The AHA today urged the Centers for Medicare & Medicaid Services to scale back the payment cuts in its fiscal year 2009 proposed rule for the skilled nursing facility prospective payment system. CMS has said the cuts are necessary to adjust for greater-than-expected utilization of the nine payment categories that were added to the PPS in 2006. In a letter, the AHA recommended that CMS reduce the proposed $770 million cut to only account for changed coding behavior rather than also adjusting for real case-mix change, and spread out any proposed cut over a two-year period to minimize its impact on providers. The AHA also cautioned CMS against proceeding with pay-for-performance and hospital-acquired conditions policies in the SNF PPS and other payment systems without first studying the operation and impact of these policies on the inpatient PPS. Comments on the proposed rule are due June 30.