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.

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

CDPH Issues AFL on Hospice Facilities

The California Department of Public Health (CDPH) has issued an All Facilities Letter regarding the option for licensed and certified hospice providers to operate a licensed hospice facility under new law effective Jan. 1, SB 135 (Statutes of 2012, Chapter 473). Under the law, hospice providers that intend to provide inpatient hospice care must apply for a hospice facility license to operate as either a freestanding facility or as a facility within the physical plant of another licensed facility. For more information, see the attached All Facilities Letter.

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

CMS Posts IRF Rate Setting Files

The Centers for Medicare & Medicaid Services (CMS) has posted to its website the rate setting files for the inpatient rehabilitation facility (IRF) prospective payment system proposed rule for federal fiscal year 2014. The files, which include average length of stay for case mix groups, are available at
www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/Data-Files.html.

CHA News Article

CMS Provides FAQs on Therapy Caps and ABNs

The Centers for Medicare & Medicaid Services (CMS) has created a list of FAQs concerning therapy caps and use of the advance beneficiary notice of non-coverage (ABN). The FAQs address the requirements under the American Taxpayer Relief Act of 2012 for therapists to issue ABNs for services that are not medically necessary. A copy of the FAQs is attached.

CHA News Article

CMS Issues IRF PPS Proposed Rule for FFY 2014

The Centers for Medicare & Medicaid Services (CMS) has issued the proposed rule for the inpatient rehabilitation facility (IRF) prospective payment system (PPS) for federal fiscal year (FFY) 2014. Overall, CMS estimates that payments to IRFs will increase 2 percent, or approximately $150 million. The new rates will apply to services furnished to Medicare beneficiaries during FFY 2014, beginning with discharges on or after Oct. 1, 2013. CMS also proposes to remove a number of diagnosis codes from the list used to determine a facility’s presumptive compliance with the “60 percent rule.” In addition, the proposed rule includes three new measures for the quality reporting program: 1) Percentage of patients who were assessed and appropriately given the seasonal influenza vaccine; 2) Influenza vaccination coverage among health care personnel; and 3) An all-cause unplanned readmission measure for 30 days post discharge. Revisions to the IRF patient assessment instrument (IRF-PAI) to reflect new quality measure reporting requirements are also proposed. CHA will issue a more detailed summary, including facility-specific DataSuite reports, of the proposed rule in the coming weeks. CHA will also work with members to develop comments, which are due by July 1. The proposed rule is attached and will appear in the May 8 Federal Register.
 

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

Proposed Rule Includes Changes to LTCH Payment and Policies

The proposed rule for the Medicare inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) PPS for federal fiscal year (FFY) 2014, issued April 26 by the Centers for Medicare & Medicaid Services (CMS), contains several provisions affecting payment and policy for LTCHs. For a CHA overview of policy proposals related to LTCH payment, the “25 percent rule,” quality reporting, and patient and facility criteria research, select “Read more” below. In the coming weeks, CHA will issue a more detailed summary, including facility-specific DataSuite reports, and will collaborate with members to develop comments in response to the proposed rule (a first-glance summary related to the IPPS proposals was released in yesterday’s CHA News). The complete proposed rule is available at www.calhospital.org/regulatory-advisory/cms-releases-proposed-rule-ffy-2014-ipps-and-ltch-pps and will be published in the May 10 Federal Register. Comments are due June 25 at 2 p.m. (PT).

CHA News Article

OIG Reports Many LTCHs Not Reporting Co-Located Status
Inaccurate information may lead to Medicare overpayments

The U.S. Department of Health and Human Services Office of Inspector General (OIG) notified the Centers for Medicare & Medicaid Services last week that many long-term care hospitals (LTCHs) have not, as required by federal regulations, notified their claims processing contractors that they are co-located with another hospital-level provider or skilled-nursing facility. According to the OIG’s early alert memorandum report, the lack of information on co-located status can prevent the application of two payment polices that lower Medicare payments, including the “25-percent rule” governing admission referral sources and payment policy for interrupted stays. The OIG’s preliminary analysis revealed that nearly half of the 211 LTCHs identified as having co-located status had not reported this information to their claims processing contractors. A copy of the OIG’s report is attached.

CHA News Article

IRF, LTCH Quality Program Recordings Available

Recordings of recent conference calls held by the Centers for Medicare & Medicaid Services on the quality reporting programs for inpatient rehabilitation facilities (IRFs) and long-term-care hospitals (LTCHs) will be available July 30 through Aug. 1. Facilities may access the calls by dialing (855) 859-2056, and using conference IDs 13189170 for IRFs and 13198135 for LTCHs. As mandated by the Affordable Care Act, IRF and LTCH quality reporting programs will begin Oct. 1. 

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

Effort to Rescind Medi-Cal Cuts Makes Headway in Legislature but Faces Court Setback

CHA-sponsored AB 900 (Alejo, D-Salinas), which would reverse pending cuts implemented by AB 97 in 2011, today passed out of the Assembly Appropriations Committee. The bill, which previously had been expanded to include many provider groups, was reportedly amended to focus on cuts to distinct-part skilled-nursing facilities. CHA will provide additional information as soon as it becomes available.

CHA also learned today that the Ninth Circuit Court of Appeals has denied CHA’s motion for an en banc review of the December 2012 decision that cleared the way for state implementation of the Medi-Cal cuts. In the attached CHA media statement on the court’s decision, CHA President/CEO C. Duane Dauner states that “We are evaluating next steps in terms of the judicial process. Today’s decision only reinforces CHA’s effort as part of a bipartisan statewide coalition to reverse the cuts as part of the state budget process.”

CHA News Article

CHA Member Testifies on Behalf of DP/SNFs at Assembly Committee Hearing

Today, CHA member Molly Forrest, president/CEO of Los Angeles Jewish Home, testified on behalf of CHA and all distinct-part skilled-nursing facilities at an Assembly committee hearing about the devastating Medi-Cal cuts imposed by AB 97. At the Assembly Budget Subcommittee No. 1 on Health and Human Services hearing, Forrest explained why the AB 97 cuts, not yet implemented, should be rescinded, as proposed in AB 900 (Alejo, D-Salinas) and SB 640 (Lara, D-Bell Gardens). She testified that there are two parts to the Medi-Cal cuts that will make them impossible for facilities such as hers to sustain — an immediate rate cut reduced from 2008 rates plus the retroactive reduction, amounting to millions of dollars for Los Angeles Jewish Home alone.

CHA continues its campaign to stop the AB 97 cuts, reminding members of the June 4 rally at the State Capitol. All members are encouraged to send employees to join We Care for California, a statewide coalition of health care leaders, at this important rally to support AB 900 and SB 640. Information about the rally is attached.

CHA News Article

Hospital Patients, Family Members Speak Out About Damaging Medi-Cal Budget Cuts
New video series captures impact on frail, elderly patients

As budget discussions begin to kick into high gear following the release of the May revision to the proposed 2013-14 state budget, those most directly affected by the pending Medi-Cal payment cuts are speaking out.

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 Develops LTC HAI Data Collection Tool

The California Department of Public Health (CDPH) Healthcare Associated Infections Program (HAI) has developed a self-assessment tool for long-term care facilities (LTCFs) to help them collect data and evaluate their infection control practices. The HAI program will also use the online tool to collect and summarize data — aggregated from all LTCFs that volunteer to participate. According to CDPH, the goals of using the tool are to better understand infection control needs and challenges in the long-term care setting and help CDPH plan educational programs and consultative services. The tool was developed in consultation with the Centers for Disease Control and Prevention. More information, including a link to the tool, is available in attached CDPH letter.

CHA News Article

CDPH Posts MDS Newsletter

The California Department of Public Health (CDPH) has issued an All Facility Letter (AFL) to remind skilled-nursing facilities that the December 2012 Minimum Data Set (MDS) newsletter, California MDS Nuggets, has been issued. CDPH encourages SNFs to submit clinical and technical inquiries regarding MDS 3.0 to mdsoasis@cdph.ca.gov. For more information, see attached AFL and newsletter.

Commands