LeadingAge NY Comments on Proposed Federal Regulations for ACOs

LeadingAge New York submitted comments on proposed federal regulations governing Accountable Care Organizations (ACOs). The proposed ACO regulations solicit comments on potential waivers of regulations affecting long-term/post-acute care providers serving patients assigned to ACOs. Specifically, CMS is contemplating waivers of:

• the Skilled Nursing Facility (SNF) three-day stay rule;
• the coverage and billing requirements for telehealth services;
• the homebound requirement for home health care; and
• the prohibition on hospital recommendations of post-acute care providers.

More information on the proposed regulations and the waivers is available here, and here.

LeadingAge NY supported waivers of the three-day stay rule. We recommended that any SNF that has the capacity to serve the beneficiary appropriately and to participate in care coordination activities with the ACO should be permitted to admit patients under such a waiver, regardless of whether it is an ACO participating provider. We also recommended that this waiver be available to address the acute and post-acute care needs of long-term nursing home residents, as well as those beneficiaries who require only a short-term stay.

LeadingAge NY supported expanded coverage of telehealth services to permit payment for telehealth delivered in urban and suburban communities, as well as rural communities and coverage of services such as remote patient monitoring and e-consults. In addition, we supported broad waivers of the homebound requirement, including coverage of home health services to manage chronic conditions in the absence of an acute episode.

With respect to these proposed waivers, we noted that incentives associated with the opportunity to earn shared savings and/or to avoid readmission penalties would protect against inappropriate utilization.

LeadingAge NYexpressed concerns about waivers of the prohibition on hospital steering to post-acute care providers. We pointed out that beneficiary needs and preferences should drive the discharge process. We requested that, if the waiver is made available, hospitals should be required to provide beneficiaries with a complete list of post-acute care options, should clearly make available the option of returning to an originating facility or agency and should ensure that referrals to hospice are made if appropriate and consistent with the beneficiary's preferences and goals for care.

The complete text of the comments is available here.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124