We have an obligation to speak up for those we and our sister organizations serve. As difficult choices are made regarding the future if the healthcare and human services system AJAS operates not only on behalf of the enlightened self interest of its members but in the interest of those without resources or the ability to raise their voices in advocacy. We recognize that the Federal Budget and the laws and policies established by our government must be moral documents that represent our best values as a nation. AJAS will speak as one to help to frame the debate and to stand for those who cannot stand alone.
Public Policy & Legislative Group Advocacy Plan for 2016
1. Medicare Hospital Observation Stay
Many elderly admitted to the hospital are being admitted under “Observation” status. They receive the same care as “Inpatient” status in the hospitals. Hospitals are placing patients under observation status to avoid fines if the patient is re-hospitalized/re-admitted back to the hospital within 30 days from the original hospitalization. The key issue is when the patient is discharged from the hospital and requires “post hospital rehab care” under Medicare. A (SNF benefit) they are unable to obtain these services. Why? Because the hospital classified them as observation stay patients.
Support HR1571, Improving Access to Medicare Coverage Act of 2015. This legislation would allow elderly under Medicare to receive needed skilled nursing post acute rehab care, following a 3-day hospital stay (regardless of observation stay status).
2. Impact Act
The Improving Medicare Post Acute Care Transformation Act, passed in 2014. The Impact Act has important implications for AJAS members, these include:
a. New quality measures for SNF’s
b. Alternative SNF payment models
c. Value based purchasing (HR3298)
As the regulations for these are being developed, we need to closely monitor and provide input on these areas as these will impact future skilled nursing payments we receive under Medicare.
3. Med PAC – Medicare Payment Advisory Commission
The Medicare Payment Advisory Commission (Medpac) is recommending freezing skilled nursing rate freezes in 2017 and 2018 to Congress.
Closely monitor and inform Congressional Reps regarding the need to update and increase SNF rates to reflect inflation and increased chronicity of patients receiving SNF services.
4. Home Health Care
Medicare Home Health Services are facing significant issues in terms of excessive and duplicative documentation, home health client certification delays, etc. Therefore, AJAS members who provide home health care services are adversely affected and burdened by such excessive and costly requirements.
a. Support HR1342 (Home Health Planning Improvement Act), which allows nurse practitioners, clinical nurse specialists and physician assistants to write orders for Medicare home health services.
b. Support S.1650 – Home Health Documentation & Program Improvement Act, which would simplify documentation requirements.
5. Hospice Services
Many AJAS members provide Hospice Services under Medicare. Many states, such as New York, are considering incorporating Medicare Hospice benefits into Medicare Advantage Plans/Managed Care Plans.
Issues Include: Contracting, billing, claim and payment problems. Most importantly, a major problem is a patient right’s issue. Individuals with life limiting conditions and their families should not be restricted in their choice of hospice organization or have to figure out which hospice is in their plan network.
Oppose the current Senate working group on chronic care’s suggestion that the Medicare hospice benefit be incorporated into Medicare Advantage Plans.