PAC Reform



AAPM&R works to ensure that Physiatry’s voice is heard in every aspect of Post-Acute Care (PAC) reform given that physiatrists work in each PAC setting. 

AAPM&R's Principles for a Medicare Unified Post-Acute Care Payment System are 11 principles that ensure physiatry’s needs are met in any PAC reform. These principles are used to guide AAPM&R advocacy on this important issue.

Congress passed the Improving Medicare Post-Acute Care Transformation (IMPACT) Act at the end of 2014. The IMPACT Act intended for standardized PAC data to improve Medicare beneficiary outcomes through shared-decision making, care coordination, and enhanced discharge planning. Since this legislation was signed into law, AAPM&R has focused its advocacy efforts on ensuring that any implementation of a Unified Post-Acute Care (PAC) Prospective Payment System (PPS) would take into account the concerns of the specialty and protect access to care for the patients that physiatrists treat.

AAPM&R’s advocacy on PAC reform has two main prongs: 

1. Participating on the RTI International Technical Expert Panel (TEP). This TEP works with the Centers for Medicare and Medicaid Services (CMS), which is responsible for drafting a report and creating a prototype on a Unified PAC Prospective Payment System (PPS) to present to Congress, as mandated by the IMPACT Act of 2014.

AAPM&R's Participation on the RTI TEP began in 2018, when the TEP was convened, and has involved working with a wide range of additional stakeholders who have common interests in this issue:

While this initiative has not led to implementation of a Unified PAC PPS, AAPM&R continues to monitor these efforts and engage when necessary to ensure that the concerns of physiatry are heard by federal policymakers.

2. Advocating to Congress to delay the implementation of the IMPACT Act. The Resetting the IMPACT Act (TRIA) was initially introduced in 2020, prompted by the COVID-19 Public Health Emergency (PHE). This legislation reset the implementation timeline for the IMPACT Act to ensure CMS can incorporate patient and quality data that reflect the impact of COVID-19 and other recent changes to Medicare PAC payment. While this legislation was not signed into law, AAPM&R’s advocacy helped to educate Congress on this important issue. 

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