ACHA Reveals Payment Reform Initiative

The National Association for the Support of Long Term Care benefited from a presentation by AHCA and Governor Mark Parkinson, President & CEO along with Michael Cheek, SVP, Reimbursement & Legal Affairs covering AHCAs proposal for Payment reform.  Under the auspices of “taking control of the future”, AHCA has proposed payment reform that catapults LTC providers beyond traditional Fee For Service Payment models. 

The payment reform model would reflect 4 priorities:

  1. Ensure quality patient services and supports
  2. Offer a viable payment system for all AHCA members
  3. Provide savings for the federal government
  4. Frame an implementable system for CMS

The payment reform initiative would adopt a SNF Bundled PPS concept or B-PPS.

  1. Replace existing Medicare SNF PPS
  2. Includes only SNF Part A services
  3. Prepares the profession for the future

The payment reform model would be driven by historical diagnosis data and groupings plus:

  1. Data collection and assignment to payment bundle with SNF claim becoming basis for payment and the MDS being used for quality only
  2. Requiring Doctors, NPs, and/ or Pas to certify the diagnosis data
  3. Expanding the use of the MDS or other identified assessment tools into payment as Value Based Purchasing expands
  4. Computing Length of Stay for each condition
  5. Formulas for truncated stays (short stays, expired stays, transfer stays)
  6. Creating an interrupted stay episode and low volume payment adjustment of 10%

AHCA’s payment reform initiative would transition during a 3 year period giving SNFs the option to go directly to national vs state rates.

AHCA also proposes developing Value Based Payment no sooner than 3 years after full implementation of quality reporting as specified under IMPACT Act with caps on incentive/penalties.  Other relief sought is rescinding regulations that differentiate between concurrent and group therapy time. 

For more information visit www.ahcancal.org/solutions/download/Medicare_concept_issue_brief.pdf

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