LTCN February 2019, page 4, Aaron Tripp
Aaron Tripp

Long-term care stakeholders continued to bask in the government’s announced $879 million market basket update for nursing homes in fiscal 2020 on Monday.

But they did so with traces of reservation while also pointing out other potentially positive elements of the Centers for Medicare & Medicaid Services rule that was proposed late Friday.

“It is nice to see a positive, not negative, number for the update,” said Aaron Tripp, LeadingAge’s vice president for reimbursement and financing policy. But he quickly added that the net 2.5% proposed Medicare pay increase could change before being finalized.

“The underpinning data can change between now and the final rule in August,” he cautioned. “We might see a slight derivation from the actual update. Second, Congress might decide to override existing statute with new legislation, as they did last year in the Bipartisan Budget Act. So we are monitoring this.”

Tripp said policymakers and legislators still need to take a “more holistic” and “resident-centric” view when it comes to long-term care financing. Medicaid does not pay nearly as well as Medicare, yet caregivers are expected to treat patients covered by both the same way, he noted.

Such a “siloed” approach “only adds to the fragmentation of care and maintains an unreliable financial foundation” for providers, Tripp observed.

“Given the significant scale of the Medicare payment shift occurring with the implementation of [the Patient-Driven Payment Model] in October and the spillover effects on Medicaid rate setting for nursing homes in the many states that historically relied on RUGs to set Medicaid rates, we believe that CMS, MedPAC, MACPAC, and Congress ought to consider nursing homes as complete organizations,” Tripp said.

Cynthia Morton, the executive vice president for the National Association for the Support of Long-Term Care, said most of the proposal was not a surprise, calling the 2.5% market basket update “healthy and very needed in the sector.”

“We had asked for a change in how CMS defines group therapy and are pleased to see that CMS recognized that therapists can use their judgment to identify the patients who would benefit from group therapy and form those groups,” she added. “The proposed change also aligns the definition of group therapy with the definition used in the [Inpatient Rehabilitation Facility] setting.”

While not a shock, she said that the measures about transfer of information have a quirk.

“They have been changed into a process measure for whether a medication reconciliation was communicated to the next setting and or the patient and their caregiver,” she explained. “It’s important to note that CMS talks about these measures in terms of interoperability but they do not measure any type of electronic transfer of information.”

Those measures are for fiscal 2022 — two years out — so they are not mandatory right away, she pointed out.