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

CMS to Host Call on Home Health Certification

The Centers for Medicare & Medicaid Services (CMS) will conduct a national provider call on new patient certification requirements for home health agencies. The call will take place Dec. 16 from 10:30 a.m. – noon (PT). In the recently released calendar year home health prospective payment system final rule, CMS finalized a new patient certification requirement for home health agencies beginning Jan. 1, 2015. During the MLN Connects National Provider Call, CMS subject matter experts will discuss the changes to the Medicare home health benefit, followed by a question-and-answer session. Registration is available at MLN Connects Event Registration.

CHA News Article

CMS Issues Home Health PPS Final Rule

The Centers for Medicare & Medicaid Services (CMS) has issued the final rule for the home health prospective payment system for calendar year 2015, with provisions to take effect Jan. 1, 2015. Under the final rule, including implementation of payment updates and the second year of a four-year rebasing, CMS estimates that payments to home health agencies will decrease 0.3 percent compared to 2014.

CHA News Article

CMS Announces 2 Quality Improvement Initiatives

The Centers for Medicare & Medicaid Services (CMS) has announced two initiatives addressing quality improvement in post-acute care settings. Beginning in 2015, CMS will implement improvements to the nursing home five-star rating system, including the development of a process to collect and audit payroll data to monitor staffing, changes in scoring methodology and the addition of new quality measures addressing the use of anti-psychotic medications and re-hospitalization rates. CMS also announced it is proposing new conditions of participation (COPs) for home health agencies in an effort to update and modernize the COPs, with a focus on patient-centered, coordinated care. The proposed regulation was published in the Oct. 9 Federal Register

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 Posts Q&As on Hospice Item Set

The Centers for Medicare & Medicaid Services (CMS) has posted a new question-and-answer document about the hospice item set (HIS). The Q&As reflect frequently asked HIS-related questions received by the CMS quality help desk during the third quarter (July through September) of 2014. A copy of the document is attached. 

CHA News Article

Post-Acute Care Bill Signed Into Law

On Oct. 6, President Obama signed into law the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The bipartisan bill was designed to increase quality, transparency and accountability in post-acute care for Medicare beneficiaries. The Act would require post-acute care providers — including long-term acute care hospitals, inpatient rehabilitation facilities, skilled-nursing facilities and home health agencies — to collect and report standardized assessment data as a first step in developing recommendations for alternative post-acute care payment models. Additionally, the legislation includes new survey and medical review requirements for hospices. These provisions will be implemented between 2016 and 2022. A copy of the bill is available at www.congress.gov/113/bills/s2553/BILLS-113s2553is.pdf. CHA has also created the attached summary of the bill.  

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.

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 Notice of Public Hearing to Revise Official Medical Fee Schedule

The Division of Workers’ Compensation (DWC) has issued a notice of public hearing to revise various provisions of the Official Medical Fee Schedule (OMFS). The hearing will be held Nov. 14 at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, in Oakland. Written comments on the regulations may be submitted until 5 p.m. Nov. 14. The notice, initial statement of reasons and text of the regulations are available on the DWC’s OMFS web page.

CHA News Article

CMS Extends Deadline for IRF, LTCH NHSN Data Submission

The Centers for Medicare & Medicaid Services (CMS) has extended the deadline for 2014 quality measure data submitted via the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) for the inpatient rehabilitation facility (IRF) and the long-term acute care (LTCH) quality reporting programs (QRP). For IRFs, the new deadline for submission of quarter one 2014 NHSN data is Nov. 15, which aligns with the previously established quarter two 2014 deadline, effectively requiring the submission of all NHSN data for quarters one and two on Nov. 15. For LTCHs, the new deadline for submission of quarters one and two 2014 NHSN data is Nov. 15, which aligns with the previously established quarter three 2014 deadline, effectively requiring the submission of NHSN data for the first three quarters of 2014 on Nov. 15.

CHA News Article

Open Door Forum Scheduled for IRF Quality Reporting Program

The Centers for Medicare & Medicaid Services (CMS) will host a conference call on the inpatient rehabilitation facility (IRF) quality reporting program (QRP) on Oct. 29 from 10 a.m. – 11:30 a.m. (PT). Information on data collection and reporting requirements for the NHSN Facility-wide Inpatient Hospital-onset Methicillin-resistant Staphylococcus aureus Bacteremia Outcome measure (NQF #1716) and Facility-wide Inpatient Hospital-onset Clostridium difficile Infection Outcome measure (NQF #1717) will be provided, which IRFs are required to report to CMS beginning Jan. 1, 2015. A question-and-answer session will follow the presentation.

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 Extends Deadline for IRF, LTCH NHSN Data Submission

The Centers for Medicare & Medicaid Services (CMS) has extended the deadline for 2014 quality measure data submitted via the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) for the inpatient rehabilitation facility (IRF) and the long-term acute care (LTCH) quality reporting programs (QRP). For IRFs, the new deadline for submission of quarter one 2014 NHSN data is Nov. 15, which aligns with the previously established quarter two 2014 deadline, effectively requiring the submission of all NHSN data for quarters one and two on Nov. 15. For LTCHs, the new deadline for submission of quarters one and two 2014 NHSN data is Nov. 15, which aligns with the previously established quarter three 2014 deadline, effectively requiring the submission of NHSN data for the first three quarters of 2014 on Nov. 15.

CHA News Article

CMS Guidance Focuses on New LTCH Moratorium

The Centers for Medicare & Medicaid Services (CMS) has issued guidance on its moratorium on new and satellite long-term care hospitals (LTCH). The moratorium prohibits an increase in the number of an LTCH’s certified beds, effective April 1, 2014, through Sept. 30, 2017. According to the attached memo, CMS regional offices will be charged with determining if a hospital seeking to convert to LTCH status or to open an LTCH satellite will qualify for an exemption.

CHA News Article

NHSN Issues Guidance on Reporting Requirements for IRFs and LTCHs
Information specific to MRSA and CDI reporting

The National Health Safety Network (NHSN) has issued information on new reporting requirements for inpatient rehabilitation facilities (IRFs) and long-term acute care hospitals (LTCHs). Beginning Jan. 1, 2015, all IRFs and LTCHs — both free-standing and units within affiliated acute care facilities — will begin reporting facility-wide inpatient  Methicillin-resistant Staphylococcus aureus (MRSA) blood specimen and Clostridium difficile infection (CDI) laboratory-identified event data to NHSN. Operational guidance documents detailing the reporting requirements will be posted in the coming months at www.cdc.gov/nhsn/cms/index.html.

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 Issues AFL on New Law for Optional Services in Federally Certified and Skilled-Nursing Facilities

The California Department of Public Health (CDPH) has issued an All Facilities Letter superseding its AFL 13-19. Beginning Jan. 1, 2015, occupational therapy, physical therapy, speech pathology and audiology services will no longer be considered special services — also known as optional services — when provided to inpatients of federally certified nursing facilities or skilled-nursing facilities. However, the services will still be considered optional as they pertain to non-residents on an outpatient basis. It is important to note that physical therapy, occupational therapy, speech pathology and audiology, social work and special treatment program services in licensed-only skilled-nursing facilities will continue to be considered optional services by the CDPH Licensing and Certification Program. For more information, see the attached AFL.

CHA News Article

CMS Expands SNF PPS Payment Reform Research Project

The Centers for Medicare & Medicaid Services (CMS) is expanding the scope of its skilled-nursing facility (SNF) payment reform project to examine potential improvements and refinements to the overall SNF prospective payment system (PPS). In the first two phases of the project, the contractor focused on SNF PPS therapy payment by reviewing current policy and research and identifying potential therapy models suitable for further analysis. CMS is considering stakeholder comments and concerns as it continues to investigate alternative therapy payment approaches.

CHA News Article

Antipsychotic Drug Use in California SNFs Declines

According to data recently released by the Centers for Medicare & Medicaid Services, prescriptions of antipsychotic medications to residents of California skilled-nursing facilities have declined by 26.5 percent since 2011. The decline reflects the efforts of the National Partnership to Improve Dementia Care in Nursing Homes to improve the quality of care for individuals with dementia living in nursing homes. The National Partnership measure is the percentage of long-stay nursing home residents who are receiving an antipsychotic medication, excluding those diagnosed with schizophrenia, Huntington’s disease or Tourette syndrome.

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 AFL on New Law for Optional Services in Federally Certified and Skilled-Nursing Facilities

The California Department of Public Health (CDPH) has issued an All Facilities Letter superseding its AFL 13-19. Beginning Jan. 1, 2015, occupational therapy, physical therapy, speech pathology and audiology services will no longer be considered special services — also known as optional services — when provided to inpatients of federally certified nursing facilities or skilled-nursing facilities. However, the services will still be considered optional as they pertain to non-residents on an outpatient basis. It is important to note that physical therapy, occupational therapy, speech pathology and audiology, social work and special treatment program services in licensed-only skilled-nursing facilities will continue to be considered optional services by the CDPH Licensing and Certification Program. For more information, see the attached AFL.

CHA News Article

CMS Expands SNF PPS Payment Reform Research Project

The Centers for Medicare & Medicaid Services (CMS) is expanding the scope of its skilled-nursing facility (SNF) payment reform project to examine potential improvements and refinements to the overall SNF prospective payment system (PPS). In the first two phases of the project, the contractor focused on SNF PPS therapy payment by reviewing current policy and research and identifying potential therapy models suitable for further analysis. CMS is considering stakeholder comments and concerns as it continues to investigate alternative therapy payment approaches.

CHA News Article

Antipsychotic Drug Use in California SNFs Declines

According to data recently released by the Centers for Medicare & Medicaid Services, prescriptions of antipsychotic medications to residents of California skilled-nursing facilities have declined by 26.5 percent since 2011. The decline reflects the efforts of the National Partnership to Improve Dementia Care in Nursing Homes to improve the quality of care for individuals with dementia living in nursing homes. The National Partnership measure is the percentage of long-stay nursing home residents who are receiving an antipsychotic medication, excluding those diagnosed with schizophrenia, Huntington’s disease or Tourette syndrome.

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