Hot Topics in Post Acute Care
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1 HCCA Hawaii Regional Conference October 15, 2010 Hot Topics in Post Acute Care Lynda Hilliard, CHC, CCEP Deputy Compliance Officer University of California
2 Hot Topics in Post Acute Care Presentation Objectives: Outline the major initiatives of PPACA on long term care: Skilled Nursing/Nursing Facilities (SNF/NF) Home Health Care (HHA) Hospice (HMB)
3 What is Considered Post Acute or Long Term Care under PPACA Nursing Homes (Medicare SNFs, Medicaid NFs) Home Health Care (Medicare, Medicaid, private) Hospice (Medicare, Medicaid, private) Others Assisted Living (largely private) Long Term Care Hospitals (LTCHs - primarily Medicare) Independent Rehab Facilities (IRFs - primarily Medicare) Home & Community Care (Medicaid) Independent Care Facilities for Mental Retardation/Developmental Disabilities (ICF-MR/DD - Medicaid) Outpatient Rehab
4 Medicare Spending on LTC Type of Entity 2010 Projected Percentage of Spending 2019 Projected Percentage of Spending LTCH $5.1B 7.3% $9.3B 7.7% IRF $6.0B 8.6% $11.7B 9.7% SNF $26.2B 37.6% $44.1B 36.7% Hospice $13.2B 19.0% $19.8B 16.5% Home Health $19.2B 27.6% $35.3B 29.4%
5 Key Regulations in the PPACA Skilled Nursing Facilities Key Act Provisions Section Transparency (2012) Expansion of Ownership Disclosure Requirements Section Mandatory Compliance and Ethics Programs (2012) effective in preventing and detecting criminal, civil and administrative violations under the Act and in promoting quality of care Section 6102(b) Required elements outlined in the Act - USSC Sentencing Guidelines 7 Elements
6 Key Regulations in the PPACA Skilled Nursing Facilities (continued) Section 3023 Post Acute Care Payment Bundling 5 yr pilot Section 6103 Changes to the Nursing Home COMPARE website (2011 except staffing) 1. Staffing data for each facility including information on staff turnover and tenure 2.Links to state websites fur state survey and certification programs 3. Standardized complaint form including explanatory materials 4.Summary of complaint information 5.Information regarding criminal violations by a facility and its employees 6. Consumer rights information Section 6104: Reporting of Expenditures (2012)
7 Key Regulations in the PPACA Skilled Nursing Facilities (continued) Section 6105 Development of Standardized Complaint Form (2011) Section 6106 Electronic Submission of Staffing Information (2012) Section 6107 GAO Study on Five-Star Quality Rating System Based on health inspections, quality measures and staffing levels (2012) Section Potential Reduction of Civil Monetary Penalties (2011) Section 6112 National Independent Monitor Demonstration Project (2011) Section 6113 Notification of Facility Closure (2011) Section National Program for Background Checks Section RUGs-IV not to be implemented prior to 1/1/11 except for changes to concurrent basis therapy and look back - RUGs-III implementation by 1/1/10 not to be delayed
8 Key Regulations in the PPACA Home and Community Based Services Key Act Provisions Provides for Community First Choice Option Section 2401 provide addt l federal funding for home and community based services through a state plan amendment meeting specified requirements for level of care, eligibility and needs-based criteria. Section 2402 removes barriers to providing home and community based services Section 2403 extends the Money Follows the Person Rebalancing Demonstration DRA 2005 Section 2404 Protection against spousal impoverishment Section 2406 provides funding to expand state aging and disability resource centers
9 Key Regulations in the PPACA Key Act Provisions Home Health Care Reimbursement Productivity & Trend Factor Adjustments Post Acute Care Bundling (Hospitals, Physicians, SNFs, HHAs) 5 yr pilot program Section 3023 Therapy Cap Exception Process (Section 3103) 36 month rule Ownership Transparency (proposed rule) Face to face encounters within 30 days (or 2 weeks?) of SOC
10 Key Regulations in the PPACA Key Act Provisions Hospice Reimbursement Productivity & Trend Factor Adjustments Section Face to face encounters by hospice physician/nurse practitioner prior to 180 recertification and each period thereafter to determine continued eligibility
11 OIG Work Plan FY2011 Home Health Care Part B Payments to HH Beneficiaries HHA claims for Medicare HHRGs Oversight of OASIS Data HHS PPS Controls HHA Profitability HHA Enrollment
12 OIG Work Plan FY2011 Skilled Nursing Facilities (SNF) Part A payments to SNFs Medicare requirements for quality of care in SNFs Assessment and monitoring of nursing home residents receiving atypical antipsychotic drugs Oversight of poorly performing nursing homes Hospitalization of nursing home residents Emergency preparedness and evacuation plans during selected natural disasters Criminal background checks for nursing facility employees Program for national and state background checks for LTC employees Medicare part B services during non-part A nursing stays
13 OIG Work Plan FY2011 Hospice Hospice utilization in nursing facilities Services provided to hospice beneficiaries residing in nursing homes
14 Hot Topics in Post Acute Care Summary Strong compliance program is an asset to managing high level risks and providing comprehensive oversight Senior leadership and Board knowledge and involvement necessary for success Flexibility in compliance and operations to incorporate new changes.
15 Hot Topics in Post Acute Care Questions & Answers For Further Information
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