October 9, 2014

New Reporting Requirements under the IMPACT Act for Post-Acute Care Providers

President Obama signed into law on October 6th, 2014 the “Improving Medicare Post-Acute Care Transformation Act of 2014”, also known as the “IMPACT Act of 2014”.  The IMPACT Act of 2014 amends the Social Security Act to require home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals to report on a variety of measures including, standardized patient assessment data, quality measures, and resource use.  The IMPACT Act of 2014 will be phased-in over the next several years, with the first reporting requirements beginning in 2016 for certain data points for skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals.  The other data points will be implemented and all reporting requirements for these facilities will be required by October 1, 2018.  The reporting requirements for home health agencies will not begin until January 1, 2017 and will be implemented over the years with all data points being required by January 1, 2019. 

One of the primary purposes of this law is to address the payment methodology for post-acute care (PAC) providers.  Currently, PAC providers receive varying Medicare payments depending upon the care setting.  PAC providers previously sent numerous letters to Congress seeking standardized post-acute assessment data.  In response, this law was enacted and the new reporting requirement will enable stakeholders and policymakers to evaluate the types of services provided, quality of those services, and cost of those services across the continuum and have quantitative data to re-evaluate the current payment system. It will also allow patients to compare outcomes across care settings. Moreover, a study will be conducted by the Secretary of Health & Human Services to “examine[] the effect of individuals’ socioeconomic status on quality measures and resource use and other measures for individuals under the Medicare program under title XVIII of the Social Security Act”. (Sec. 1899B(b)).  The law also charges the Medicare Payment Advisory Committee with evaluating and recommending to Congress a prospective PAC payment system and to evaluate switching from a traditional fee-for-service payment model.  Summary from the Senate Can Be Found Here

To accomplish these goals, the law has set forth specific requirements in three key areas that PAC providers will be required to report.  The first area is standardized patient assessment data that will include reporting on conditions such as functional status, cognitive function, special services, treatments and interventions, medical conditions and co-morbidities, impairments, and possibly other areas as deemed necessary by the Secretary of Health & Human Services. (Sec. 1899B(b)(B)).  Reporting on quality measures will have some overlap with patient assessment data such as functional data and cognitive function, but also requires reporting on skin integrity, medication reconciliation, incidence of major falls, and communications with the patient and family.  (Sec. 1899B(c)(1)).  The last area for reporting, concerns resource use, which will include reports on “resource use measures, including estimated Medicare spending per beneficiary, discharge to community, [and] measures to reflect all-condition risk-adjusted potentially preventable hospital readmission rates.”  (Sec. 1899B(d)(1)).  Feedback on the data will be provided to post-acute care (PAC) providers confidentiality the first year after roll-out, but the law also provides that the data will be made available to the public as well.

Other than these reporting requirements, the law also requires that providers use this data to inform their discharge planning while still taking into account patient preferences. The law also affects hospice providers by requiring a standard survey to be completed every three years for the next ten (10) years.  Additional regulations and interpretive guidance about these aspects and others of the law will be forthcoming by the Secretary by January 1, 2016.

This article was written by Danielle Holley.  She can be reached by calling (518) 462-5601 or by email at dholley@oalaw.com