Post-Acute Care

Overview

Home Health

Home health care is a formal, regulated program of care delivered by a variety of health care professionals in the patient’s home for the treatment of a medical condition, illness or disability. Home health is provided through certified home health agencies (HHAs).

As components of the post-acute continuum of care, HHAs provide essential health care services. This specialized support allows patients to remain at home when they would otherwise have to be admitted to a costly institutional setting, such as a skilled-nursing facility or hospital.

CHA provides state and federal representation and advocacy in the legislative and regulatory arenas to improve access to quality, cost-effective home health care services.

CHA News Article

Ordering and Referring Denial Edits Will Apply to Certifying HHA Physicians
Implementation to begin July 7

Beginning July 7, the Centers for Medicare & Medicaid Services will apply phase 2 ordering and referring denial edits to certifying physicians of Part A home health agencies (HHAs).

CHA News Article

CMS Posts CY 2014 PC Pricer for Home Health PPS

CMS has announced that the calendar year 2014 home health prospective payment system (HH PPS) PC Pricer is now available in the “Downloads” section of the CMS website. The HH PPS Pricer makes all reimbursement calculations applicable under HH PPS, including percentage payments on requests for anticipated payments, claim payments for full episodes of care and all payment adjustments, including low utilization payment adjustments, partial episode payment adjustments, significant change in condition adjustments and outlier payments.

CHA News Article

CMS Releases Information on Home Health MD NPI Requirement

A new article from the Centers for Medicare & Medicaid Services (CMS), titled “Certifying Physicians and the Phase 2 Ordering and Referring Denial Edits for Home Health Agencies,”  includes information providers need to know about the requirement – effective July 1 – to report the National Provider Identifier of the certifying physician along with the attending physician. The article, which appears in MLN Matters, is attached.   

Overview

Hospice

Hospice provides comprehensive and interdisciplinary health care to terminally ill patients, as well as bereavement and support services to the patients’ loved ones. Patients receiving hospice care forgo curative treatments. Hospice care is provided through certified hospice programs, and may be delivered in any patient care setting, but is most often provided in the patient’s home.

CHA provides state and federal representation and advocacy in the legislative and regulatory arenas to improve access to quality, cost-effective hospice health care services.
 

CHA News Article

Registration for Hospice Item Set User IDs Now Available

Online registration for the Hospice Item Set (HIS) Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing system is now available.

CHA News Article

HIS Technical Training Modules Available Online

The Quality Improvement and Evaluation System (QIES) Technical Support Office has posted recorded technical trainings for Medicare-certified hospices required to submit Hospice Item Set (HIS) records for the hospice quality reporting program. The trainings, which are short WebEx modules, focus on the registration of two separate user IDs, installation of the Juniper communication software, submission of HIS records to the QIES Assessment Submission and Processing system, and retrieval of hospice final validation reports from the Certification and Survey Provider Enhanced Reports (CASPER) reporting system. Also available on the website are the HIS Submission User’s Guide and the CASPER Reporting User’s Guide for Hospice Providers. See the attached announcement to access the training modules and user guides. 

CHA News Article

New PEPPER Release Available for Many Providers

A new release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) is now available for skilled-nursing facilities, hospices, critical access hospitals, long-term acute care hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities and partial hospitalization programs. PEPPER summarizes provider-specific data statistics for Medicare services that may be at higher risk for improper Medicare payments. For more information about PEPPER, resources, users’ guides and recorded training sessions, visit www.PEPPERresources.org.  

Overview

Inpatient Rehabilitation & Therapy Services

Medical rehabilitation focuses on improving or restoring functional independence for individuals with disabilities resulting from injury, illness or a medical condition.

Medical rehabilitation is provided at all levels of the health care continuum, including general acute-care hospitals, inpatient rehabilitation facilities (IRFs), skilled-nursing facilities, long-term-care hospitals, outpatient programs and home health agencies.

CHA News Article

DWC Issues Final OMFS Regulations for Hospital Outpatient Departments
Transitions payment for therapy services to new RBRVS payment system

The Division of Workers’ Compensation has adopted and filed an amendment to the hospital outpatient department (HOPD) and ambulatory surgical center fee schedule section of the official medical fee schedule (OMFS). The final regulations, effective Sept. 1, are very similar to the proposed regulations issued April 11.

CHA News Article

New Reports: Developing Outpatient Therapy Payment Alternatives

The Centers for Medicare & Medicaid Services recently released three new Developing Outpatient Therapy Payment Alternatives (DOTPA) reports — the DOTPA Measurement Report, DOTPA Payment Alternatives Report and DOTPA Final Report.

CHA News Article

New PEPPER Release Available for Many Providers

A new release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) is now available for skilled-nursing facilities, hospices, critical access hospitals, long-term acute care hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities and partial hospitalization programs. PEPPER summarizes provider-specific data statistics for Medicare services that may be at higher risk for improper Medicare payments. For more information about PEPPER, resources, users’ guides and recorded training sessions, visit www.PEPPERresources.org.  

Overview

Long-Term-Care Hospitals

Long-term-care hospitals (LTCHs) provide hospital-level care for medically complex, long-stay patients. LTCHs meet the same requirements as general acute-care hospitals, but have significantly longer average lengths of stay of 25 days or greater. LTCHs may be freestanding facilities or be co-located within hospitals, and treat a wide variety of conditions, including respiratory failure with ventilator dependency, infections, complex wounds and trauma.

CHA provides state and federal representation and advocacy in the legislative and regulatory arenas to improve access to quality, cost-effective long-term health care services.

CHA News Article

OIG Releases Report on Interrupted Stays in LTCHs

The Department of Health and Human Services Office of the Inspector General last week issued the attached report on the long-term acute care hospital (LTCH) interrupted-stay policy. The report, Vulnerabilities in Medicare’s Interrupted-Stay Policy for Long-Term Care Hospitals, identifies several vulnerabilities in the policy, including inappropriate payments, financial incentives to delay readmissions and potential overpayments to co-located LTCHs.

CHA News Article

New PEPPER Release Available for Many Providers

A new release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) is now available for skilled-nursing facilities, hospices, critical access hospitals, long-term acute care hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities and partial hospitalization programs. PEPPER summarizes provider-specific data statistics for Medicare services that may be at higher risk for improper Medicare payments. For more information about PEPPER, resources, users’ guides and recorded training sessions, visit www.PEPPERresources.org.  

CHA News Article

CMS Requests Early Input on LTCH Criteria Changes Slated for FFY 2016
Proposed rule issued yesterday

The Centers for Medicare & Medicaid Services (CMS) has released the federal fiscal year (FFY) 2015 long-term care hospital (LTCH) prospective payment system (PPS) proposed rule.

Overview

Skilled Nursing Facilities / Distinct-Part Nursing Facilities

Skilled-nursing facilities (SNFs) have the staff and equipment to provide skilled nursing, medical management and therapy services to individuals, on a 24-hour basis, who do not require high-intensity services provided in the hospital setting.

CHA News Article

CDPH Reminds SNFs to Review MDS Newsletters

The California Department of Public Health has issued the attached All Facilities Letter (AFL) to remind skilled-nursing facilities that its Minimum Data Set (MDS) newsletters, California MDS Nuggets, are posted on the CDPH website. The AFL also notes that the April issue includes information on MDS 3.0 record maintenance; provides links to new training videos for providers on Sections I, G, M and O; and offers details about upcoming revisions to the Physician Order for Life-Sustaining Treatment form and Section S.

CHA News Article

OIG Issues Report on California Nursing Home Survey

The Department of Health and Human Services Office of Inspector General (OIG) has issued the attached report on the oversight of quality of care in California nursing homes.

CHA News Article

New PEPPER Release Available for Many Providers

A new release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) is now available for skilled-nursing facilities, hospices, critical access hospitals, long-term acute care hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities and partial hospitalization programs. PEPPER summarizes provider-specific data statistics for Medicare services that may be at higher risk for improper Medicare payments. For more information about PEPPER, resources, users’ guides and recorded training sessions, visit www.PEPPERresources.org.  

Overview

Subacute Care

Subacute-care units provide a specialized level of care to medically fragile patients. Subacute patients are individuals who do not need acute care, but who are too ill to be cared for by most skilled-nursing facilities. Frequently, these individuals are ventilator-dependent or require frequent respiratory treatments. While subacute beds are licensed as skilled-nursing beds, they are reimbursed differently and are subject to additional staffing and patient criteria requirements.

CHA provides state and federal representation and advocacy in the legislative and regulatory arenas to improve access to quality, cost-effective subacute-care services.

CHA News Article

CMS Releases Final Rule on SNF Hospice Agreements

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.

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