MHA's Executive Briefing

CMS issues final rule implementing ACA long-term care requirement

The Centers for Medicare & Medicaid Services on March 19 published a final rule implementing a Patient Protection and Affordable Care Act requirement that long-term care facilities provide before closing at least 60 days advance written notice and a plan for relocating residents. Effective April 18, the rule adopts with only technical changes an interim rule published in February 2013.

[ via AHA News Now ]

CMS issues technical correction to final rule for LTCHs

The Centers for Medicare & Medicaid Services on Oct. 12 issued a technical correction to the final rule for long-term care hospitals for fiscal year 2013. The notice, effective Oct. 1, 2012, specifies CMS' methodology for determining the percentage of discharges that will not count toward the 25% payment adjustment threshold policy for LTCHs and their satellite facilities with cost reporting periods beginning between July 1 and Oct. 1, 2012.

CMS said the document corrects technical and typographical errors in the text of the FY 2013 Inpatient Prospective Payment System/LTCH PPS final rule published Aug. 31, and "does not make substantive changes to the policies or payment methodologies that were adopted in the final rule."

Long-Term Care Hospital PPS: Final Rule for FY 2013

The Centers for Medicare & Medicaid Services (CMS) on Aug. 1 placed on display its fiscal year (FY) 2013 final rule for the inpatient prospective payment system (PPS) and long-term care hospital (LTCH) PPS. Under the final rule, LTCHs will receive a net update of 1.7 percent, a $92 million increase over FY 2012 payment levels.

In FY 2013, LTCHs will receive a 2.6 percent market-basket update, which is offset by several reductions, including cuts required by the Patient Protection and Affordable Care Act. Medicare payments to LTCHs in FY 2013 also will be influenced by the expiration of legislative relief initially authorized by Congress in 2007.

These include two LTCH cuts that will be reinstated beginning Dec. 29 – the very short-stay outlier reduction and a ”one-time budget neutrality adjustment,” which corrects for payments CMS estimates were overpaid during the first year of the LTCH PPS. In addition, the regulation implements relief from full implementation of the LTCH “25% Rule” beginning with discharges on or after Oct. 1.

The American Hospital Association has published a Regulatory Advisory covering only the LTCH provisions in the final rule - a separate advisory was published detailing the final inpatient PPS provisions. If you are an MHA member and would like the LTCH advisory, email Shawn Rossi at srossi@mhanet.org. 

AHA urges changes to proposed long-term care hospital payment rule

The American Hospital Association on June 21 urged the Centers for Medicare & Medicaid Services to revise its proposed rule for the long-term care hospital prospective payment system for fiscal year 2013. "While we greatly appreciate several provisions in the rule, such as a delay in full implementation of the '25% Rule' and a three-year phase-in of the so-called 'one-time' budget neutrality adjustment, we have strong concerns with several aspects of these changes, as well as other elements of the regulation," AHA wrote.

For example, the association said it is "deeply disappointed" the proposed 25% Rule delay would not begin for one-third of LTCHs until July 2013, one year after the 25% Rule takes effect for these facilities. Among other concerns, AHA said the methodology used to calculate overpayments for the budget neutrality adjustment "has yielded an erroneous over correction" and should be modified to account for other payment policy changes implemented since 2003.

The association encourages hospital leaders to submit their own comments to CMS by the June 25 deadline, using the AHA letter as a model.

AHA Regulatory Advisory: Long-Term Care Hospital PPS Proposed Rule for FY 2013

CMS recently published its FY 2013 proposed rule for the inpatient prospective payment system (PPS) and long-term care hospital (LTCH) PPS. The FY 2013 proposed rule for LTCHs is positive for the industry overall.

The American Hospital Association is pleased that CMS has provided 12 months of 25% Rule relief to LTCHs, but they are deeply disappointed that a significant portion of LTCHs would be required to wait until next year for this relief to take effect. The delay in full implementation of the 25% Rule should apply to all LTCHs this year, and the AHA is urging CMS to address this issue.

AHA has published a Regulatory Advisory covering the LTCH provisions in the proposed rule. If you are an MHA member and would like a copy, email srossi@mhanet.org. Hospital CEOs will find the advisory in the documents section of their community  at MHA Connect.

Bill would implement comprehensive LTCH criteria

Sens. Pat Roberts (R-KS) and Bill Nelson (D-FL) on Aug. 2 introduced the Long-Term Care Hospital Improvement Act, American Hospital Association-supported legislation that would replace Medicare’s “25% Rule” for LTCHs with comprehensive patient and facility criteria. The 25% Rule cuts payments for certain LTCH patients based on where they received care prior to LTCH admission, and was implemented due to the current lack of criteria. Since 2004 and most recently in 2011, the Medicare Payment Advisory Commission has recommended patient and facility criteria to distinguish LTCHs from general acute-care hospitals and other post-acute settings.

“Today’s bipartisan legislation is an important step forward in protecting patients’ access to the critical services provided in long-term care hospitals,” said AHA President and CEO Rich Umbdenstock. “These hospitals provide vital care to clinically complex patients that require inpatient care for extended periods. We commend Senators Pat Roberts and Bill Nelson for their leadership on this issue.”

What the Future of Long-Term Care Means For Hospitals

As technologies empower patients to control their health care journeys, hospitals may downsize to the point where they will provide only advanced trauma and critical care. Declining inpatient and increasing outpatient business are signals of impending change.

Read more from David Ellis in Hospitals & Health Networks here.

The CareSpan: A New Health Affairs Feature On Long-Term Care

Major changes lie ahead in the structure and delivery of long-term health care services and supports, accelerated by the Affordable Care Act. Among these are expanded options for people to receive services in their homes and communities; care coordination for the disabled population dually enrolled in Medicare and Medicaid; and the creation of a new social insurance program dedicated to providing help for people with disabilities.

To meet the needs of policy makers for increased tracking and analysis of these and other issues, Health Affairs, with the support of The SCAN Foundation, is launching a new feature called The Care Span. The series  debuts with two articles in the newly released March issue of Health Affairs, and it will cover a range of topics relevant to long-term services and supports, as well as aging, disability, chronic disease, end-of-life care, community-based care, and the continuum of care.

Read more here.

AHA supports bill extending long-term care hospital provisions

The American Hospital Association on May 4 expressed “strong support” for the Medicare Long-Term Care Hospital Improvement Act (H.R. 2124). The bill would extend for two years certain provisions of the 2007 Medicare, Medicaid and SCHIP Extension Act to allow more time to develop LTCH facility and patient criteria.

Set to expire Dec. 29, 2010, the provisions delay full implementation of the so-called 25% Rule, which reduces payment for certain patients transferred to LTCHs from general acute-care hospitals. They also postpone payment reductions for very short-stay cases and place a moratorium on new LTCH facilities and beds, with certain exceptions.

“Extending these provisions would provide critical regulatory stability to the long-term care hospital community, and allow an essential segment of the post-acute health care delivery system to continue providing quality services to the patients who rely on them,” the AHA said in a letter to H.R. 2124 sponsors Reps. Earl Pomeroy (D-ND), John Yarmuth (D-KY), Lloyd Doggett (D-TX) and Bill Pascrell (D-NJ).

[ via AHA News Now ]

New Nursing Home Survey on Patient Safety Culture Now Available

AHRQ’s new Nursing Home Survey on Patient Safety Culture helps nursing homes assess nursing home staff opinions on 12 domains of patient safety culture in the nursing home. This information can help nursing homes evaluate the safety culture of their institution, track changes over time, and evaluate the impact of safety interventions.

The evidence-based, easy-to-understand survey and user’s guide are free. View the survey here.

Technical assistance for survey administration and access to a user’s group is also available for free by emailing safetyculturesurveys@ahrq.hhs.gov.