Unless Congress acts fast, temporary Medicare payment add-ons that were first given to skilled nursing facilities in 1999 will expire Oct. 1 That could create major access problems for all patients not just Medicare patients, according to a report in the September/October issue of the journal Health Affairs. The report notes that the add-ons are keeping many SNFs afloat, and that their expiration could have dire consequences for the long-term care industry. The House added $2 billion in payments over 10 years in legislation (H.R. 4954) passed this summer. The measure also included a prescription drug benefit and about $30 billion for providers over the next decade. At press time, the Senate was reportedly considering $30 to $50 billion in provider relief .