Besides cuts to entitlement programs, President Trump’s budget proposal included another major provision affecting long-term providers: a proposed unified payment system that has been promoted by advisory panels and others for several years.

Under the proposal, the budget would transition payment for post-acute care to site-neutral payments over the span of five years. It also would reduce the growth rate of post-acute care payment during the transition period. The payment system would apply to skilled nursing facilities, home health agencies, long-term care hospitals and inpatient rehabilitation facilities.

“The proposed value-based payment system is based on the anticipated clinical needs and risk factors of the patient, rather than the site of service,” the document states. “All types of facilities would remain available, and patients with their doctors would determine the right site of care.”

LeadingAge noted that concept is still under development. It pointed out that two reports are still due to Congress about the system.

 “Additionally, new legislation is likely necessary for such a significant payment change,” the organization cautioned. “It is premature to assume savings in general, much less to the scale identified in the budget, to an as yet undefined payment system.”