Payment Update and PDGM
This final rule delivers on a number of statutory imperatives from the Bipartisan Budget Act of 2018. They include:
The Toolkit includes:
As Best Buy continues its push into healthcare, senior care remains a strong focus—and could make Best Buy the leader in the space.
Hospice Aggregate Cap
MedPAC staff presented a new policy option for consideration by the Commission – wage adjusting the hospice aggregate cap and lowering it by 20%.
The hospice aggregate cap was created as part of the original Medicare Hospice Benefit in order to ensure savings. The cap limits aggregate payments a hospice can receive annually and if a provider receives payments in excess of the cap, those excess payments must be re-payed to the Medicare Trust Fund.
While this Executive Order requires rules to be promulgated on a number of its items within the next year, changes to Medicare FFS payments are not part of this timeline. The Executive Order also does not immediately implement a change in its Medicare FFS payment policies to begin paying providers at rates similar to what Medicare Advantage (MA) plans or the commercial insurance market pay providers.
Life plan communities are uniquely situated to maximize value and add additional revenue streams through value-based payment arrangements with managed care entities.
As of October 1, Medicare Advantage (MA) and Special Needs Plans' (SNP) could begin marketing --sharing information about their plans and benefits. Medicare beneficiaries can enroll in one of the available plans in their market between October 15 – December 7. Recent federal policy changes have expanded the types of supplemental or extra benefits that plans can offer to their beneficiaries to include some home and community-based services and targeted benefits for those who are chronically ill.
The new Patient-Driven Payment Model (PDPM) is more complex than the previous Resource Utilization Groups (RUGs). We are pleased to offer three tools to help with financial planning and budgeting to take away some of the uncertainty with PDPM.
As a reminder, PDPM is the new payment model that CMS is implementing to shift the focus of Medicare fee-for-service reimbursement away from thresholds related to therapy provision to an emphasis on the clinical characteristics of the residents that your organization provides care to. There will be five case-mix categories, physical therapy, occupational therapy, speech-language pathology, nursing, and non-therapy ancillary. Each resident will be assessed into a group within each of the case-mi categories and that will determine Medicare Part A payment.
The calculator is based on the FY 2020 Hospice Final Rule that features the rebasing of the continuous home care (CHC), general inpatient care (GIP), and inpatient respite care (IRC) per diem payment rates as well as the elimination of the 1-year lag in the wage index. It also includes the 2% sequestration reduction that remains in effect for FY 2020.
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