Published August 24, 2020
Follow our Medicare Coronavirus News page for related information on coronavirus (COVID-19) and its impact on Medicare beneficiaries.
Help is on the way for nursing homes.
Join our email series to receive your free Medicare guide and the latest information about Medicare and Medicare Advantage.
By clicking "Sign me up!” you are agreeing to receive emails from MedicareAdvantage.com.
Speak with a licensed insurance agent
The Centers for Medicare and Medicaid Services (CMS) announced July 31 that it will grant a 2.2 percent pay increase to nursing homes for fiscal year 2021, which begins Oct. 1.
That boost amounts to an additional $750 million and is in line with the 2.3 percent payment hike that was originally proposed by CMS on April 10, which would have totaled around $784 million.
The pay raise comes as a result of hefty cost increases for equipment and extra staffing needed to combat the COVID-19 pandemic. The finalized payment rule will also update the ways that certain billing codes are reimbursed under the Patient-Driven Payment Model (PDPM), which is the new Medicare payment system that went into effect for fiscal year 2020.
Also in the rule is a 5 percent cap on wage index decreases, along with an updated definition of “urban” and “rural” facility classifications.
The new rule also makes minor changes to the Value-Based Purchasing (VBP) program, for which providers automatically lose 2 percent of their Medicare reimbursements and are then given the opportunity to win them (and potentially more) back by meeting certain benchmarks.
Although the pay increase is largely a response to the added strain nursing homes have faced during the novel coronavirus pandemic, it remains separate from any financial support provided to nursing homes as part of recent congressional coronavirus aid packages and relief funds.
Skilled nursing facilities are typically profitable on fee-for-service Medicare reimbursements, having recorded a 10.3 percent margin in 2018 (the most recent year for available data). However, those gains are often offset by long stays of Medicaid patients and other factors that resulted in an average total margin of -0.3 percent in 2018. That marked the first time since 1999 that the margin has been reported to be in the red.
Learn more about how Medicare is responding to the coronavirus pandemic and the health care issues it is causing.
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
Where you've seen coverage of Christian's research and reports: