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’s Center for Post-Acute Care represents the interests of CHA member post-acute care providers,  including inpatient rehabilitation hospitals and units,  long-term acute care hospitals, distinct-part skilled-nursing facilities and home health agencies.  As a part of CHA, the Center for Post-Acute Care serves as the primary public policy arm of the hospital association for post-acute care issues. The center also advocates for hospital-based post-acute care services  in the federal and state legislative and regulatory arenas.

CHA News Article

CMS Suspends DMEPOS Competitive Bidding Program
Also updates ESRD payments for 2019

The Centers for Medicare & Medicaid Services (CMS) last week finalized a rule that suspends the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program beginning Jan. 1. CMS expects that the program will be suspended until at least Dec. 31, 2020.

CHA News Article

CMS Extends Timeline for Publishing Discharge Planning Requirements

The Centers for Medicare & Medicaid Services (CMS) has extended until Nov. 9, 2019, its timeline for revising discharge planning requirements for hospitals, critical access hospitals and home health agencies. 

On Nov. 3, 2015, CMS proposed updates to discharge planning requirements that included provisions required by the Improving Medicare Post-Acute Care Transitions (IMPACT) Act of 2014. At that time, CHA submitted a comment letter on members’ behalf. Based on the numerous comments and information it received, CMS has determined that significant policy issues must be resolved and it needs additional time to coordinate with other government agencies. More information is available in the attached notice. 

CHA News Article

CHA Issue Brief Describes Durable Medical Equipment Challenges for Hospitals

CHA has developed the attached issue brief to summarize member concerns about lack of timely access to durable medical equipment (DME) for Medicare beneficiaries upon hospital discharge. This challenge has become increasingly acute since the Centers for Medicare & Medicaid Services implemented its Competitive Bidding Program. The issue brief includes results from a survey of more than 400 hospital-based case managers, as well as case examples and policy recommendations, and will be used to support CHA’s ongoing advocacy on this issue.

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 to Hold Meeting on Hospice Regulations

On Nov. 16 from 2-3:30 p.m. in Sacramento, the California Department of Public Health will host a stakeholder meeting on hospice regulations. The department asks that attendees review and come prepared to discuss a series of questions related to hospice services and facilities. For more information and to register, see All Facilities Letter 18-47.

CHA News Article

CMS Provides Updates for Post-Acute Care Quality Reporting

The Centers for Medicare & Medicaid Services (CMS) regularly provides important updates for post-acute care quality reporting programs, including training opportunities, public reporting details and reminders of data submission and review deadlines.  

Inpatient Rehabilitation Facilities 
Provider Preview Reports
Updated inpatient rehabilitation facility (IRF) provider preview reports are now available. Providers have until Oct. 8 to review their 2017 quality measure performance data prior to their posting to the IRF Compare website in December. Corrections to the underlying data will not be permitted during this time. However, providers can request CMS review if they believe the data scores displayed are inaccurate. 

Four new quality measures will be reported on IRF Compare: 

  • Assessment-based measures:
    • Application of Percent of Long-Term Care Hospital Patients With an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)
    • Application of Percent of Residents Experiencing One or More Falls with Major Injury (NQF #0674)
  • Claims-based measures: 
    • Medicare Spending Per Beneficiary
    • Discharge to Community
CHA News Article

CMS Issues FFY 2019 Hospice Wage Index Final Rule

The Centers for Medicare & Medicaid Services (CMS) has issued its final rule updating the hospice wage index for federal fiscal year (FFY) 2019. CMS finalized a 1.8 percent hospice payment update based on a 2.9 percent inpatient hospital market basket update, reduced by a 0.8 percent productivity adjustment and a 0.3 percentage point adjustment mandated by the Affordable Care Act. The agency estimates the payment update will result in a $340 million increase in hospice payments compared to FFY 2018.

CMS also finalized several changes to the Hospice Quality Reporting Program and, as required by the Bipartisan Budget Act of 2018, expanded the definition of a “hospice attending physician” to include physician assistants in addition to physicians and nurse practitioners. Additional information is available in a CMS fact sheet.

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.Services may range from coordinated interdisciplinary programs to individual therapy disciplines.

CHA News Article

CMS Suspends DMEPOS Competitive Bidding Program
Also updates ESRD payments for 2019

The Centers for Medicare & Medicaid Services (CMS) last week finalized a rule that suspends the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program beginning Jan. 1. CMS expects that the program will be suspended until at least Dec. 31, 2020.

CHA News Article

CMS Extends Timeline for Publishing Discharge Planning Requirements

The Centers for Medicare & Medicaid Services (CMS) has extended until Nov. 9, 2019, its timeline for revising discharge planning requirements for hospitals, critical access hospitals and home health agencies. 

On Nov. 3, 2015, CMS proposed updates to discharge planning requirements that included provisions required by the Improving Medicare Post-Acute Care Transitions (IMPACT) Act of 2014. At that time, CHA submitted a comment letter on members’ behalf. Based on the numerous comments and information it received, CMS has determined that significant policy issues must be resolved and it needs additional time to coordinate with other government agencies. More information is available in the attached notice. 

CHA News Article

CMS Provides Updates for IRF, LTCH 2019 Policy Changes

The Centers for Medicare & Medicaid Services (CMS) has issued the attached MLN Matters article about federal fiscal year 2019 policy changes to the inpatient rehabilitation facility (IRF) and long-term care hospital (LTCH) prospective payment systems. Included are MS-DRG grouper changes, wage index changes, and updates to quality reporting and value-based purchasing programs. 

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’s Center for Post-Acute Care represents the interests of CHA member post-acute care providers,  including inpatient rehabilitation hospitals and units,  long-term acute care hospitals, distinct-part skilled-nursing facilities and home health agencies.  As a part of CHA, the Center for Post-Acute Care serves as the primary public policy arm of the hospital association for post-acute care issues. The center also advocates for hospital-based post-acute care services  in the federal and state legislative and regulatory arenas.

CHA News Article

CMS Extends Timeline for Publishing Discharge Planning Requirements

The Centers for Medicare & Medicaid Services (CMS) has extended until Nov. 9, 2019, its timeline for revising discharge planning requirements for hospitals, critical access hospitals and home health agencies. 

On Nov. 3, 2015, CMS proposed updates to discharge planning requirements that included provisions required by the Improving Medicare Post-Acute Care Transitions (IMPACT) Act of 2014. At that time, CHA submitted a comment letter on members’ behalf. Based on the numerous comments and information it received, CMS has determined that significant policy issues must be resolved and it needs additional time to coordinate with other government agencies. More information is available in the attached notice. 

CHA News Article

CMS Provides Updates for IRF, LTCH 2019 Policy Changes

The Centers for Medicare & Medicaid Services (CMS) has issued the attached MLN Matters article about federal fiscal year 2019 policy changes to the inpatient rehabilitation facility (IRF) and long-term care hospital (LTCH) prospective payment systems. Included are MS-DRG grouper changes, wage index changes, and updates to quality reporting and value-based purchasing programs. 

CHA News Article

CHA Issue Brief Describes Durable Medical Equipment Challenges for Hospitals

CHA has developed the attached issue brief to summarize member concerns about lack of timely access to durable medical equipment (DME) for Medicare beneficiaries upon hospital discharge. This challenge has become increasingly acute since the Centers for Medicare & Medicaid Services implemented its Competitive Bidding Program. The issue brief includes results from a survey of more than 400 hospital-based case managers, as well as case examples and policy recommendations, and will be used to support CHA’s ongoing advocacy on this issue.

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 Updates Recommendations for Flu Prevention in Skilled-Nursing Facilities

The California Department of Public Health has updated its recommendations for preventing the spread of influenza in skilled-nursing facilities.

CHA News Article

Training Resources Available for Skilled-Nursing Facilities

The Centers for Medicare & Medicaid Services has developed in-service training materials for skilled-nursing facilities to assist them in managing residents with dementia and preventing abuse. Downloadable presentation materials and a toolkit are also available.

CHA News Article

CMS Announces Release of SNF Quality Measures

The Centers for Medicare & Medicaid Services (CMS) has released new Skilled-Nursing Facility Quality Reporting Program data on Nursing Home Compare. The following five items are now being displayed on the public website:  

Assessment-based measures:

  • Percent of Residents or Patients with Pressure Ulcers that are New or Worsened (Short Stay) (National Quality Forum #0678)
  • Application of Percent of Long-Term Care Hospital Patients With an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)
  • Application of Percent of Residents Experiencing One or More Falls with Major Injury (NQF #0674)
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 Provides Updates for Post-Acute Care Quality Reporting

The Centers for Medicare & Medicaid Services (CMS) regularly provides important updates for post-acute care quality reporting programs, including training opportunities, public reporting details and reminders of data submission and review deadlines.  

Inpatient Rehabilitation Facilities 
Provider Preview Reports
Updated inpatient rehabilitation facility (IRF) provider preview reports are now available. Providers have until Oct. 8 to review their 2017 quality measure performance data prior to their posting to the IRF Compare website in December. Corrections to the underlying data will not be permitted during this time. However, providers can request CMS review if they believe the data scores displayed are inaccurate. 

Four new quality measures will be reported on IRF Compare: 

  • Assessment-based measures:
    • Application of Percent of Long-Term Care Hospital Patients With an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)
    • Application of Percent of Residents Experiencing One or More Falls with Major Injury (NQF #0674)
  • Claims-based measures: 
    • Medicare Spending Per Beneficiary
    • Discharge to Community
CHA News Article

Skilled-Nursing Facility Notice of Non-Coverage Revised

The Centers for Medicare & Medicaid Services (CMS) has issued the attached MLN Matters article about the recently revised Skilled-Nursing Facility Notice of Non-coverage form. With this revision, CMS is discontinuing five skilled-nursing facility denial letters, specified in the article, and the Notice of Exclusion from Medicare Benefits. The revised form will be required effective April 30, but facilities are encouraged to begin using it as soon as practicable.

CHA News Article

Guidance Reiterates Flu Prevention, Control in Long-Term Care Facilities
Subscriber alert reports no statewide shortage of antiviral medications

The California Department of Public Health (CDPH) today released the attached All Facilities Letter 18-08 addressing the state’s high rate of influenza activity. The guidance emphasizes infection control measures for long-term care facility residents with suspected or confirmed influenza and includes steps to take for implementation of droplet precautions. The department advises that residents should stay in their own rooms as much as possible, employees and visitors should be screened for illness, ill health care personnel should be furloughed and ill visitors discouraged from entering the facility. The guidance refers providers to the Centers for Disease Control and Prevention guidelines titled “Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities,” and the CDPH “Recommendations for the Prevention and Control of Influenza – California Long-Term Care Facilities.”

CDPH has also issued a subscriber alert on influenza antiviral recommendations and strategies to obtain influenza antivirals, reporting there does not appear to be a nationwide antiviral shortage. Pharmacies are encouraged to contact their wholesaler’s customer service desk to request drop shipments of antivirals from the manufacturers if the wholesaler is unable to supply needed medications in a timely manner.

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