The Medicare Payment Advisory Commission yesterday finalized recommendations that Congress forgo increasing or reduce Medicare payment rates in 2018 for home health agencies, skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals. Citing a 15.6% Medicare fee-for-service margin in 2015, the recommendations would subject HH payments to a 5.0% cut in 2018 and another round of rebasing in 2019 and 2020, in addition to the rebasing authorized by the Affordable Care Act. The commission also recommended that, concurrent with this rebasing, the Health and Human Services Secretary eliminate using the number of therapy visits as a factor in setting HH payments. The recommendations provide no increase for SNF payments in fiscal years 2018 and 2019 and call for the Secretary to revise the SNF payment system. Also, in 2020, the Secretary would report on the impact of these SNF reforms and make any further adjustments to more closely align payments and costs. For IRFs, the recommendation would reduce FY 2018 payments by 5.0% due to a projected increase in IRF fee-for-service margins from 13.9% to 14.3% between 2015 and 2017. The draft LTCH recommendation calls for no update in FY 2018, but no further interventions, in recognition of both lower fee-for-service margins and the transformation already underway due to LTCH site-neutral payment.