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

First Round of Home Health Compare Quality of Patient Care Star Ratings Released

As required by the Affordable Care Act and to provide consumers with a summary of quality measures in an accessible format, the Centers for Medicare & Medicaid Services (CMS) has published a quality of patient care star rating for home health agencies (HHAs) on the Home Health Compare website. Star ratings are designed to help consumers more quickly identify differences in quality and make use of information when selecting a health care provider, as well as assist agencies in identifying areas for improvement. Each HHA will receive a single star rating encompassing that agency’s relative performance on nine of the 29 quality measures already posted on Home Health Compare. The measures are calculated using information from patient assessments performed by the HHA and from Medicare claims submitted by the HHA, and will be updated quarterly. In addition, CMS plans to introduce additional star ratings based on a patient experience of care survey in January 2016. For more information on home health star ratings, visit the CMS website

CHA News Article

Save the Date for CHA’s Post-Acute Care Conference

CHA’s next Post-Acute Care Conference will be held Feb. 10-12, 2016, in Redondo Beach. Save the date and plan to attend this annual event tailored to providers from across the care continuum, including medical rehabilitation, distinct-part skilled nursing and home health. Sessions will focus on innovations in care and ways to improve integration of patient services. Detailed agenda information will be available in August.

CHA News Article

Five-Star Ratings Announced for Home Health
CMS will host provider webinar

The Centers for Medicare & Medicaid Services (CMS) has finalized the methodology for a star ratings program to be added to the Home Health Compare (HHC) website. HHC star ratings will be published beginning in July, and preview reports will be available to providers in late March or early April. CMS will hold a webinar March 26 at 10 a.m. (PT) to review the report format as well as the process for requesting review of star ratings. To register for the webinar, visit www.livemeeting.com/lrs/8000055450/Registration.aspx?pageName=h1m25cfj95z4zdq0. Additional information on HHC star ratings is available on the HHC website. A document addressing frequently asked questions 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

CMS Issues FFY 2016 Hospice Final Rule

The Centers for Medicare & Medicaid Services (CMS) has issued the attached final rule updating the federal fiscal year (FFY) 2016 payment rates and wage index for hospices serving Medicare beneficiaries. The overall impact of the rule will be an estimated $160 million (1.1 percent) increase in payments to hospices. In addition, the rule adopts CMS’ proposal to differentiate payments for routine home care based on a beneficiary’s length of stay and implements a service intensity add-on payment that would help to promote and compensate for the provisions of skilled visits at end of life. Both policies will become effective Jan. 1, 2016.

The final rule also changes the aggregate cap calculation as mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act); aligns the cap accounting year for both the inpatient cap and the hospice aggregate cap beginning with FFY 2017; changes the hospice quality reporting program; and clarifies that hospices must report on the hospice claim all diagnoses identified in the initial and comprehensive assessments, whether related or unrelated to the terminal prognosis of the individual. CHA is currently analyzing the final rule and will release a detailed summary in the coming weeks. Payment and policy changes will be effective Oct. 1 unless otherwise noted.

CHA News Article

CMS Announces Awardees for Medicare Care Choices Model

The Centers for Medicare & Medicaid Services (CMS) has invited more than 140 Medicare-certified hospices to participate in the Medicare Care Choices Model, which is designed to evaluate whether eligible Medicare beneficiaries would elect to receive supportive care services typically provided by hospices if they also continue to receive curative services. Under the model, participating hospices will receive a monthly per-beneficiary fee to provide services that are currently available through the hospice benefit, including nursing, social work, bereavement, nutritional support and others.

To read a fact sheet about the model, including a list of participants, visit www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-20.html.

CHA News Article

Save the Date for CHA’s Post-Acute Care Conference

CHA’s next Post-Acute Care Conference will be held Feb. 10-12, 2016, in Redondo Beach. Save the date and plan to attend this annual event tailored to providers from across the care continuum, including medical rehabilitation, distinct-part skilled nursing and home health. Sessions will focus on innovations in care and ways to improve integration of patient services. Detailed agenda information will be available in August.

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

Joint Commission Debuts New Strategies to Reduce Patient Falls

The Joint Commission Center for Transforming Healthcare last week debuted the Preventing Falls Targeted Solutions Tool (Preventing Falls TST) to help hospitals reduce the number of patient falls. Over the past four years the commission has worked with several hospitals, including one in California, to develop a system for assessing whether a patient is at risk for falling and created 21 different solutions to address the common risk factors associated with falls. Using the Preventing Falls TST, pilot hospitals were able to reduce all falls by about 35 percent and those resulting in injury by 62 percent. More information is available on the Joint Commission website.

CHA News Article

CHA Members Meet with Government Accountability Office
Discussion focuses on DME issues

Representatives of CHA’s Center for Post Acute Care advisory board participated in a call Aug. 7 with staff from the U.S. Government Accountability Office to discuss the Centers for Medicare & Medicaid Services (CMS) competitive bidding program for durable medical equipment (DME) prosthetics, orthotics and supplies.

CHA News Article

CMS Issues Final FFY 2016 IRF PPS Rule

The Centers for Medicare & Medicaid Services (CMS) has issued the attached inpatient rehabilitation facility prospective payment system (IRF PPS) final rule for federal fiscal year (FFY) 2016. The overall impact of the rule will be a $135 million (estimated 1.8 percent) increase in payments to IRFs over FFY 2015 levels. In addition, a substantial portion of the rule addresses revisions and updates being made to the Inpatient Rehabilitation Facilities Quality Reporting program (IRF QRP). Of paramount interest are changes in the collection of quality data under the IRF QRP and data collection requirements arising from the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014.

Other policy changes finalized in the rule include the adoption of an IRF-specific market basket that reflects the cost structures of only IRF providers, a one-year phase-in of the revised wage index changes and a three-year phase-out of the rural adjustment for certain IRFs. CHA is currently analyzing the final rule and will release a detailed summary in the coming weeks. Payment and policy changes will be effective Oct. 1 unless otherwise noted.

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

CMS Issues Final FFY 2016 LTCH Rule

The Centers for Medicare & Medicaid Services (CMS) has issued its long-term care hospital prospective payment system (LTCH PPS) final rule for federal fiscal year (FFY) 2016. The final rule implements the Bipartisan Budget Act of 2013 mandate to add a site-neutral payment component to the LTCH PPS, which will be phased in through a two-year transition that begins Oct. 1. CMS estimates that the combined fiscal impact of the FFY 2016 payment changes to both the “site neutral “ cases and those paid under the LTCH PPS will be negative 4.6 percent, or a decrease in LTCH payments of $250 million as compared to FFY 2015.

CHA News Article For Members

CMS Issues Final FFY 2016 Inpatient PPS Rule

The Centers for Medicare & Medicaid Services (CMS) late Friday issued its hospital inpatient prospective payment system (IPPS) final rule for federal fiscal year (FFY) 2016. The final rule will increase hospital inpatient fee-for-service rates by 0.9 percent. Also in the rule, CMS adopts a market-basket update of 2.4 percent for hospitals that were meaningful users of electronic health records in FFY 2014 and that submit data on quality measures, and then reduces that amount by 0.5 percent for multi-factor productivity and an additional market-basket cut of 0.2 percent, as mandated by the Affordable Care Act (ACA). In addition, CMS finalizes a legislatively mandated 0.8 percent cut that would recoup, in part, what CMS claims is the effect of documentation and coding changes. The rule also includes ACA-mandated Medicare disproportionate share hospital (DSH) reductions, which will reduce overall Medicare DSH payments by $1.2 billion in FFY 2016 as compared to FFY 2015. CHA estimates California hospitals will experience a nearly $146 million (1.3 percent) reduction in Medicare DSH payments.

Education event

Decision Making for Unrepresented Patients Webinar
Court decision expands patient protections, prompts change in policies and procedures

October 13, 2015
10:00 a.m.  — 12:00 p.m., PT

Recently, the Alameda County Superior Court found unconstitutional a California law that permits skilled-nursing facilities (SNFs) to use interdisciplinary teams to make medical decisions for patients who lack capacity and have no one to make decisions for them. While the law applies to SNFs, many hospital interdisciplinary teams have also been operating under a CHA/CMA/ACH model policy, which is based the SNF law. Participate in this webinar to learn about this important case decision and how SNFs and hospitals should revise policies and procedures to comply.

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

CMS Provides Details on SNF Staffing Data Submission
Training modules and updated draft manual available

The Centers for Medicare & Medicaid Services (CMS) will provide training to help skilled-nursing facilites (SNFs) meet new electronic staffing reporting requirments. Effective July 1, 2016 long-term care facilities, including SNFs, will be required to electronically submit to CMS complete direct care staffing information, including information for agency and contract staff. CMS has developed a system — Payroll-Based Journal (PBJ) — for facilities to submit staffing and census information. To help facilities prepare, CMS is providing training modules, available online. CMS will also collect staffing and census data during a voluntary submission period beginning Oct. 1, 2015.

CMS has posted an updated PBJ Policy Manual Draft and a list of frequently asked questions on its website

CHA News Article

CDPH Issues Guidance for Arbitration Agreements
Affects SNFs and ICFs

The California Department of Public Health (CDPH) has issued the attached All Facilities Letter on revisions to sections 72516(d) and 73518(d) of Title 22 of the California Code of Regulations (CCR). Effective May 27, the revisions change the required text that must be inserted in proposed arbitration agreements presented to prospective skilled-nursing facility and intermediate care facility residents. CDPH advises facilities to refer to the full text of all applicable sections of the Health and Safety Code, Title 22 of the CCR and applicable federal law to ensure compliance. 

CHA News Article

Joint Commission Debuts New Strategies to Reduce Patient Falls

The Joint Commission Center for Transforming Healthcare last week debuted the Preventing Falls Targeted Solutions Tool (Preventing Falls TST) to help hospitals reduce the number of patient falls. Over the past four years the commission has worked with several hospitals, including one in California, to develop a system for assessing whether a patient is at risk for falling and created 21 different solutions to address the common risk factors associated with falls. Using the Preventing Falls TST, pilot hospitals were able to reduce all falls by about 35 percent and those resulting in injury by 62 percent. More information is available on the Joint Commission website.

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

CDPH Issues Guidance on Health Care Facility License Renewal Fees

The California Department of Public Health has issued the attached All Facilities Letter (AFL) informing health care facilities of the 2015-16 license renewal fees approved by the Governor and effective July 1. The AFL contains instructions for completing a license renewal and a link to the current fee schedule.

The Center for Health Care Quality will send renewal notices/applications to each facility’s licensee 45-120 days prior to its license expiration date. Late payment penalties will be applied to delinquent renewal fees. 

CHA News Article

Save the Date for CHA’s Post-Acute Care Conference

CHA’s next Post-Acute Care Conference will be held Feb. 10-12, 2016, in Redondo Beach. Save the date and plan to attend this annual event tailored to providers from across the care continuum, including medical rehabilitation, distinct-part skilled nursing and home health. Sessions will focus on innovations in care and ways to improve integration of patient services. Detailed agenda information will be available in August.

CHA News Article

CHA Center for Post-Acute Care Announces 2015 Officers

The CHA Center for Post-Acute Care has announced its leadership team for 2015. Mivic Hirose, administrative director, Laguna Honda Hospital and Rehabilitation Center, will assume the position of chair. Pamela Chevreaux, vice president for ambulatory services, Long Beach Memorial Hospital, has been appointed to serve as chair-elect. Hirose and Chevreaux will represent the Center on the CHA Board of Trustees.

The CHA Center for Post-Acute Care was established in 2011 to serve the needs of CHA members at all levels of the post-acute care continuum, including inpatient rehabilitation facilities, long-term acute care hospitals, skilled-nursing facilities and home health agencies.

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