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MedPAC Reviews Requirements in a Unified Post-Acute Care PPS

Posted on Friday, September 14, 2018 4:16 PM

Last week, MedPAC continued their work to establish a unified post-acute care prospective payment system (PAC PPS).  Commissioners received a presentation from MedPAC titled “Aligning Medicare’s Statutory and Regulatory Requirements Under a Unified Payment System for Post-acute Care,” which reviewed MedPAC’s past recommendations on a unified PAC PPS, presented existing statutory and regulatory requirements for PAC providers, and offered suggestions on new policies for requirements in a unified PAC PPS.

“In reviewing the most recent utilization and spending information, MedPAC presented data for the four PAC providers from 2016.

  • Home Health: $18.1 billion, 6.5 million 60-day episodes
  • Skilled Nursing Facilities: $29.1 billion, 2.3 million stays
  • Inpatient Rehabilitation Facilities: $7.7 billion, 390,514 discharges
  • Long-Term Care Hospitals: $5.1 billion, 125,586 discharges

As a review of MedPAC’s past recommendations on a unified PAC PPS, they target a 2021 start date, and a 5% payment reduction.”

In the presentation, it was suggested that there be a common set of requirements for benefits, conditions of participation, and facility criteria for all post-acute care settings.  The new requirements would then be applied in a two-tiered system.  Tier one would cover most patients and the requirements established would cover what was necessary for that population.  Tier two would create and implement condition specific requirements to accurately target patients with specialized care needs.

After the presentation, the Commissioners offered much praise and interest in the common requirements and two-tiered system.  The development of the unified PAC PPS is an ongoing project, as ordered in the IMPACT Act of 2014. MedPAC continues to progress towards a finalized model that they think should be implemented in 2021.

Source: NAHC Report

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