MaineCare & Medicare: Long-Term Care Update. berrydunn.com GAIN CONTROL
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1 MaineCare & Medicare: Long-Term Care Update berrydunn.com
2 Agenda National initiatives impacting you today and in the future Changes and regulatory considerations close to home Remain compliant recent regulations and their impact on you Review the latest trends and proposals impacting assisted living providers Potpourri of other key regulations impacting you
3 IMPACT Act of 2014 Timeline
4 Bundled Payments Overview of Comprehensive Care for Joint Replacement Bundle Bundled Payment for Care Improvement (BPCI) Pilot
5 Fee for Service - Prospective Payment System Significant Changes are on the Horizon
6 With Implementation of SNFVPB by FY 18, all FFS payments will be impacted by VBP FY 2009 FY 2015 Medicare Advantage [VALUE] Traditional Medicare [VALUE] Medicare Advantage [VALUE] Traditional FFS [VALUE] ACO [VALUE] Dual Demos [VALUE]
7 AHCA Proposed Payment Reform Payment landscape We are at a crossroads AHCA payment reform taskforce
8 AHCA Proposed Payment Reform Bundled SNF-Stay PPS (B-PPS) Move from PPS to a Single SNF-Stay Payment Includes only SNF Part A services Prepares the profession for the future
9 AHCA Proposed Payment Reform Bundled SNF-Stay PPS (B-PPS) Clinical Condition Categories Risk Mitigation Geographic Adjustment Payment Market Basket Update Short Stay Policy Payment Transitional Risk Corridor Outlier
10 AHCA Quality Initiatives Improve Organizational Success By: Improve Short- Stay/Post Acute Care By: Improve Long- Term/Dementia Care By: Decrease turnover by 15% or achieve/maintain at or less than 40% At least 25% of members measure satisfaction using Core-Q survey Reduce unintended health outcomes by March 2018 Safely reduce hospital readmissions w/in 30 days of skilled stay by an add l 15% or achieve/maintain 10% Improve discharge to community by 10% or maintain rate of at least 70% 25% of members use LTC trend tracker for outcome measures Safely reduce antipsychotics by add l 10% Safely reduce rehospitalizations by 15% or achieve/maintain 10%
11 Changes to the Principles of Reimbursement
12 Changes to the Principles of Reimbursement LD 1776 / Rebasing Depreciation recapture Ventilator care
13 Passed Legislation Nursing homes COLA and continued rebasing PNMI Appendix C 4% COLA & 3% adult and family homes rate increase effective July 1, 2015 Service provider tax to increase 1% effective January 1, 2016 Direct care education reimbursed in direct care component
14 Proposed Legislation Short Session
15 ICD-10
16 NF Rebasing Where Are We Now and Where Are We Heading? Effective July 1, 2014 COLA and Funding Adjustment ( Haircut ) Hold Harmless Adjustment What s next?
17 Assisted Living Update Demographics Assistance with ADL s Adult day services center Home health agency Nursing home Residential care community Bathing Dressing Toileting Eating Source: AHCA and NCAL 2015 Annual Convention and Expo, Harris-Kojetin L., Sengupta M., Park-Lee., Valverde R. Long-term care services in the United States: 2013 Overview. Hyattsville, M: National Center for Health Statistics, 2013.
18 Assisted Living Update Demographics Skilled / Nursing Services Adult day services center Home health agency Hospice Nursing home Residential care community Source: AHCA and NCAL 2015 Annual Convention and Expo, Harris-Kojetin L., Sengupta M., Park-Lee., Valverde R. Longterm care services in the United States: 2013 Overview. Hyattsville, M: National Center for Health Statistics, 2013.
19 Assisted Living Update Demographics FTEs By Provider Type and Position Aide Licensed practical or vocational nurse Registerd nurse Adult day services center (20,700 FTEs) Home health agency (143,600 FTEs) Hospice (57,800 FTEs) Nursing home (952,100 FTEs) Residential care community (278,600 FTEs) Source: AHCA and NCAL 2015 Annual Convention and Expo, Harris-Kojetin L., Sengupta M., Park-Lee., Valverde R. Long-term care services in the United States: 2013 Overview. Hyattsville, M: National Center for Health Statistics, 2013.
20 Assisted Living Update Demographics Therapeutic Services Adult day services center Home health agency Hospice Nursing home Residential care community Source: AHCA and NCAL 2015 Annual Convention and Expo, Harris-Kojetin L., Sengupta M., Park-Lee., Valverde R. Long-term care services in the United States: 2013 Overview. Hyattsville, M: National Center for Health Statistics, 2013.
21 Assisted Living Update Demographics Hospice Services Adult day services center Home health agency Nursing home Residential care community Source: AHCA and NCAL 2015 Annual Convention and Expo, Harris-Kojetin L., Sengupta M., Park-Lee., Valverde R. Long-term care services in the United States: 2013 Overview. Hyattsville, M: National Center for Health Statistics, 2013.
22 Assisted Living Update Long-Term Services and Support Costs Service National Median NF PVT $91,250 NF Semi-PVT 80,300 Home Health Aide 45,760 RCF / AL 43,200 Adult Day 17,904 Source: AHCA and NCAL 2015 Annual Convention and Expo, Genworth, 2015 Cost of Care Survey.
23 Assisted Living Update Regulations and Reimbursement COLA Service Provider Tax Federal Focus Challenges Proposed PNMI Changes HCBS Final Rule
24 Compliance and Ethics Programs Are you Compliant? Focused Surveys Payroll-Based Journal Value-Based Purchasing CMPs Compliance Programs
25 Proposed Requirements of Participation New requirements, language and concepts Reorganize existing requirements Existing practices incorporated Major concerns
26
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