Post-acute care payment advocacy

Medicare's recent implementation of the SNF Patient Driven Payment Model (PDPM) and the Home Health Patient Driven Groupings Model (PDGM) have resulted in significant changes to therapy practice and the amount of therapy provided to patients in post- acute care settings. AOTA is closely monitoring these changes and meeting with Congress, the Centers for Medicare and Medicaid Services (CMS), the Medicare Payment Advisory Commission (MedPAC), and industry leaders regularly to promote and protect occupational therapy.

Policy-makers are contemplating additional post-acute care payment reforms such as site-neutral payment, expansion of bundled payments, and value-based purchasing. These reform efforts could change the way post-acute care payment is determined, which in turn could impact the utilization of therapy in all post-acute care settings. If you currently work in a post-acute care setting, these issues will affect your daily practice.

The Resetting the Impact Act (TRIA) - H.R. 8826 would "reset" the development of a unified post-acute care payment system, to ensure these efforts use the most recent data from the most recent payment systems (i.e. PDPM and PDGM). This would also provide time for any new payment system to understand "lessons learned" from PDGM and PDPM and account for the long-term effects of the COVID pandemic.

Developing a unified post-acute care payment system based on old information and data could lead to a payment system that does not appropriately value occupational therapy services and prevent Medicare beneficiaries from getting medically necessary occupational therapy services.