MedPAC Discusses Requiring a Three-Day Hospital Stay for All Post-Acute Care, Threatening Access to Care

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.”[1] 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.”[2] MedPAC envisions that a “common set of requirements . . . [would] apply to all providers.”[3]

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.”[4] 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.[5] 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.[6] 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.