Diane JusticeNational Academy for State Health Policy

February 9, 2011

Post-Acute Care and Long-Term Care: A Complex Relationship

AcademyHealth

2011 Long Term Care Interest Group Policy Seminar

Long Term Services and Supports (LTSS)

• Support for Daily Activities, Functional Capacity

• Characteristics of LTSS Recipients

• Shift to the Community

• Increased Institutional Acuity Levels

Medicaid Financed LTSS Trends

• Case Management: Increased Focus on Chronic Care Coordination, Transitions

• Payment Policy: FFS—Movement to Managed Care

• Community Based Providers—Movement to Self Direction

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LTSS Relationship to Post-Acute Care

• Medicare SNF Benefit

• LTSS Institutional Providers

• Medicare Home Health Benefit

• LTSS Community Based Providers

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Payment Bundling

• Length of Episode

• Discharge Criteria

• Service Scope

• Co-payment Policy

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To Be Resolved• Will payment bundling automatically result

in better care coordination?

• Will there be room in the payment structure for the cost of care coordination?

• Will individual payment rates reflect the complexity of both medical and functional need?

• Will the contribution of Medicaid LTSS to positive post-acute outcomes be recognized in Medicare payment policy?

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