President Signs IMPACT Act of 2014

Long Term Care Providers to Standardize Assessment Data

The Improving Medicare Post- Acute Transformation Act of 2014 (IMPACT) or HR 4994,was signed into law  on Monday, October 6, 2014.

The enacted law mandates that hospices be surveyed at least once every three years through FY 2025 and implements a medical review process for hospices who have a percentage of patients receiving care for more than 180 days. However, the law contains additional language that would align hospice reimbursement and the hospice aggregate financial cap to a common inflationary index and standardize assessment data across post-acute provider types.
IMPACT timeline
Four post-acute care (PAC) provider types are targeted, including skilled nursing facilities, inpatient rehabilitation facilities, home health agencies and long term care hospitals.  The new law will provide comparable information across these PAC settings that would enable policymakers and providers to determine whether the patients treated and the care provided in different settings is the same or more appropriate in a specific PAC setting. Without having this comparable data, it is difficult for CMS to move forward with Medicare PAC payment reforms.

Specifically, the IMPACT Act of 2014 requires standardized data that will enable Medicare to:

  • Compare quality across PAC settings by building on existing PAC assessment tools

  • Improve hospital and PAC discharge planning

  • Use the comparable data to reform PAC payments (such as site-neutral or bundled payments) and ensure beneficiary access to the most appropriate care setting.

The Act also proposes standardized quality measures across PAC settings which the National Quality Forum (NQF) strongly supports. Suggested measures to be compared across PAC settings include functional status, skin integrity, medication reconciliation, major falls and patient preferences regarding treatment and discharge options. The proposed timeline requires quality measures to be reported for providers starting between years 2016 and 2018 followed by standardized assessment data beginning in 2019. CMS and MedPAC reports on PAC prospective payment along with a study on hospital assessment data are projected to be available in 2022.

H.R. 4994, the “Improving Medicare Post-Acute Care Transformation Act” or the “IMPACT Act of 2014,” which creates a standardized Medicare assessment tool for comparing patient data across the various types of post-acute care settings for purposes of quality, payment, and discharge planning, and makes other changes to Medicare current law relating to post-acute care.

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