Trend Watch: The Impact of the BBA and the BBRA
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* Quantify the BBA and BBRA
impacts on the secular growth in the size of hospital residency programs through changes in actual, allowed, and capped residents.
Rural hospitals cannot continue business as usual, even with the recent relief provided through the 1999 Balanced Budget Revision Act (BBRA
One study found that implementation of the Medicare Prospective Payment System (PPS) was associated with a statistically significant increase in the number of quality-of-care deficiencies, but the trend reversed following the Medicare funding adjustments in the BBRA
. The study, by the University of North Carolina at Chapel Hill (UNC) School of Public Health, with financial support from Beverly Enterprises, also suggests that PPS implementation was associated with a reduction in professional nurse staffing hours, also reversed after BBRA
went into effect.
was introduced to try and offset some of these reductions but according to the American Hospital Association, hasn't gone far enough.
These rates also include a $0.05 reduction in per diem rates to account for the new items excluded from consolidated billing as a result of the BBRA
of 1999, including certain prosthetic and orthotic devices and certain chemotherapy services.
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Since then, legislation was passed to relieve some of the BBA cuts, including the BBRA
of 1999, BIPA of 2000, and the Medicare Modernization Act of 2003.
As a result, Congress passed the Balanced Budget Refinement Act of 1999 (BBRA
) and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA).
The legislative response to several years of M+C plan exodus has been substantial payment increases and regulatory compromises contained in the Balanced Budget Refinement Act of 1999 (BBRA
), the Benefits Improvement and Protection Act of 2000 (BIPA), and the MMA.
This article examines the provisions of the Balanced Budget Act (BBA) of 1997 and the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act (BBRA
) of 1999 related to the Program of All-Inclusive Care for Elders (PACE).