Home Health & Hospice Week

Commission looks for ways to decrease payments to for-profits, freestandings.

It may not be on the top of the agenda for Congress or the Centers for Medicare & Medicaid Services, but don't dismiss altogether a PPS system that spans four post-acute settings.

Expect Medicare Payment Advisory Commission members to approve language recommending CMS start implementing a Post-Acute Care Prospective Payment System in 2019, when they meet to vote on recommendations for their March report Jan. 11 and 12.

MedPAC made the same suggestion last year, but CMS hasn't made any moves toward implementing it (see Eli's HCW, Vol. XXVI, No. 24). In a June report to Congress, MedPAC estimated that for HHAs, a PAC PPS would decrease payments by 1 percent on average. Further, about 42 percent of HHAs would see a payment decrease, and 53 percent would see a payment increase under PAC PPS.

In its presentation for its Dec. 7 meeting, a MedPAC staffer outlined advice to start phasing in the PAC PPS incrementally and in a cost-neutral manner. It would redistribute payments away from for-profit and freestanding providers and toward nonprofit and hospital-based providers, MedPAC's Carol Carter noted.

A PAC PPS would cover home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals. In the December meeting, commissioners expressed approval for a three-year transition to PAC PPS. Prior to a full PAC PPS implementation in the third year, CMS could "use a blend of the setting-specific and unified PAC PPS relative weights to establish payments," according to the presentation.