House members urge CMS to waive FFS barriers to alternative payment models

Seventy members of the House of Representatives today urged the Centers for Medicare & Medicaid Services to waive fee-for-service regulations, such as the 25% Rule for long-term care hospitals, that limit care coordination and collaboration for acute care hospitals and post-acute care providers entering into alternative payment models with downside risk. “The continued application of FFS regulatory barriers within downside risk payment reform models often hinders providers’ ability to identify and place beneficiaries in the most clinically appropriate setting,” the House members wrote. “It also inhibits their ability to test new, more patient-centered and streamlined clinical pathways.” The representatives also encouraged CMS to consider new payment approaches for inpatient rehabilitation facilities and LTCHs. “These higher-cost settings face challenges within downside risk payment reform models because currently, any new efficiencies achieved are not reflected in their per-discharge Medicare reimbursement,” they wrote. “Hospitals and other stakeholders, in order to effectively partner with these settings within downside risk payment reform models, need more flexibility.” The letter was spearheaded by Reps. Pat Tiberi (R-OH) and Ron Kind (D-WI).