Medicaid
Making Georgia's Nursing Home Reimbursement More Equitable Gao ID: HRD-86-58 May 12, 1986GAO studied Georgia's reimbursement system for free-standing intermingled nursing homes to determine whether: (1) its grouping methodology for reimbursement purposes resulted in equitable reimbursement for intermingled homes; and (2) applying minimum nursing standards resulted in appropriate payment levels.
GAO noted that: (1) Georgia did not conduct studies or analyses to serve as a basis for establishing appropriate nursing home groupings for reimbursement purposes; and (2) the Health Care Financing Administration (HCFA) accepted Georgia's assurance that its nursing home reimbursement rates were reasonable and adequate without supporting analysis. GAO found that Georgia's grouping method: (1) resulted in the classification of 66 percent of its nursing homes as free-standing intermingled homes able to provide care for residents requiring either skilled-nursing or intermediate care; (2) did not consider homes' resident mixes, a significant cost determinant; (3) may cause inadequate reimbursement for some homes with a high concentration of skilled-care residents and few intermediate-care residents; and (4) may provide higher reimbursement to some intermingled nursing homes having primarily intermediate-care residents with lower nursing-related costs. GAO also found that Georgia could reduce Medicaid costs by basing its minimum nursing standards on nursing home residents' actual care requirements rather than on facility classification.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
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