Diane Justice National 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: FFSMovement to Managed Care Community Based ProvidersMovement to Self Direction 3

LTSS Relationship to Post-Acute Care Medicare SNF Benefit LTSS Institutional Providers Medicare Home Health Benefit LTSS Community Based Providers 4

Payment Bundling Length of Episode Discharge Criteria Service Scope Co-payment Policy 5

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? 6