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.

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 Final Rule for FFY 2015 Medicare Hospice Wage Index and Payment Rates

On Aug. 1, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to update the Medicare hospice payment rates and wage index for federal fiscal year (FFY) 2015.

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. 

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

Final OMFS Regulations for Hospital Outpatient Departments Effective Sept. 1

Beginning Sept. 1, final regulations for hospital outpatient departments (HOPD) and the ambulatory surgical center fee schedule section of the 2014 official medical fee schedule (OMFS) will take effect. The regulations include the 2014 OMFS resource-based relative value system (RBRVS) physician fee schedule for therapy services, diagnostic tests and other non-emergent, non-surgical services. Emergent and surgical procedures performed in the hospital outpatient setting will continue to be paid according to the Medicare outpatient prospective payment system. However, the payment multiplier has been updated to 121.2 percent. In addition, a new “facility only” payment category will be covered under the HOPD OMFS and paid using a 101.01 percent multiplier. The final regulations and RBRVS fact sheet are attached and available on the Division of Workers’ Compensation website, along with FAQs about the RBRVS. Questions about the final regulations can be sent to DWCFeeSchedule@dir.ca.gov.

CHA News Article

CHA To Provide IRF Technical Expertise on National Panel

CHA will represent California inpatient rehabilitation facilities (IRFs) on a technical expert panel for the Office of Health Policy, the Office of the Assistant Secretary for Planning and Evaluation, and the Centers for Medicare & Medicaid Services. The panel will examine potential alternative approaches to using Continuity Assessment Record and Evaluation (CARE) items in the current IRF prospective payment system and is scheduled to meet Sept. 18 in Washington, D.C. CHA Vice President for Post-Acute Care Services Pat Blaisdell was nominated for the panel by the American Hospital Association.

CHA News Article

CMS Issues IRF PPS Final Rule

The Centers for Medicare & Medicaid Services (CMS) has issued the final rule for the inpatient rehabilitation facility (IRF) prospective payment system for federal fiscal year (FFY) 2015. Provisions of the final rule go into effect Oct. 1, 2014.

Under the provisions of the IRF final rule, CMS estimates that payments to IRFs will increase by 2.4 percent. CMS finalizes revisions to comorbidity, impairment group code and etiologic portions of the presumptive compliance methodology to be consistent with changes implemented in the FFY 2014 final rule, but delays the effective date for changes to the presumptive compliance methodology to a compliance period beginning on or after Oct. 1, 2015.

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 Finalizes 1.1 Percent Increase to LTCHs in FFY 2015

The Centers for Medicare & Medicaid Services (CMS) has finalized updates to the long-term care hospital (LTCH) prospective payment system for federal fiscal year (FFY) 2015. The final rule, issued late yesterday, increases payments to LTCHs by 1.1 percent, or approximately $62 million, in FFY 2015.

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.  

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 Requires New POLST Form After Oct. 1

The California Department of Public Health (CDPH) has issued an All Facility Letter (AFL) to skilled-nursing facilities updating the Physician Orders for Life Sustaining Treatment (POLST) form and providing guidance in coding the revised sections of Minimum Data Set 3.0 “Section S.” The new form will be effective Oct. 1. CDPH will honor previous versions after Oct. 1, but only for preexisting POLSTs. New submissions after Oct. 1 must use the new form. For more information, see the attached AFL.

CHA News Article

CDPH Warns Against Overuse of Antipsychotics in Nursing Facilities

The California Department of Public Health (CDPH) has issued an All Facility Letter (AFL) to skilled-nursing facilities and nursing facilities urging a vigilant effort to curb non-medically necessary prescriptions of antipsychotics and their misuse. CDPH highlights studies that show over-prescribing antipsychotics in nursing homes can place residents at increased risk of death. CDPH also urges facilities to review their practices, ensuring that each antipsychotic prescription is necessary and that all requirements related to their use are met. For more information, see the attached AFL.

CHA News Article

CMS Issues SNF PPS Final Rule

The Centers for Medicare & Medicaid Services (CMS) has issued the final rule for the skilled-nursing facility (SNF) prospective payment system for federal fiscal year (FFY) 2015. Provisions of the final rule take effect Oct. 1, 2014.

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 Requires New POLST Form After Oct. 1

The California Department of Public Health (CDPH) has issued an All Facility Letter (AFL) to skilled-nursing facilities updating the Physician Orders for Life Sustaining Treatment (POLST) form and providing guidance in coding the revised sections of Minimum Data Set 3.0 “Section S.” The new form will be effective Oct. 1. CDPH will honor previous versions after Oct. 1, but only for preexisting POLSTs. New submissions after Oct. 1 must use the new form. For more information, see the attached AFL.

CHA News Article

CDPH Warns Against Overuse of Antipsychotics in Nursing Facilities

The California Department of Public Health (CDPH) has issued an All Facility Letter (AFL) to skilled-nursing facilities and nursing facilities urging a vigilant effort to curb non-medically necessary prescriptions of antipsychotics and their misuse. CDPH highlights studies that show over-prescribing antipsychotics in nursing homes can place residents at increased risk of death. CDPH also urges facilities to review their practices, ensuring that each antipsychotic prescription is necessary and that all requirements related to their use are met. For more information, see the attached AFL.

Commands