In order to qualify for a reimbursement under a Medicare supplement payment program, the facility (MDS) must meet Medicare requirements. The minimum data set is an application called a Supplemental Payment Estimate (SPE). The SPE includes information that supports the Medicare benefit plan that is used by the government to determine how much to pay the MDS and other long-term care facilities. It includes information such as the number of beds per patient, the number of beds needed by the patient, the number of inpatient stays in the facility and the number of outpatients who come to the facility.
For many states, the number of beds required for a person in a particular condition is determined by the number of beds in other Medicare payment plans. Thus, if a person has Medicare Part B and is admitted to an MDS for an acute stroke, the bed requirement would be determined by the number of beds in Medicare Part B. When the same patient is admitted to a Medicare Part C facility for a hip operation, the number of beds in Medicare Part C will determine the number of beds required for someone with a chronic back condition.
The number of beds that are necessary for an MDS varies between states
In addition to the number of beds required for the patient, the SPE will also include information about the condition of those beds. A person can be admitted to an MDS for a variety of conditions, such as traumatic brain injury (TBI), Alzheimer's disease, cancer or pneumonia.
When a person first arrives at the MDS, there will be an admission form and a list of all the rooms that are needed. The person will need to sign a consent form indicating that he or she understands the implications of having to share one of their rooms. An MDS cannot force anyone to stay in the same room as another person in the same condition. If one patient requires an overnight stay, the patient may not be asked to share a bed with an inpatient.
Because many people who use MDSs to stay in their homes receive Medicaid benefits, there are no limits on the number of people who can use the rooms at once or who can use more than one. A person in a MDS is considered to be a resident of that MDS until he or she moves out of it. At that point, the person is considered an out-patient.
The MDS will send a list of in the form of a Supplemental Payment Estimate to the Medicaid office of each state in which the MDS is located, and these documents are submitted to the CMS (Centers for Medicare & Medicaid Services. CMS is the federal agency that determines what amount to pay for the services. Medicare supplement payments will depend on the state where the MDS is. In some cases, CMS has to make a decision based on what CMS determines the highest cost for the service in a particular state.
To receive a Medicare supplement payment, the MDS is required to provide the CMS with as many details about the services rendered by the MDS as possible.
In addition to the list of beds, a list of patients and their diagnoses is required
CMS has the responsibility to review the MDS's records and adjust its rates accordingly to keep costs down and keep them within the limits of the existing Medicare program. The MDS can adjust its rates only after receiving a notice from CMS.