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


70.1

100 100 100

76.1


Home healthagency

Hospice Nursing home Residential carecommunity

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Assisted Living Update Demographics – FTEs By Provider Type and Position


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


(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


63.8

96.6 98.4 99.3 88.7


Home healthagency

Hospice Nursing home Residential carecommunity

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Assisted Living Update Demographics – Hospice Services


24.4

5.6

78.6

89.4


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]

mainecare & medicare: long-term care update€¦ · demographics – ftes by provider type and...

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