Both the American Health Care Association and LeadingAge voiced concerns about the proposed Medicaid Fiscal Accountability Regulation (MFAR), warning it targets vital supplemental payment programs and state provider taxes. 

In a joint statement, AHCA and the American Hospital Association said MFAR could cut up to $50 billion nationwide from the Medicaid program annually. 

“Entire communities could lose access to care under this proposal, especially in rural areas where 15 percent of hospital revenue and nearly two-thirds of nursing facility revenue nationwide depend on Medicaid funding,”  AHCA President and CEO Mark Parkinson and AHA President and CEO Rick Pollack wrote. 

Katie Smith Sloan, LeadingAge president and CEO, said if implemented as written the rule “could have a devastating impact on providers and thereby harm the very older adults the Medicaid program is designed to protect.”

But in many cases, overall (prorated) provider revenue was below base-year projections due to “atrophy” of the Medicare fee-for-service population, Zimmet CEO Marc Zimmet explained. 

“Provider per diem rates are up under PDPM more than expected, but it’s all heavily impacted by local market conditions,” Zimmet cautioned.

PDPM is structurally sound but may be highly sensitive to poorly targeted funding adjustments, report authors noted.

LeadingAge noted that the proposal would cut post-acute care and hospice services’ Medicare spending by more than $100 billion over the next 10 years. This “would in fact be crippling not only for providers of aging services but also to the older adults who depend on Medicare benefits to meet their care needs as they age and at the end of life,” the organization said.

The budget proposal, which was released in early February, also calls for about $920 billion in cuts to Medicaid over the next decade. The American Health Care Association said it is “concerned about any changes to Medicaid that would threaten funding and access to long-term care.”

The change would allow users to access the same information through a single entry point and offer simplified navigation, Administrator Seema Verma wrote in a blog post in January. “The new ‘Medicare Care Compare’ on Medicare.gov will offer Medicare beneficiaries and their caregivers and other users a consistent look and feel, providing a streamlined experience to meet their individual needs in accessing information about health care providers and care settings,” Verma wrote. 

“In the new, unified experience, patients will be able to easily find the information that is most important to help make healthcare decisions, like getting quality data by the type of health care provider,” she added. 

Advocates called on CMS to ensure information on the new site would benefit providers.

The legislators joined an array of providers also taken aback by the threatening proposal.

The lawmakers asked for more information on how CMS reached their decision to ask for the cuts.

CMS’ 2020 Physician Fee Schedule Payment System Final Rule seeks to strengthen Evaluation and Management (E/M) Services coding and increase payments for office and outpatient E/M visits. It would become effective in January 2021.

Providers have warned that the reduction in Part B services would affect skilled nursing facilities’ billing of Part B therapy — which ultimately could hurt residents.

Professor Geoffrey Tofler of the University of Sydney, Australia, and colleagues found that low daily doses of a beta blocker and aspirin for six weeks following a bereavement successfully reduced spikes in blood pressure and heart rate. There were also positive changes in blood clotting tendency. The study was published in the American Heart Journal.

Researchers reviewed falls intervention studies involving 30,000 eldercare community residents. They found that exercise as a single intervention reduced the number of fallers by 36% and recurrent fallers by 41%. 

Residents typically participated in gait, balance and functional training, as well as strength and resistance training. Recurrent falls also dropped when staff were educated on polypharmacy risks.

The findings demonstrate exercise’s critical role in improving function, study author Andrea Iaboni, M.D., Ph.D., wrote.

Under the proposal, the budget would transition payment for post-acute care to site-neutral payments over the span of five years. It also would reduce the growth rate of post-acute care payment during the transition period. The payment system would apply to skilled nursing facilities, home health agencies, long-term care hospitals and inpatient rehabilitation facilities.

“The proposed value-based payment system is based on the anticipated clinical needs and risk factors of the patient, rather than the site of service,” the document states. “All types of facilities would remain available, and patients with their doctors would determine the right site of care.”

LeadingAge noted that concept is still under development. It pointed out that two reports are still due to Congress about the system.

 “Additionally, new legislation is likely necessary for such a significant payment change,” the organization cautioned. “It is premature to assume savings in general, much less to the scale identified in the budget, to an as yet undefined payment system.”

The Census Bureau will conduct the Group Quarters Advance Contact process to ensure all seniors are “counted as accurately as possible,” LeadingAge explained.

Seniors who live in nursing homes, skilled nursing facilities and inpatient hospitals should be counted as group quarters and should be counted together. Seniors who live at home, or in senior housing, assisted living or the independent living section of a life plan community should be counted individually.

The Group Quarters Enumeration process takes place in three phases and runs through March. It includes phone interviews with Census Bureau representatives and possible site visits. 

Providers also will have to schedule an appointment for an official count. 

LeadingAge warned that providers will have to do their part to ensure residents are counted accurately during this year’s 2020 census. Not doing so could have implications on the amount of federal funding allotted to senior services.

A:Two things. One is raising the visibility of aging. When we started the Foundation 12 years ago, there wasn’t much philanthropic work on aging and public policy. For a small foundation, we picked an important niche, and we worked hard on it. I am also proud of the team we built. They work tirelessly to improve systems for older adults that preserve dignity and independence.

Q: What accomplishments are you most pleased about? 

A:I’m really proud of the Master Plan for Aging initiative, because I think it will change the direction of how we think about getting older in California. I’m also pleased about the multiyear LTSS State Scorecard, which measures state performance from the viewpoint of users of services and their families. States use it to hold officials accountable and drive federal policy.

Q: What does retirement mean to you?

A:If I could banish a word from my vocabulary, it would be retirement. I will make the  transition from a full-time job to a series of projects over the next decade or more. I’m stepping away from the Foundation to give someone else a chance to lead, but I’m certainly not done working on healthcare issues.