The Medicare Payment Advisory Commission yesterday finalized its recommendations to provide no updates in fiscal year 2017 for Medicare payments to home health agencies, skilled nursing facilities, inpatient rehabilitation facilities or long-term care hospitals. In addition, the commission recommended rebasing the HH payment system over a two-year period starting in 2018, and eliminating therapy as a factor in setting HH payments. It also recommended that the Department of Health and Human Services reform the SNF prospective payment system and report to Congress in 2019 on the impacts of those reforms and need for further payment system changes. In addition, the commission voted in favor of focused audits of IRFs that have “unusual patterns of case mix and coding,” and expanding the outlier pool “to redistribute payments more equitably across cases and providers.” The recommendations will be presented to Congress in March. The commission also provided an update on its research on a unified payment system for post-acute care, which was legislatively mandated and will be presented to Congress in June. MedPAC and HHS would develop the new payment approach to replace the current prospective payment systems for post-acute care, with this work slated for presentation to Congress in 2022. Services would be paid for based on patients’ clinical characteristics, rather than care setting.

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