The Medicare Payment Advisory Commission (MedPAC) held a public meeting on September 6, 2018. Commissioners listened as staff presented on “Aligning Medicare’s statutory and regulatory requirements under a unified payment system for post-acute care.” Specifically, the presentation discussed the need to make level-of-care requirements consistent across post-acute care (PAC) settings under a unified PAC prospective payment system (PPS). The objective of the unified PAC PPS is to “set payments based on patient characteristics, not site of care.” MedPAC envisions that a “common set of requirements . . . [would] apply to all providers.”
In discussing what policies might ensure appropriate PAC use under the unified PAC PPS, MedPAC staff suggested “requiring a three-day stay for PAC to ensure appropriate use.” The presentation highlighted that the three-day hospital stay requirement may be mitigated by allowing observation days to count towards the requirement and allowing accountable care organizations or entities at financial risk to waive the requirement. Even with limited exceptions, MedPAC’s proposal would create a substantial barrier to care for countless Medicare beneficiaries who need post-acute care would not meet an arbitrary three-day hospital stay requirement.
In order to qualify for skilled nursing facility coverage, beneficiaries must have a qualifying three-day inpatient hospital stay. There is currently no similar three-day hospital stay requirement for care at inpatient rehabilitation facilities, long-term care hospitals, or for home health. In fact, Congress specifically removed a prior Part A hospital stay requirement for home health in 1980. Adding a hospital stay requirement now for home health or any other post-hospital care setting is a step back for the Medicare program and beneficiaries. It is also contrary to health policy goals of avoiding and reducing hospitalization, the most expensive setting for care.
 Evan Christman, Aligning Medicare’s statutory and regulatory requirements under a unified payment system for post-acute care, MedPAC (Sept. 6, 2018), http://www.medpac.gov/docs/default-source/default-document-library/aligning-pac-requirements_fin.pdf?sfvrsn=0.
 The Omnibus Reconciliation Act of 1980, Pub. L. No. 96-499. See also Medicare Home Health Coverage is Not a Short-Term, Acute Care Benefit ─ Congress Acted in 1980 to Provide for Longer-Term Coverage, Center for Medicare Advocacy, https://www.medicareadvocacy.org/alert-spotlight-on-medicare-home-health-care-tax-cuts-set-stage-for-medicaremedicaid-cuts-aca-news/#1 (last visited Sept. 11, 2018).