The Center for Post-Acute Care represents the interests of CHA member post-acute care providers, including inpatient rehabilitation hospitals and units, long-term acute care hospitals, distinct-part skilled-nursing facilities and home health agencies. As a part of CHA, the Center for Post-Acute Care serves as the primary public policy arm of the hospital association for post-acute care issues. The center also advocates for hospital-based post-acute care services in the federal and state legislative and regulatory arenas.
Every patient has a unique pathway. From hospital to rehabilitation, SNF, or home, our job is to help patients to the best outcome possible. Post-acute care providers need to find new pathways, too. Our health care system is evolving fast as we begin active implementation of the ACA. This year’s program is full of pertinent and timely topics to help you address and plan for coming change.
The Department of Health and Human Services’ Office of Inspector General (OIG) has issued a report reviewing hospital admission rates for Medicare beneficiaries who live in nursing homes. According to the OIG, nursing homes transferred one-quarter of their Medicare residents to hospitals for inpatient admissions in fiscal year 2011, costing $14.3 billion.
Based on the results, the OIG recommended that the Centers for Medicare & Medicaid Services (CMS) develop a quality measure to capture the rate of nursing home residents who are hospitalized, and instruct state survey agencies to review the proposed quality measure as part of the survey and certification process. CMS agreed with the recommendation.
Home health (HH) agencies paid under Medicare’s prospective payment system (PPS) will see a 1.05 percent decrease in payments in calendar year (CY) 2014 as compared to CY 2013 under a final rule released by the Centers for Medicare & Medicaid Service (CMS). The decrease reflects the combined effects of an increase in the home health market basket update percentage of 2.3 percent, offset by a rebasing adjustment of negative 2.7 percent as required by the Affordable Care Act (ACA), and a .62 percent decrease due to a refinement of the HH PPS Grouper. The ACA requires CMS to begin phasing in rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates and the non-routine supply conversion factor to reflect changes since the inception of the HH PPS. For hospital-based facilities, CMS estimates the reduction will be smaller, negative .58 percent, for CY 2014.
The Centers for Medicare & Medicaid Services (CMS) will conduct a special open door forum on Thursday, Nov. 21 from 10-11:30 a.m. (PT), addressing the quality reporting program (QRP) for long-term care hospitals (LTCHs). The forum’s purpose is to provide updated data collection and submission information to LTCH providers for fiscal year 2016 and the 2017 payment update determination. The forum will also feature a number of frequently asked questions and answers related to the QRP, and CMS invites questions and comments from stakeholders.
To participate, call (866) 402-6263 and enter conference ID 94517614.
The Centers for Medicare & Medicaid Services (CMS) has issued to state survey agency directors information regarding CPR in nursing homes. CMS Survey & Certification memo 14-01-NH disallows nursing home policies that prohibit employees from administering CPR to residents. Effective Oct. 18, nursing facilities must provide basic life support to a resident who experiences cardiac arrest, in accordance with that resident’s advance directives or a do-not-resuscitate order. CPR-certified staff must be available at all times and must administer CPR prior to the arrival of emergency medical personnel. A copy of the memo is attached.
The Department of Health Care Services (DHCS) continues to host its monthly stakeholder webinars on the Coordinated Care Initiative (CCI), which is currently scheduled to begin no sooner than April 2014. The webinars are open to all interested parties. The next monthly webinar will be held Tuesday, Nov. 18 from 1 p.m. to 2 p.m. (PT). For more information and to register, visit http://www.calduals.org/2013/09/05/upcoming-webinars-covering-the-coordinated-care-initiative/.
The Centers for Medicare & Medicaid Services (CMS) has updated its frequently asked questions (FAQs) document regarding therapy services functional reporting. The document, attached, provides information about CMS coverage for physical therapy, occupational therapy, and speech/language pathology services.
The California Department of Public Health has issued an All Facilities Letter (AFL) concerning Minimum Data Set 3.0 discharge assessments that have not been completed and/or submitted. The AFL provides information about recent communication from the Centers for Medicare & Medicaid Services, which is providing an opportunity for facilities to rectify any missing and/or incomplete discharge assessments. Beginning Oct. 1, 2013, MDS assessments older than three years will not be accepted. For more information, see the attached AFL.
The Centers for Medicare & Medicaid Services (CMS) is seeking input from providers related to the implementation of the Hospice Quality Reporting Program (HQRP). On behalf of CMS, Health Care Innovation Services is requesting that interested providers participate in brief interviews to help CMS better understand the burdens of the HQRP, how providers ensure accuracy of data, how the HQRP has impacted patient services and outcomes, and what CMS can do in the future to improve the program and processes.
Interviews will be conducted by telephone, and reports or supplemental documents submitted to CMS will not link answers to any specific providers. Anyone interested in participating should contact Pat Hanson at firstname.lastname@example.org.
Every patient has a unique pathway. From hospital to rehabilitation, LTAC, SNF or home, our job is to help patients to the best outcome possible. Post-acute care providers need to find new pathways, too. Our health care system is evolving fast as we begin active implementation of the ACA. This year’s program is full of pertinent and timely topics to help you address and plan for coming change.
The Centers for Medicare & Medicaid Services (CMS) is seeking input from inpatient rehabilitation facilities (IRFs) and long-term care hospitals (LTCHs) regarding implementation of new quality reporting programs (QRPs) for those settings. On behalf of CMS, Health Care Innovation Services is requesting that IRF and LTCH providers participate in brief interviews to help better understand the burdens imposed on providers, how providers ensure accuracy of data, how the QRP has impacted patient services and outcomes, and what CMS can do in the future to improve the program and processes.
Interviews will be conducted by telephone, and reports or supplemental documents submitted to CMS will not link specific answers to any specific providers. Anyone interested in participating for either the IRF or the LTCH QRP should contact Pat Hanson at email@example.com.
The Department of Health Care Services (DHCS) announced yesterday that, under its planned implementation of the AB 97 rate reductions, rural distinct-part skilled-nursing facilities (DP/SNFs) will be partially exempted from pending Medi-Cal cuts. The facilities will not face the rate freeze at 2008-09 levels or a looming 10 percent reduction.
CHA President/CEO C. Duane Dauner commended the decision, saying, “The announcement will protect the state’s most vulnerable patients who live in rural areas by sparing these hospitals from previously announced 25 percent or greater cuts, and halting a rate freeze based on 2008-09 payment levels.”
CHA continues to work with DHCS to address the rate cut for non-rural DP/SNFs as well as the impact of the clawback, or retroactive recoupment, for all DP/SNF providers. The DHCS announcement is attached.
The California Department of Public Health (CDPH) has issued a reminder to skilled-nursing facilities (SNF) that optional services provided must be approved by the Licensing and Certification (L&C) program. SNFs must post a copy of the facility’s license, including a list of its optional services, in a location accessible for public view. Optional services are units within the SNF that provide specific types of care such as physical therapy, occupational therapy, speech pathology, audiology, social work services and special treatment program services. See the attached All Facilities Letter for more information on special approvals and requirements that must be met whenever a SNF adds, deletes or modifies an optional service.
The U.S. House of Representatives Ways and Means Committee has released draft legislation that includes several provisions affecting payment policy for post-acute care (PAC) services. The committee held a hearing on the topic on June 14.
The latest legislative proposals mirror PAC proposals put forth by President Obama in his FFY 2014 budget, as well as discussions by Simpson-Bowles and the Bipartisan Policy Commission. The committee’s draft legislation specifically addresses the following changes:
Reducing market basket updates for home health agencies, skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs) and long-term care hospitals;
Creating site-neutral payments between IRFs and SNFs for certain procedures;
Modifying the criteria required for IRF status (the so-called “75 percent rule”);
The Centers for Medicare & Medicaid Services (CMS) has issued the final rule updating federal fiscal year (FFY) 2014 Medicare payment rates and the wage index for hospices. In the rule, CMS estimates that Medicare reimbursement will increase by 1 percent, or $160 million, for FFY 2014, which begins Oct. 1. The rule also makes changes to the hospice quality reporting program for 2014 and the future, including adding a Hospice Experience of Care survey in 2015.
The Centers for Medicare & Medicaid Services (CMS) has issued the final rule for the long-term care hospital (LTCH) prospective payment systems (PPS) for federal fiscal year (FFY) 2014. Under the provisions of the LTCH final rule, CMS estimates that payments to LTCHs will increase by 1.3 percent, as compared to FFY 2013. CMS also finalizes a proposal to phase in the full “25 percent rule,” starting with cost reporting periods beginning on or after Oct. 1, 2013. In addition, CMS confirms its plans to continue with research on a FFY 2015 proposal that would dramatically reduce LTCH payments by excluding patients who do not meet certain clinical criteria. CMS also finalizes proposals for changes and additions to the LTCH Quality Reporting Program (QRP), including adding three new measures for the 2017 LTCH QRP and one new measure for 2018.
The Centers for Medicare & Medicaid Services (CMS) has issued the final rules for the inpatient rehabilitation facility (IRF) and skilled-nursing facility (SNF) prospective payment systems (PPS) for federal fiscal year (FFY) 2014. Provisions of the final rules go into effect Oct. 1.
Under the IRF final rule, CMS estimates that payments to IRFs will increase by 2.3 percent. In an improvement over the proposed rule, CMS makes some changes to its proposal to update the list of codes that may count toward an IRF’s “60 percent rule” compliance assessment using the presumptive test. CMS will remove fewer codes than originally proposed, and the shortened list of eligible codes will not take effect for one year. CMS also finalizes proposals and adds several new measures to the IRF Quality Reporting Program, and makes changes to the IRF patient assessment instrument.
The California Department of Public Health (CDPH) has issued a reminder that the California Minimum Data Set newsletters (California MDS Nuggets) are posted on the CDPH website. The MDS is a powerful tool offered by the Centers for Medicare & Medicaid Services (CMS) for implementing standardized assessment and for facilitating care management in nursing homes and non-critical access hospital swing-beds. The MDS 3.0 has been designed to improve the tool’s reliability, accuracy and usefulness, and to expand resident input during the assessment process. Visit the CDPH website to access other California MDS 3.0 information at www.cdph.ca.gov/programs/LnC/Pages/MDS.aspx. For more information on the MDS newsletters, see the attached All Facilities Letter.
Under a final rule recently issued by the Centers for Medicare & Medicaid Services (CMS), skilled-nursing and other long-term care facilities that provide hospice care through a Medicare-certified hospice provider must have a written agreement with the hospice specifying the roles and responsibilities of each entity. The goal of the rule is to improve the quality and consistency of hospice care for long-term care residents, and to reduce duplication by increasing care coordination and communication between the two types of providers. A copy of the rule is attached.
The Centers for Medicare & Medicaid Services (CMS) has issued a reminder to state survey agencies about access and visitation rights for residents for long-term care facilities (LTCs), including skilled-nursing facilities. The CMS memorandum reviews current interpretive guidelines that require that all individuals seeking to visit a resident be given full and equal visitation privileges, based on resident preference and within reasonable restrictions for resident safety. Residents must be notified of their rights to have visitors on a 24-hour basis, including but not limited to spouses (including same-sex spouses), domestic partners (including same-sex domestic partners), other family members and friends.