Post Acute Care Reorganization

1. Post Acute Care Reorganization presentation

2. Agenda • Post Acute Care (Reorganization) • IMPACT Act implementation • Legislative overview • Implications/Expectations presentation

3. Downstream Effects of MACRA • To partially offset the cost of repealing the SGR, MACRA cuts Medicare payments to hospitals and to post-acute providers: • Adjusts Disproportionate Share Hospital (DSH) funding for states, delaying cuts until 2017 and extending them through 2025 • Payments to hospitals scheduled for 2018 to be phased in over six years • Limits the 2018 payment update for post-acute providers to 1.0% presentation

4. IMPACT Act Implementation 5 parts to IMPACT Act Implementation • Incorporate standardized assessment, including components of the CARE tool, into existing assessment tools across PAC providers • Development and public reporting of quality measures across settings • Hospitals and PAC providers required to provide quality measures to consumers when transitioning to PAC provider (market basket penalty of 2%) • HHS and MedPAC required to conduct studies and reports to link payment to quality • Adds $11M in funding for CMS to use payroll data to measure staffing in SNF setting presentation

5. Implications of Data Standardization • 1st round of CARE items implemented in PAC settings in 2016 ( Mobility, Self care) • Measures will be ADDED to existing measurement instruments (FIM, MDS,OASIS etc.) • Some measures may be placed into the rule prior to being endorsed by NQF or others • Opportunity: critical we comment/advocate how we measure items in the PAC setting. If the item is defined, can we impact what tool is used? Or the specifications of new measures to be inserted in existing tools? presentation

6. IMPACT Act Timeline presentation

7. Post Acute Care & Bundled Payments Congress – “Bundling Legislation” • Two bills introduced in Congress • While similar in nature one bundles post-acute care settings • While the other bundles both acute and post-acute care settings • Comprehensive Care Payment Innovation Act of 2015 (H.R. 2502) • Introduced by Representative Diane Black, (R-TN) and referred to the House Ways & Means Committee • Bundles in the acute and post-acute care settings • Defines a ‘qualified entity’ i.e. bundle holder • Bundling and Coordinating Post-Acute Care Act of 2015 (BACPAC) • Introduced by Representative David McKinley, (R-WV) • Bundles in the post-acute care setting presentation

8. Post Acute Care & Bundled Payments Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298) • Rep. Kevin Brady (R-TX) introduced the Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298) • H.R. 3298 seeks to amend the Social Security Act (SSA) to provide for value-based purchasing of post-acute care (PAC) services under the Medicare program and financially reward quality care and innovation within PAC services. presentation

9. Post Acute Care & Bundled Payments Repeal of Market Basket Cuts for Post-Acute Providers Section 2 • Repeals Medicare Access and CHIP Reauthorization Act of 2015’s (MACRA’s) prohibition of the market basket percentage increase exceeding one percent in FY 2018 for home health agencies (HHAs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs). • MACRA amends the SSA so that HHAs, SNFs, IRFs, and LTCHs receive market-based cuts • Amendments made by this section shall be effective as if included in the enactment of MACRA presentation

10. Post Acute Care & Bundled Payments • Post-Acute Care Value Based Purchasing Program …….Section 3 • Amends the SSA by having the Secretary of Health and Human Services (the “Secretary”) establish a post-acute care value-based purchasing program (PAC VBP Program) under which value-based incentive payments are made in a payment year to PAC providers • Implementation date: October 1, 2019 • Scope: Applies to all HHAs, SNFs, IRFs, and LTCHs. presentation

11. Post Acute Care & Bundled Payments • Implements one quality measure, the Medicare Spending per Beneficiary (MSPB) measure from the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 • The Secretary must specify a value-based incentive payment percentage for each provider for a payment year. • May include zero percent but not a percentage below zero. • Value-based incentive payments will be funded by an incentive pool. • The Secretary shall make available to the public the PAC composite performance score of each PAC provider and its ranking on the relevant Compare Medicare website. presentation

12. Post Acute Care & Bundled Payments • Sunsetting of Skilled Nursing Facility Value-Based Purchasing Program Section 4 Sunsets the Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) within Section 215 of the Protecting Access to Medicare (PAMA) Act of 2014 presentation

13. Post Acute Care & Bundled Payments • Center for Medicare & Medicaid Services (CMS) Initiatives • Developing and laying out proposed rules to address MACRA • CMS announced 2100 acute care hospitals, skilled nursing facilities, physician group practices, long-term care hospitals, inpatient rehabilitation facilities and home health agencies already in an implementation period for new payment model • This new model transitions these facilities to a risk-bearing implementation period in which they assume financial risk for episodes of care • 360 organizations that have entered into agreements with CMS to participate in the Bundled Payments for Care Improvement Initiative presentation

14. Post-Acute Care & Bundled Payments • Organizations actively involved • CMS • Congress • American Hospital Association • American Public Health Association • IRFs, SNFs & University Medical Centers • Medical Societies • AAPM&R • Many others presentation

15. Post-Acute Care & Bundled Payments • Who will control the bundle???????? presentation

16. Questions? Thank You! presentation