Proposed Changes for PAC Settings

DATE: June 21, 2018

CMS looks to payment and program revisions—comments due to CMS

In new proposed rules, the Centers for Medicare and Medicaid Services (CMS) is calling for payment and program changes for four post-acute care settings: skilled nursing facilities (SNFs), long-term care hospitals (LTCHs), inpatient rehabilitation facilities, and inpatient psychiatric facilities.

In addition to the customary marketbasket adjustments, CMS is proposing refinements to the quality reporting programs (such as fewer measures to track) for all of these care settings.   CMS made the following programmatic proposals:

  • Reducing health disparities: CMS is considering options to reduce health disparities among patient groups within and across hospitals by increasing the transparency of disparities through quality measures and other programs.
  • Considering costs and benefits: CMS proposes an additional factor to consider when evaluating if a quality measure should be removed: if the costs associated with the measure outweigh the benefit of its continued use in the program.
  • Communicating through more channels: CMS is proposing to notify post-acute care (PAC) providers of noncompliance with Quality Reporting Program requirements by letter sent at least once by the Quality Improvement and Evaluation System Assessment Submission and Processing (QIES ASAP) system, the U.S. Postal Service, or in an email from their Medicare administrative contractor.
  • Soliciting feedback on interoperability: CMS is soliciting feedback on positive solutions to more effectively achieve interoperability in sharing healthcare data between providers.

Two additional proposals are worth highlighting, related to payment:

  • LTCH: CMS proposes eliminating the 25% payment threshold.
  • SNF: CMS proposes changing the SNF case-mix methodology from resource utilization group IV to a patient-driven payment model (PDPM) with the interrupted stay policy.

The payment adjustments LTCHs and SNFs face as a result of these proposed changes will have lasting effects. Planning now to adjust to these proposed changes is critical.  If you have comments, they must be submitted to CMS by June 25 for LTCHs, and by June 26 for the other PAC settings.

Click here to read the full version of Proposed Changes for PAC Settings. For more information, contact DataGen and follow us on LinkedIn.

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