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Payment & Reimbursement

Your Guide to Payment & Reimbursement Policy

Navigating payment and reimbursement policy for Indiana’s senior living sector.

Obtaining payment for the important services provided to Indiana’s elderly and disabled is critical to the success of communities and the hands-on care provided each and every day.  IHCA/INCAL has led the way in the development of Medicaid policy and advocacy, while AHCA/NCAL concentrates on policy and advocacy in the Medicare program, to help skilled nursing facilities and assisted living communities to receive compensation for their services.

CMS Updates Nursing Home Care Compare Staffing and Quality Measures

The Centers for Medicare & Medicaid Services (CMS) has released QSO-23-21-NH regarding updates coming in April 2024 to Nursing Home Care Compare Staffing and Quality Measures. The updates accommodate previously announced changes to the Minimum Data Set (MDS) taking place October 1, 2023. This includes changes to the staffing level case-mix adjustment methodology from RUG-IV to PDPM. Additionally, CMS announced it will be removing the CMS-672 form (Resident Census and Conditions of Residents).

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Medicaid

Indiana’s Case Mix reimbursement system is complex and frequently changing. We track and provide guidance on a range of matters from Quality Assessment Fee to Payment Add-ons to Value based Purchasing to Cost Reports and Audits.

We also engage in policy development and expansion of Medicaid Long Term Services and Supports, Medicaid Waiver and Home and Community Based Services.

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Medicare

The intersection of quality and payment in the Medicare program continues to advance at a rapid pace. We help members learn and adapt to these changes. Data and guidance on the Patient Driven Payment Model, Skilled Nursing Facility Value-Based Purchasing, Quality Reporting Program, and more are available for members to access.

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I have appreciated the support of IHCA/INCAL for many years. Long-term and post-acute healthcare is complex and is constantly changing. The association provides a larger voice to the issues that plague our profession and hinder our ability to thrive. It also facilitates the needed tools, training and support for survival and success.

Mary Pankey RN HFA

Revenue Cycle Director , CarDon and Associates, Inc.

Featured Resources

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IHCA/INCAL CONTACT

Elizabeth Eichhorn, eeichhorn@ihca.org 

Email Elizabeth