Medicare Beneficiary Access to Care: The Effects of New Prospective Payment Systems on Outpatient Hospital Care, Home Health Care, and Skilled Nursing Facility Care

Publication Date: February 2000

Publisher: Library of Congress. Congressional Research Service

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Research Area: Health

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Abstract:

The Balanced Budget Act of 1997 (BBA 97) required that prospective payment systems replace retrospective cost-based reimbursement systems for Medicare beneficiaries receiving care in hospital outpatient departments, from home health care agencies, and in skilled nursing facilities. These new payment systems either have reduced or are predicted to reduce payments to providers, some of whom say that beneficiaries will face restricted access to care either because they will be turned away or because facilities or agencies will be forced to close. Investigators have found little evidence that beneficiaries have been denied care, although federal analysts have recommended that if further evidence emerges indicating unmet care needs, Congress might make targeted modifications to the new payment systems for patients with exceptionally costly conditions. This report will be updated when new information becomes available or when there is congressional action.