s Congressional delegates.

ADDITIONAL ACTION STEPS

• Thank Senator Ben Nelson for his stalwart position on protecting Medicare and thorough understanding of recent issues in the debt ceiling debate. (Senator Nelson was the only Congressional delegate to vote no on the debt deal, based upon the Medicare ramifications.)
• During the current Congressional recess, take time to attend Town Hall meetings and express your concerns.
• If you have a personal and/or otherwise influential relationship with Nebraska’s delegation, their aides, etc., contact them and ask for an opportunity to discuss your concerns.

SAMPLE EMAIL

Dear (Insert Delegate’s Name):

As (a member of Tabitha’s Board of Directors, Tabitha Leader, concerned citizen, etc.), I am writing to express my deepest concern for the recently announced 11.1% cut in Medicare reimbursement to Skilled Nursing Facilities providing post-acute rehabilitation services for Elders transitioning from hospitals to home.

I am asking for your help in getting Congress to act now on this very serious matter. It will, in the very short term, jeopardize access to services for Elders and eliminate jobs for caregivers.

This cut will produce a loss of almost $1.0 million/year to Tabitha Nursing & Rehabilitation Center alone. Combined with recent Medicaid cuts, Tabitha has the potential to lose up to $1.5 million in reimbursement next year. And more cuts to Medicare are anticipated from the newly formed ‘Super Committee’ which has been charged with finding an additional $1.2 trillion in debt reduction. Cumulatively, this spells disaster for Elders relying on rehabilitation services which will get them out of the hospital and back home.

Skilled Nursing Facilities do not operate with large margins. In Tabitha’s case, this already slim margin is further eroded by the high number of Medicaid clients receiving long-term care services (on average, 50% of the total patient population).

I understand the need for CMS to correct their Resource Utilization Group, Version IV matrix. I understand they must achieve budget neutrality. But this cut is too fast and too deep. It produces a jolt that is unmanageable and it will alter Tabitha’s capacity to serve Elders. Additionally, it will force Tabitha to eliminate jobs at a time when they are needed to bolster the struggling economy.

I am asking for your help in changing the CMS ‘claw-back’ strategy. Please act so Providers receive additional time to manage the impact of the reduction in reimbursement, the quality of care does not suffer and jobs can be preserved.

Please help. This ‘all-in’ approach by CMS will cause needless harm to good people in our care and in our employment.

Most sincerely yours,
Your Name
Your Contact Information

CONTACT INFORMATION

Senator Ben Nelson
www.bennelson.senate.gov

Washington, D.C. Office:
720 Hart Senate Office Building,
District of Columbia 20510-2706
Phone: (202) 224-6551
Fax: (202) 228-0012

Lincoln Office: (more district offices)
440 North 8th Street, Suite 120
Lincoln, Nebraska 68508
Phone: (402) 441-4600
Fax: (402) 476-8753

Senator Mike Johanns
www.johanns.senate.gov

Washington, D.C. Office:
404 Russell Senate Office Building,
District of Columbia 20510-2705
Phone: (202) 224-4224
Fax: (202) 228-0436

Scottsbluff Office: (more district offices)
115 Railway Street, Suite C102
Scottsbluff, Nebraska 69361
Phone: (308) 632-6032
Fax: (308) 632-6295

Representative Jeff Fortenberry
www.fortenberry.house.gov

Washington, D.C. Office:
1514 Longworth House Office Building,
District of Columbia 20515-2701
Phone: (202) 225-4806
Fax: (202) 225-5686

Lincoln Office:
301 South 13th Street, Suite 100
Lincoln, Nebraska 68508
Phone: (402) 438-1598
Fax: (402) 438-1604

TOWN HALL MEETINGS, ETC

Jeff Fortenberry
Monday, August 8 | 5:15 pm
Lincoln Town Hall Meeting
Southeast Community College
Room U102
8800 O Street | Lincoln, NE

Tuesday, August 9 | Noon
Wahoo Town Hall Meeting
Wahoo Public Library
637 N Maple Street | Wahoo, NE

Wednesday, August 17 | 11:00 am
Mary Riepma Ross Arts Center
313 North 13th Street | Lincoln, NE
(Former Comptroller General David
Walker will address Lincoln audience on issues of America’s debt challenges and fiscal policies – at the invitation of Rep. Fortenberry)

Mike Johanns
Monday, August 8
11:30 am–12:30pm
Open Coffee in Lincoln
Cornhusker Marriott Grand Ballroom
333 S. 13th St. | Lincoln, NE 68508
 

Tabitha - Emergency Call to Action

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LB436:  Cigarette Tax Statute Change

LB436 calls for additional State tax on cigarettes. A portion of the proceeds will be used to fund the Health Care and Human Service Provider Rate Stabilization Fund

Status
This is an emergency Call to Action.  Your help is needed now!

LB436 is likely to ‘die’ in committee today if Senator Gloor cannot garner 5 more votes by the Revenue Committee members.  

Call to Action
Please pick up the phone today and call before 5:00 pm, or send an email to the members of the Revenue Committee and ask for their support of LB436.

What to do:

PRIMARY ACTION:
Call a member of the Revenue Committee (phone numbers and email addresses are posted at the end of this message) and let them know why LB436 is important to Tabitha and ask him/her to please vote in favor of moving the bill to the floor for debate.

And/Or:
Compose a short email and send it to the members of Revenue Committee (sample email is attached)

ADDITIONAL ACTION STEPS:

• Contact Senators Mike Gloor, Kathy Campbell, Annette Dubus, Gwen Howard and Bill Avery and let them know we are grateful for their support of LB436
• If you have a personal and/or otherwise influential relationship with other Senators or the Governor, contact them and ask them for their support of LB436.

Thank you!