Explaining state Medicaid nursing home reimbursement.


Medicaid nursing home reimbursement methods and per diem rates affect costs, quality, equity, and access. State rate-setting is a laboratory of policymaking, which can inform state and federal Medicaid reform initiatives. This paper explains state Medicaid nursing facility rates in 1979-1994. Findings suggest that prospective facility-specific methods constrained rates in some but not all periods, particularly when older cost-reports were employed in rate-setting. Analysis failed to show that prospective class rate-setting methods constrained rate increases. Findings suggest that the efficacy of reimbursement methodology to control rates depends upon wider health care policy trends and that future facility-level analyses should consider policy contexts as between states.

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@article{Swan2001ExplainingSM, title={Explaining state Medicaid nursing home reimbursement.}, author={James H. Swan and Charlene A Harrington and Ruth B Pickard}, journal={Journal of health & social policy}, year={2001}, volume={12 4}, pages={53-73} }