On June 26, 2014 the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) (H.R. 4994/S. 2553) was introduced by Representatives Dave Camp (R-MI) and Sandy Levin (D-MI) and Senators Ron Wyden (D-OR) and Orrin Hatch (R-UT).

The bipartisan, bicameral bill was developed jointly by the Senate Finance Committee and the House Ways and Means Committee. In March, the committees released a discussion draft of the IMPACT Act that was based on 2013 feedback from the post-acute care (PAC) community on how to integrate post-acute care provided under the Medicare program. The committees solicited providers’ input on the discussion draft, and the version of the bill that was introduced is responsive to providers’ concerns on several issues, such as the effective dates for quality measures, the transparency of the process, and the ability of stakeholders to provide input to CMS as the process moves forward.

PAC providers, which are defined in the bill to be skilled nursing facilities (SNFs), long term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), and home health agencies (HHAs), overwhelmingly highlighted the need for standardized PAC assessment data across Medicare PAC provider settings. As a result, the IMPACT Act requires SNFs, IRFs and LTCHs to report standardized patient assessment data by October 1, 2018 and HHAs to report such data by January 1, 2019. The standardized patient assessment data is required to include functional status, cognitive function and mental status, special services, medical condition, impairments, prior functioning levels, and other categories specified by the Secretary of the Department of Health and Human Services (HHS).

In addition, PAC providers will be required to report quality measures, which will address at least the following domains: functional status and changes in function; skin integrity and changes in skin integrity; medication reconciliation; incidence of major falls; and patient preference regarding treatment and discharge options. HHS is required to specify resource use and other measures to be included in the applicable reporting provisions. The resource use measures must address at least Medicare spending per beneficiary; discharge to community; and hospitalization rates of potentially preventable readmissions. SNFs, IRFs and LTCHs will be required to submit quality and resource use measures beginning on October 1, 2016, and HHAs will be required to submit these measures beginning on January 1, 2017. There will be payment consequences for PAC providers that fail to report standardized assessment data, quality measures, resource use and other measures.

The bill requires the Medicare Payment Advisory Commission (MedPAC) and HHS to submit reports to Congress that use the PAC assessment data to construct payment prototypes which Congress can consider for future PAC payment reforms, which could occur as soon as 2021. Additionally, the IMPACT Act requires HHS to promulgate regulations that incorporate the measures as well as patient preferences and the goals of care into the discharge planning process.