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Balanced Budget Act Pros And Cons

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In August, 1997, the Balanced Budget Act was enacted by the United States Congress to balance the federal budget by 2002. The BBA dealt with numerous topics including Medicare, Medicaid and Children’s Health Provisions; and covered under Title IV, Medicare, Medicaid and Children’s Health Provisions, of the BBA, in Ch. 6 – Part B Premium and Related Provisions, Subchapter B, Subtitle G, Chapter 1 is the issue of Home Health Services and Benefits, more precisely, Subchapter A – Payment for Home Health Services.
BACKGROUND
The Balanced Budget Act called for using an interim payment system until October 2000, at which time the home health prospective payment system was executed. This payment system allowed Medicare to pay home health agencies …show more content…
After the first 60-day period, if the beneficiary is still in need for care, then another 60-day period starts. As long as the beneficiary meets all the requirement for home health benefits, then there are no limits as to the number of periods the beneficiary can receive. Payments made by Medicare, for each period of care, is adjusted to reflect the needs and health conditions of the beneficiary. As such, a special outlier provision is applied to guarantee the correct payment for those patients with the most expensive care / needs. (Home Health, …show more content…
As shown below, the prior year’s episode base rate receives a market basket update, net of a required 1% reduction, of 1.3% followed by a 1.32% decrease for nominal case-mix growth to create the CY2013 episode base rate. There are not further adjustments to the episode base rate since the services are provided in an urban area and the HHA submitted the quality data elements to the Medicare claims contractor. The CY2013 episode base rate is multiplied by the applicable HHRG case-mix weight to create the case-mix adjusted rate. The case-mix adjusted rate is then split between the labor-related share, which is multiplied by the wage index for New York City, and the non-labor-related share. The final episode rate is calculated by summing the adjusted labor-related, non-labor related share, and an NRS payment at the minimum severity level. There are no outlier payments or PEP adjustments for this calculations.” (Talaga,

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