Healthcare Reform Bill Proposes Critical Long-term Care Changes

Introduced on Tuesday and cited as the work of three different House committees, America's Affordable Health Choices Act of 2009 addresses multiple long-term care issues.

Of most concern to long-term care providers and industry leaders are the proposed cuts in Medicare payments to skilled nursing facilities (SNF), which would add up to approximately $44 billion over the next 10 years. The cuts are included in multiple provisions of the bill, but the proposed changes with the most significant impact on SNF reimbursement are as follows:

• On January 1, 2010, the SNF market basket update implemented on October 1, 2009 will be removed.
• The SNF market basket will be further reduced by a productivity adjustment.
• As of October 1, 2010, SNFs will only be paid a certain percent of the charges on a claim if the resident was readmitted to a hospital within 30 days of his or her initial discharge. For fiscal year 2011, the percent paid would be 0.993.

Ninety-five of the bill's 1018 pages fall under Subtitle B, or the Nursing Home Transparency Act, which could also have a negative impact on SNF reimbursement. The provisions included in Subtitle B aim to further standardize skilled and non-skilled facilities through more easily accessible information, stronger enforcement, and detailed staff training programs. Among the proposed regulation changes are:

• Required disclosures of facility ownership
• Accountability requirements that include compliance and ethics programs
• Adjustments to the Nursing Home Compare Web site
• Expenditure reporting
• Standardized complaint forms
• Staffing accountability
• Civil money penalties
• A national independent monitor pilot program focusing on the oversight of chain facilities
• Notification of facility closures
• Dementia and abuse prevention training
• Study and report on training required for certified nurse aides and supervisory staff

The bill also calls for the secretary of Health and Human Services to develop a plan for post-acute care payment reform that includes bundled payment specifications. In addition, the secretary will be able to incorporate payment bundling into a voluntary pilot program.