Long Term Care and Rehabilitation - Section Priorities

1. Adequacy of PPS Post-Acute Payment

Goal: To support AHA's priorities to seek adequate payment for post-acute care services under PPS.


  • Continue appropriate collaboration with other organizations to support:
    • An October 1 start-up date for the Inpatient Rehabilitation PPS system, and to support the substitution of the FIM for the MDS-PAC patient assessment instrument.
    • The development of a PPS for Long Term Acute Care facilities.
    • Significantly streamline the patient assessment instrument used in Skilled Nursing Facilities, and, refine the assessment instrument to address Medicare Part A payment system deficiencies.
  • Monitor MedPAC's research on evidence of service substitution by patient setting.
  • Promote methods to better recognize the costs of medically complex patients across the continuum.
  • Increase recognition that significant payment inequity still exists for hospital-based post-acute care providers by level of care/setting by identifying case studies or providing testimony to support AHA's grassroots efforts. In addition, to support additional federal funding to recognize the costs of recruiting and retaining staff (e.g., education and training/retraining, support for workplace reengineering), minimizing regional payment disparities, and the cost of regulatory compliance.

2. Workforce Issues in Post-Acute Care

Goal: To support AHA short and longer-term workforce priorities, with emphasis on post-acute care service providers.


  • Identify specific concerns and solutions affecting workforce access in post-acute care (i.e., encouraging more flexibility in caregiver responsibilities or new categories of workers).
  • Identify key quantifiable variables to measure trends in the post-acute care workforce shortage. Explore efforts to integrate or share databases with other organizations.
  • Collaborate with other organizations (such as AARP and/or AAHSA) to educate the public on the workforce shortage in relation to the needs of the growing elderly population.

3. Quality and Patient Safety

Goal: To recommend ways to maintain quality and ensure patient safety in post-acute settings, streamline transition between various levels of care.


  • Monitor/comment on post-acute care implications in the IOM Report.
  • Ensure that the special quality and safety needs of elderly, chronically ill, disabled persons in the health care continuum are included in all AHA quality initiatives.
  • Emphasize a better understanding of the problem of multi-drug use by chronically ill and elderly and its related impact on medical error issues in post-acute care. Support efforts to assess the impact of multi-drug use under a Medicare prescription drug benefit.

4. Regulatory Reporting Relief

Goal: To support AHA's initiative to identify examples and support regulatory relief in post-acute care settings.


  • Provide examples of excessive regulatory burden in post-acute care settings.
  • Collaborate with other organizations to identify relevant issues for AHA's initiative.
  • Actively participate in AHA's Regulatory Relief and Reform efforts to ensure regulatory relief for long term care providers are highlighted, including:
    • survey and certification
    • assessment instrument and data collection forms
    • voluntary accreditation's contribution to the unfunded reporting burden
    • fiscal intermediary requirements

5. Promoting access to an appropriate continuum of care for elderly, chronically ill, and disabled individuals

Goal: To improve continuity and integration of care in Medicare removing barriers affecting beneficiaries and providers of care for elderly, chronically ill, and disabled individuals.


  • Identify key issues constraining access for chronically ill and disabled individuals in an integrated care continuum.
  • Support a system to more effectively track/manage the patient/consumer through the continuum.
  • Support development of demonstration projects on innovative ways to manage chronic illness.


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