Central Valley Care Transitions Collaborative IMPACT ACT Lindsay Holland, HSAG May 17, 2016 Central Valley Care Transitions Collaborative

Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 Submission Requirement: Standardized Assessment Data Facility Type Software Long-Term Care Hospitals (LTCHs) LCDS Skilled Nursing Facilities (SNFs) MDS Home Health Agencies (HHAs) OASIS Inpatient Rehabilitation Facilities (IRFs) IRF-PAI Requires the submission of standardized assessment data by: Long-Term Care Hospitals (LTCHs): LCDS Skilled Nursing Facilities (SNFs): MDS Home Health Agencies (HHAs): OASIS Inpatient Rehabilitation Facilities (IRFs): IRF-PAI Requires that CMS make interoperable: Standardized patient assessments Quality measures data Data on resource use Other measures to allow for the exchange of data among PAC* and other providers to facilitate coordinated care and improved outcomes Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014

CMS Required to Make Interoperable: IMPACT Act of 2014 (cont.) CMS Required to Make Interoperable: Standardized patient assessments Quality measures data Data on resource use Other measures To allow for the exchange of data among PAC* and other providers to facilitate coordinated care and improved outcomes Requires the submission of standardized assessment data by: Long-Term Care Hospitals (LTCHs): LCDS Skilled Nursing Facilities (SNFs): MDS Home Health Agencies (HHAs): OASIS Inpatient Rehabilitation Facilities (IRFs): IRF-PAI Requires that CMS make interoperable: Standardized patient assessments Quality measures data Data on resource use Other measures to allow for the exchange of data among PAC* and other providers to facilitate coordinated care and improved outcomes *Post-Acute Care (PAC) Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014

Hospital to another setting IMPACT Act Quality Measure: Transfer of Health Information and Care Preferences Transition: Hospital to another setting Individual Family Caregivers Service Providers Individual’s health information and care preferences Transition: PAC to another setting The IMPACT Act requires a quality measure on the transfer of individual health information and care preferences of an individual to the individual, family care caregivers, and service providers when the individual transitions from: Hospital or critical access hospital (CAH) to another setting including PAC provider or home PAC provider to another setting, including a different PAC provider, a hospital or CAH, or home

IMPACT Act: Standardized Patient Assessment Data Functional status Cognitive function and mental status Special services, treatments, and interventions Medical conditions and comorbidities Impairments Other categories PAC providers report standardized assessment data IMPACT Act requires PAC providers report standardized assessment data in the following categories: Functional status Cognitive function and mental status Special services, treatments, and interventions Medical conditions and co-morbidities Impairments Other categories Standardized Assessment Data Reporting Dates LTCHs, IRFs, SNFs HHAs* 10/1/18 1/1/19 *HHA=Home Health Agency

IMPACT Act: Standardized PAC Patient Assessment Data for Quality Measures PAC providers required to report standardized assessment data for quality measure domains: Quality Measure Domains LTCH IRF SNF HHA Functional status/cognitive function 10/1/18 10/1/16 1/1/19 Skin integrity 1/1/17 Medication reconciliation Incidence of major falls Communicating the existence of and providing for the transfer of health information and care preference PAC providers required to report standardized assessment data for the following Quality Measure Domains by the following dates: The measure domains provided in the Act are not exhaustive.

Impact Act and Interoperability Why make PAC assessment data elements interoperable? “…to allow for the exchange of data among PAC providers and other providers and the use by such providers of such data that has been exchanged, including by using common standards and definitions, in order to provide access to longitudinal information for such providers to facilitate coordinated care and improved Medicare beneficiary outcomes.” The IMPACT Act requires that CMS make post-acute care assessment data elements interoperable to: “allow for the exchange of data among PAC providers and other providers and the use by such providers of such data that has been exchanged, including by using common standards and definitions, in order to provide access to longitudinal information for such providers to facilitate coordinated care and improved Medicare beneficiary outcomes.” Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014-and-Cross-Setting-Measures.html

Impact Act and Interoperability (cont.) Why make PAC assessment data elements interoperable? By sharing data and information that includes common standards and definitions, providers can better coordinate care and improve outcomes for Medicare beneficiaries. The IMPACT Act requires that CMS make post-acute care assessment data elements interoperable to: “allow for the exchange of data among PAC providers and other providers and the use by such providers of such data that has been exchanged, including by using common standards and definitions, in order to provide access to longitudinal information for such providers to facilitate coordinated care and improved Medicare beneficiary outcomes.” Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014-and-Cross-Setting-Measures.html

IMPACT Act Timeline FY 2017 FY 2018 FY 2019 FY 2022 10/1/16 10/1/17 10/1/18 10/1/21 FY 2017 Standardized resource use measure and some quality reporting begins. FY 2018 Confidential feedback provided on previous year’s reports. FY 2019 Standardized assessment data required. Public quality data available. Penalties take effect for those not reporting. FY 2022 CMS & MedPAC reports on PAC prospective payment. Study on hospital assessment data. Source: American Health Care Association (AHCA) and National Center for Assisted Living, 1201 L Street NW Washington, DC 20005, www.ahcancal.org

CMS Disclaimer This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for California, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. CA-11SOW-C.3-10222015-01