Illinois Hospital Association

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June 27, 2007

Ms. Leslie Norwalk, Esq.
Acting Administrator
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Room 445-G, Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201

ATTN.: CMS-1545-P

Re: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2008; Proposed Rule, Federal Register, Volume 72, No. 86, Friday, May 4, 2007

Dear Ms. Norwalk:

On behalf of our approximately 200 member hospitals and health care systems, the Illinois Hospital Association (IHA) is taking this opportunity to formally comment on the proposed rule establishing new policies and payment rates for hospital inpatient skilled nursing facility services for fiscal year 2008. Therefore, in accordance with instructions in the rule, the Illinois Hospital Association presents the following comments for your consideration:

BACKGROUND:

  • Forecast error adjustment: A forecast error percentage (measuring the difference between estimates of the market basket increase and the actual market basket increase) of 0.25% is currently used to determine whether an adjustment to the overall skilled nursing market basket increase is required. CMS proposes to increase that percentage difference to 0.50%, primarily to eliminate "minimal imprecision" in the data. CMS’ own analysis indicates that the percentage difference in FY 2006 is 0.3%, high enough to justify an adjustment under the current rules, but too low to justify it under the proposed rule. Whether the percentage adjustment is 0.25%, 0.50% or an amount in between, payments to skilled nursing providers are significantly impacted. Therefore, the Illinois Hospital Association recommends that CMS defer any revisions to the market basket forecast error adjustment to at least FY 2009, but also, because the data is currently available, adjust for the 0.3% "underpayment" in the FY 2008 final rule SNF base per diem rates.
  • Ms. Norwalk, thank you again for the opportunity to comment. The Illinois Hospital Association also welcomes the opportunity to work with your agency in the continued development and refinement of the Medicare payment system for all providers.

    Sincerely,

    Thomas A. Jendro
    Senior Director, Finance
    Illinois Hospital Association
    (630) 276-5516
    tjendro@ihastaff.org