- THCA

Volume XXXI, Number 1
January 2016

MedPAC Presents Recommendations to Congress

In a recent communication from the American Health Care Association (AHCA), it was announced that the Medicare Payment Advisory Commission (MedPAC) presented an updated draft recommendation to Congress at its December meeting. According to AHCA, MedPAC’s general recommendation was to freeze future increases to Medicare payment rates for skilled nursing providers.

AHCA stated that it will vigorously oppose this recommendation because of the commission’s continued focus on Medicare fee-for-service (FFS) margins, while “merely acknowledging lower Medicare Advantage plan payment levels and negative Medicaid margins” and that the recommendation falls short “of a more thorough discussion of the impact of total margins.”

AHCA summarized the key observations of MedPAC staff as:

Broad SNF prospective payment system (PPS) challenges remain
PPS continues to favor therapy over medically complex care
The level of Medicare’s payments remains too high
Wide variation in margins reflects patient selection, service provision, and cost control
In terms of “broad SNF PPS challenges”, the Commission notes concern about therapy overpayments and that “payments for non-therapy ancillary (NTA) services are poorly targeted.”
The Commission recommended revising PPS — first to address NTA and therapy challenges, then to rebase the “level of payments to help protect low-margin SNFs.”

In addition to conveying to MedPAC the challenges nursing facilities face with total margins, AHCA will also emphasize the impact of Medicare alternative payment methods and demonstrations such as the Comprehensive Care Joint Replacement (CJR) demonstration, Accountable Care Organizations (ACOs), and growth in Medicare Advantage enrollment.

President’s Report

President’s Report

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Legislative Update

Warren Tells House Committee that High Workforce Turnover, Low Wages Threaten Long Term Care

Representative Four Price Honored As Long Term Care Champion

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Commitment to Care

Cutting Edge CMS Funded Dementia Training is Texas Bound

CMS Clarifies Coding “Present on Admission” for Pressure Ulcers in MDS Item M0300

Receive Free Assistance to Report Clostridium Difficile Data and Stop Infection

If you have any questions about the THCA C to C Initiative or would like to share your facilities successes please contact Gloria Bean-Williams at gbwilliams@txhca.org or call (512) 458-1257.

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