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.
The Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office is facilitating a series of webinars for interested providers, health care professionals and others regarding the Disability-Competent Care (DCC) model. The DCC model is designed to enhance capacity to integrate care for adults with disabilities. Webinars will be tailored by audience and topic, for a total of eight webinars presented live on a weekly basis.
Initial topics will include the dignity of risk and strategies to stimulate and support participant engagement. The first webinar will take place Feb.4 from 11 a.m. – noon (PT). To register for the webinars, visit www.event.on24.com. Additional information and recordings of previous webinars are available at www.ResourcesForIntegratedCare.com.
The Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network has issued an article titled “Documentation Requirements for Home Health Prospective Payment System (HH PPS) Face-to-Face Encounter.” The article is designed to provide education on the required narrative for documenting the home health face-to-face encounter, and includes information and examples to help health care professionals avoid insufficient documentation errors and HH PPS improper payments. A copy of the article is attached.
The Division of Workers’ Compensation (DWC) has published the final regulations pertaining to the revised physician fee schedule (PFS), which became effective Jan. 1. The PFS also covers services of non-physician practitioners, such as physical therapists, occupational therapists, nurse practitioners, physician assistants, clinical social workers, clinical nurse specialists, nurse anesthetists and anesthesiologist assistants. The new PFS is based on the resource-based relative value scale system used by Medicare.
The new system implements the Medicare Multiple Procedure Payment Reduction (MPPR) on physical, occupational and speech therapy services. In addition, it applies various caps on the number of procedures that are reimbursable during a single therapy visit, requiring a written, pre-negotiated fee arrangement if the caps are exceeded. The final regulations are attached, as well as a list of procedures subject to the MPPR. For additional information, visit www.dir.ca.gov/dwc/OMFS9904.htm#6.
The California Department of Public Health (CDPH) has issued an All Facilities Letter (AFL) concerning the informed consent process for skilled-nursing facilities (SNFs). The AFL reaffirms that when SNFs admit a patient with “unchanged, preexisting orders for psychotherapeutic drugs, physical restraints, or the prolonged use of a device that may lead to the inability to regain use of a normal bodily function,” they must verify that the patient health records contain documentation that the patient gave informed consent for the order treatment. The AFL and updated FAQs are attached.
The Centers for Medicare & Medicaid Services (CMS) has approved State Plan Amendment (SPA) #13-034, exempting distinct-part skilled-nursing facilities (DP/SNFs) from the Medi-Cal payment reduction and rate freeze required by AB 97, passed in 2011. The restoration of the rates going forward is the result of provisions included in CHA-sponsored SB 239, passed by the state Legislature in 2013.
Approval of the SPA paves the way for implementation of full and unreduced 2013-14 rates, retroactive to Sept. 1, 2013, for DP/SNFs in designated rural or frontier areas, and retroactive to Oct. 1, 2013, for remaining DP/SNFs. CHA will provide additional information about the timelines for rate implementation as soon as it is available.
The CHA Center for Post-Acute Care advisory board has established leadership for 2014 and appointed several new members. David Brown, system director of rehabilitation services, Sharp HealthCare, was the 2013 advisory board chair and has been re-appointed as chair through 2014. Ed Palacios, vice president, Vibra Healthcare, will assume the position of chair-elect. Six new members have been appointed to the advisory board for three-year terms beginning in 2014.
To clarify coverage policies following a recent settlement agreement, the Centers for Medicare & Medicaid Services (CMS) has revised portions of its Medicare Benefit Policy Manual on services provided by skilled-nursing facilities, inpatient rehabilitation facilities, home health agencies and outpatient therapy. Based on the settlement agreement, Jimmo v. Sebelius, CMS Transmittal 176 specifies that standards requiring potential for improvement may not be applied as a rule of thumb to determine Medicare coverage for services that require skilled-nursing care or skilled therapy services. It also provides guidance on appropriate documentation. CMS notes that the transmittal, attached, does not represent an expansion of benefits or a change in Medicare’s longstanding policy on the need for skilled-nursing care and skilled-therapy services.
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) 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 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.
Reimbursement policy changes surrounding therapy cap expansion, manual medical review and now G-codes have the medical rehabilitation community reeling. Providers will need to closely evaluate and adapt policies and procedures including patient care policies to meet the new requirements and support claims submissions. This webinar will provide practical advice on how to implement the new regulations, including claims processing, and offer the MAC perspective on what CMS is looking for and tips to avoid common problems.
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule regarding the inpatient rehabilitation facility (IRF) quality reporting program (QRP). The proposed rule was included in the calendar year 2013 hospital outpatient prospective payment system (OPPS) proposed rule issued July 6. CHA’s “first-glance” summary of the OPPS and IRF QRP proposed rules is available at www.calhospital.org/cy2013-opps-proposed-first-glance. In the coming weeks, CHA will issue a more detailed summary of the proposed rule, and will work with members to develop comments for submission to CMS. Comments are due Sept. 4 at 2 p.m. (PT).
The CalVet Veteran’s Resource Book is a guide for all California veterans and their families to assist them in utilizing all their potential entitlements and assist their reintegration back into the community.