mainecare & medicare: long-term care update€¦ · demographics – ftes by provider type and...
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MaineCare & Medicare: Long-Term Care Update
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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
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IMPACT Act of 2014
Timeline
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Bundled Payments
Bundled Payment for Care Improvement (BPCI) Pilot
Overview of Comprehensive Care for Joint Replacement Bundle
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Fee for Service -Prospective Payment System
Significant Changes are on the Horizon
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With Implementation of SNFVPB by FY 18, all FFS payments will be impacted by VBP
Medicare Advantage [VALUE]
Traditional FFS
[VALUE]
FY 2009
Medicare Advantage [VALUE]
ACO [VALUE]
Dual Demos [VALUE]
Traditional Medicare [VALUE]
FY 2015
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AHCA Proposed Payment Reform
• Payment landscape
• We are at a crossroads
• AHCA payment reform taskforce
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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
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AHCA Proposed Payment Reform Bundled SNF-Stay PPS (B-PPS)
Clinical Condition
Categories Payment Geographic
Adjustment Risk
Mitigation
Market Basket Update
Payment
Short Stay Policy
Transitional Risk Corridor
Outlier
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Improve Organizational Success By:
AHCA Quality Initiatives 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 antipsychotics by add’l 10%
• Safely reduce rehospitalizations by 15% or achieve/maintain 10%
• 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
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Changes to the Principles of Reimbursement
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• LD 1776 / Rebasing • Depreciation recapture
• Ventilator care
Changes to the Principles of Reimbursement
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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
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Proposed Legislation Short Session
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ICD-10
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• Effective July 1, 2014
• COLA and Funding Adjustment (“Haircut”)
• Hold Harmless
Adjustment • What’s next?
NF Rebasing Where Are We Now and Where Are We Heading?
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Assisted Living Update Demographics – Assistance with ADL’s
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.
39.6
95.1 96.1
61.4
37.8
83.8 90.9
44.9 36.2
64.6
86.6
36.8 25.3
51.2 56
17.7
Adult day servicescenter
Home health agency Nursing home Residential carecommunity
Bathing Dressing Toileting Eating
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Assisted Living Update Demographics – Skilled / Nursing Services
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.
70.1
100 100 100
76.1
Adult day servicescenter
Home healthagency
Hospice Nursing home Residential carecommunity
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Assisted Living Update Demographics – FTEs By Provider Type and Position
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.
69.4
26.6 35.7
65.4 82.1
11.3
19 9.6
22.9 10.2 19.2
54.4 54.7
11.7 7.6
Adult day servicescenter
(20,700 FTEs)
Home health agency(143,600 FTEs)
Hospice(57,800 FTEs)
Nursing home(952,100 FTEs)
Residential carecommunity
(278,600 FTEs)
Aide Licensed practical or vocational nurse Registerd nurse
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Assisted Living Update Demographics – Therapeutic Services
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.
63.8
96.6 98.4 99.3 88.7
Adult day servicescenter
Home healthagency
Hospice Nursing home Residential carecommunity
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Assisted Living Update Demographics – Hospice Services
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.
24.4
5.6
78.6
89.4
Adult day servicescenter
Home health agency Nursing home Residential carecommunity
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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
Assisted Living Update Long-Term Services and Support Costs
Source: AHCA and NCAL 2015 Annual Convention and Expo, Genworth, 2015 Cost of Care Survey.
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• COLA
• Service Provider Tax
• Federal Focus
• Challenges
• Proposed PNMI Changes
• HCBS Final Rule
Assisted Living Update Regulations and Reimbursement
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Compliance and Ethics Programs Are you Compliant?
• Focused Surveys
• Payroll-Based Journal
• Value-Based Purchasing
• CMPs
• Compliance Programs
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Proposed Requirements of Participation • New requirements, language and concepts
• Reorganize existing requirements • Existing practices incorporated • Major concerns
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Interested in more? Contact us.
Kevin Ware [email protected]
Tammy Brunetti [email protected]