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Skilled Nursing Facility

Prospective Payment System (SNF PPS)


Section 4432(a) of the Balanced Budget Act (BBA) of 1997 modified how payment is made for Medicare skilled nursing facility (SNF) services. Effective with cost reporting periods beginning on or after July 1, 1998, SNFs are no longer paid on a reasonable cost basis or through low volume prospectively determined rates, but rather on the basis of a prospective payment system (PPS). The PPS payment rates is adjusted for case mix and geographic variation in wages and covers all costs of furnishing covered SNF services (routine, ancillary, and capital-related costs).

NEW Implementing instructions regarding payment and related issues can be found in sections 2831 and 2837 of the Provider Reimbursement Manual.

Implementing instructions relating to coverage and physician certification/recertification are forthcoming and are not included in these sections.

  • Nursing & Therapy Minutes
    (Used in Calculating Preliminary Rates: April 10, 2000 Federal Register
    PPS Update [65 FR 19188]) (PDF file, 223kb)

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Highlights


Go to Medlearn Matters Articles "Medlearn Matters...Information for Medicare Providers"articles are designed to help providers understand new or changed Medicare policy


General Information

SNF PPS Publications

Related Links

Resources

Last Modified on Friday, October 08, 2004