- Chiropractic visits (12/year) Limit - Added medical Benefit changes eligibility criteria for Case (cont.) Management for homeless Limit - Physical therapy (2 hr./day) - Occupational therapy (2 hr./day & 1 visit/year for palliative or maintenance care) Hospital-Acquired MaineCare implementing Expand list to $1.75M $0.7M Pros: N/A Savings realization 6-12 – Conditions (HACs) federal minimum include all of those Promotes quality mo. requirement listed for the State Reduces reimbursement to hospitals of MD and for poor health outcomes Payment adjustments made annually based on HACs Readmissions MaineCare does not Increase time span $15M $5.6M Pros: Managed care and Implementation Timeline: reimburse for readmits for Promotes quality PCCM will likely 3-6 mo. within 72 readmissions are Cons: on this area, so may Savings Realization Timeline: not reimbursed Results in reduction in hospital reduce savings 6-12 mo. reimbursement attributed to the long Changes: Systems term strategies Communication: Providers Document: SPA Leave Days Current limits: Eliminate $1.7M $0.6M Pros: N/A Implementation Timeline: Nursing Facility Nursing Facility: 10 reimbursement for Focus on eliminating waste 3-6 mo. IMD hospital leave days & hospital leave & Cons: Savings Realization Timeline: ICFMR 36 therapeutic leave therapeutic leave 6-12 mo. days days Changes: Systems
Benefit changes (cont.) - Chiropractic visits (12/year) Limit - Added medical eligibility criteria for Case Management for homeless Limit - Physical therapy (2 hr./day) - Occupational therapy (2 hr./day & 1 visit/year for palliative or maintenance care) Hospital-Acquired Conditions (HACs) MaineCare implementing federal minimum requirement Expand list to include all of those listed for the State of MD and Payment adjustments made annually based on HACs $1.75M $0.7M Pros: Promotes quality Reduces reimbursement to hospitals for poor health outcomes N/A Savings realization – 6-12 mo. Readmissions MaineCare does not reimburse for readmits within 72 Increase time span for readmissions are not reimbursed $15M $5.6M Pros: Promotes quality Cons: Results in reduction in hospital reimbursement Managed care and PCCM will likely on this area, so may reduce savings attributed to the long term strategies Implementation Timeline: 3-6 mo. Savings Realization Timeline: 6-12 mo. Changes: Systems Communication: Providers Document: SPA Leave Days Nursing Facility IMD ICFMR Current limits: Nursing Facility: 10 hospital leave days & 36 therapeutic leave days Eliminate reimbursement for hospital leave & therapeutic leave days $1.7M $0.6M Pros: Focus on eliminating waste Cons: N/A Implementation Timeline: 3-6 mo. Savings Realization Timeline: 6-12 mo. Changes: Systems