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

Home Health Agencies May Hire Accreditation Organization to Conduct Licensing Survey

A recent All Facilities Letter (AFL 17-20) from the California Department of Public Health (CDPH) states that, as of Oct. 1, home health agencies may expedite the licensing process by hiring a Centers for Medicare & Medicaid Services approved accreditation organization to conduct the initial state licensing survey, avoiding the current delay of three months to two years in initial application survey completion. If a home health agency chooses to hire its own accreditation organization and passes its initial survey, the CDPH Centralized Applications Unit will issue a six-month provisional license. More details on the process, as well as a list of approved accrediting organizations, are available in the attached AFL. 

CHA News Article

CMS Launches Jimmo Settlement Agreement Web Page
Provides clarification of “maintenance coverage standard” for therapy, skilled-nursing services

The Centers for Medicare & Medicaid Services (CMS) has developed a web page providing background and resource information on the January 2013 Jimmo Settlement Agreement, which clarified that the Medicare program covers skilled-nursing care and skilled therapy services under Medicare’s skilled-nursing facility, home health and outpatient therapy benefits when a beneficiary needs skilled care to maintain function, or to prevent or slow decline or deterioration (provided all other coverage criteria are met). The new web page provides access to various public documents related to the Jimmo Settlement Agreement, including frequently asked questions.

CHA News Article

CMS Issues Home Health PPS Proposed Rule

Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued the attached proposed rule for the home health prospective payment system (PPS) for calendar year (CY) 2018. In addition to updating payment rates and the wage index, CMS proposes to redesign the payment system in 2019. 

Specifically, CMS proposes to update the standard home health PPS rates by 1 percent from CY 2017 payment rates. Additionally, CMS proposes refinements to the case-mix adjustment methodology, including a change in the unit of payment from 60-day episodes of care to 30-day episodes for periods of care beginning on or after Jan. 1, 2019. The proposed rule also includes proposals for the home health value-based purchasing model and Quality Reporting Program.

In addition to the proposed rule, CMS released a request for information to encourage continued feedback on the Medicare program and to solicit ideas for regulatory, sub-regulatory, policy, practice and procedural changes to support increased quality of care and decreased costs. 

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

MedPAC Issues June 2017 Report to Congress

The Medicare Payment Advisory Commission (MedPAC) released its June 2017 Report to the Congress: Medicare and the Health Care Delivery System. The document includes 10 chapters covering key issues facing the Medicare program and offers solutions to ensure the program’s continued viability. 

In its June report the commission continues its work, required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, evaluating the feasibility of a unified prospective payment system (PPS) spanning post-acute care (PAC) settings (e.g., skilled-nursing facility, inpatient rehabilitation facility, long-term care hospital and home health agency). After determining a unified PPS is feasible in its 2016 report, the commission studied three implementation issues: a transition period with blended setting-specific and unified PPS rates, appropriate levels of aggregate PAC payments, and ways to address ongoing refinements to the system after implementation. MedPAC recommends that a unified PAC PPS be implemented beginning in 2021 with a three-year transition, and that aggregate payments should be reduced by 5 percent.

CHA News Article

CMS Proposes Updates to Hospice Payment Rates

On April 27 the Centers for Medicare & Medicaid Services (CMS) issued the attached proposed rule updating the federal fiscal year (FFY) 2018 payment rates and wage index for hospices. Overall, CMS anticipates that aggregate hospice payment rates will increase from FFY 2017 levels by 1 percent, or about $180 million. The proposed cap for FFY 2018 would be $28,689.04.

The proposed rule also specifies public reporting measures derived from the CAHPS Hospice survey, provides an update on the Hospice Quality Reporting Program and solicits comments on clarifying regulations on sources of clinical information for certifying terminal illness. 

CMS also releases a request for information to welcome continued feedback on the Medicare program and to solicit ideas for regulatory, sub-regulatory, policy, practice and procedural changes to support increases in quality of care and decreasing costs. 

CHA News Article

CMS Provides Post-Acute Care Quality Reporting Resources

The Centers for Medicare & Medicaid Services (CMS) has posted the attached quick reference guides for quality reporting programs for several post-acute care providers, including home health agencies, hospice providers, inpatient rehabilitation facilities and long-term care hospitals. The guides include frequently asked questions, information on quality reporting help desks, and links to additional resources.  

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 Formally Withdraws Three Proposed Rules, Including Part B Drug Model

The Centers for Medicare & Medicaid Services (CMS) formally has formally withdrawn a number of proposed rules, including the Medicare Part B Prescription Drug Model that was opposed by CHA and not finalized by the Obama Administration. In addition, CMS withdrew a proposed rule that would have specified qualifications practitioners must meet to furnish and fabricate prosthetics and custom-fabricated orthotics. In comments on the proposed rule, CHA urged CMS to withdraw the proposal and is pleased to see the agency do so.

Finally, CMS also withdrew a proposed rule that would have revised certain conditions of participation for health care providers, conditions for coverage for suppliers, and requirements for long-term care facilities to revise certain definitions and patients’ rights provisions to ensure they are consistent with the Supreme Court decision in United States v. Windsor. CMS believes that a subsequent Supreme Court decision on same-sex marriage, Obergefell v. Hodges, “has addressed many of the concerns raised” in the original rule.  

CHA News Article

Hospitals Overpaid for Outpatient Services Provided to Inpatients of Other Hospitals
Contractors directed to recover overpayments

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services has released the attached report finding Medicare overpayments to acute care hospitals for outpatient services provided to inpatients in other hospitals, including long-term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric hospitals and critical access hospitals. The OIG also determined that beneficiaries were inappropriately held responsible for deductibles and co-insurance payments.

Generally, outpatient services provided by an acute care hospital should be provided through an arrangement with the hospital where the patient is an inpatient, and Medicare should pay the inpatient facility as part of inpatient rate. The OIG recommends that the Centers for Medicare & Medicaid Services (CMS) direct contractors to recover the identified overpayments, instruct acute care providers to refund incorrectly collected payments and identify other incorrect payments. The OIG also recommended that CMS correct system edits to prevent overpayments and to educate acute care hospitals.    

CHA News Article

CMS Clarifies Definition of Hospital for Medicare Participation Purposes

The Centers for Medicare & Medicaid Services (CMS) issued a memo on Sept. 6 clarifying the definition of a hospital for Medicare participation purposes. Federal law requires that – except for critical access hospitals and psychiatric hospitals – to participate as a “hospital” in the Medicare program, an entity must be primarily engaged in providing diagnostic, therapeutic or rehabilitation services to inpatients. Facilities that primarily serve outpatients or skilled-nursing patients may not meet this definition.

CMS states that a hospital must have at least two inpatients at the time of a survey, or the survey will not be conducted. Instead, the surveyors will review the facility’s admission data to determine if the hospital has had an average daily census (ADC) of at least two inpatients and an average length of stay (ALOS) of at least two midnights over the past 12 months. If the ADC and ALOS are two or more, a survey will be attempted at a later date. If not, CMS will look at other factors to determine whether the facility meets the Medicare definition of a hospital. Hospitals with a low inpatient census — or that plan to build a new facility that will have a low inpatient census — should review the CMS memo with their legal counsel.

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

FY 2018 IPPS and LTCH PPS Claims to be Held

Due to revised rates in the fiscal year (FY) 2018 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (PPSfinal rule correction notice, published on Sept. 29, the FY 2018 IPPS and LTCH PPS pricers will be installed into production on Oct. 23.

As a result, all IPPS and LTCH PPS claims with discharge dates on Oct. 1 through Oct. 23 will be held by Medicare administrative contractors (MACs) until the pricers are tested and installed. Since the required 14-day payment floor count begins the day a claim is received by the MAC, any clean claims held until Oct. 23 will not be subject to another payment floor. Providers should contact their MAC with any questions.

CHA News Article

CMS Formally Withdraws Three Proposed Rules, Including Part B Drug Model

The Centers for Medicare & Medicaid Services (CMS) formally has formally withdrawn a number of proposed rules, including the Medicare Part B Prescription Drug Model that was opposed by CHA and not finalized by the Obama Administration. In addition, CMS withdrew a proposed rule that would have specified qualifications practitioners must meet to furnish and fabricate prosthetics and custom-fabricated orthotics. In comments on the proposed rule, CHA urged CMS to withdraw the proposal and is pleased to see the agency do so.

Finally, CMS also withdrew a proposed rule that would have revised certain conditions of participation for health care providers, conditions for coverage for suppliers, and requirements for long-term care facilities to revise certain definitions and patients’ rights provisions to ensure they are consistent with the Supreme Court decision in United States v. Windsor. CMS believes that a subsequent Supreme Court decision on same-sex marriage, Obergefell v. Hodges, “has addressed many of the concerns raised” in the original rule.  

CHA News Article

Hospitals Overpaid for Outpatient Services Provided to Inpatients of Other Hospitals
Contractors directed to recover overpayments

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services has released the attached report finding Medicare overpayments to acute care hospitals for outpatient services provided to inpatients in other hospitals, including long-term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric hospitals and critical access hospitals. The OIG also determined that beneficiaries were inappropriately held responsible for deductibles and co-insurance payments.

Generally, outpatient services provided by an acute care hospital should be provided through an arrangement with the hospital where the patient is an inpatient, and Medicare should pay the inpatient facility as part of inpatient rate. The OIG recommends that the Centers for Medicare & Medicaid Services (CMS) direct contractors to recover the identified overpayments, instruct acute care providers to refund incorrectly collected payments and identify other incorrect payments. The OIG also recommended that CMS correct system edits to prevent overpayments and to educate acute care hospitals.    

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

New Version of RAI User’s Manual Available for Long-Term Care Facilities

As of Oct. 1, all certified Medicare and Medicaid nursing facilities are required to use the latest Resident Assessment Instrument (RAI) 3.0 Manual v.1.15 as a reference in completing the Minimum Data Set (MDS) 3.0. This version of the RAI user manual, published by the Centers for Medicare & Medicaid Services, incorporates new guidance, coding instruction, steps for assessments and clarifications for:

  • Overview, content and components of the RAI
  • The RAI assessment process, requirements, state designation and nursing home responsibilities
  • Overview of the item-by-item guide to the MDS
  • Care area assessments, and care planning guidance and directions
  • Medicare skilled-nursing facility prospective payment system eligibility criteria

More information is available in the attached All Facilities Letter 17-19.

CHA News Article

CMS Clarifies Definition of Hospital for Medicare Participation Purposes

The Centers for Medicare & Medicaid Services (CMS) issued a memo on Sept. 6 clarifying the definition of a hospital for Medicare participation purposes. Federal law requires that – except for critical access hospitals and psychiatric hospitals – to participate as a “hospital” in the Medicare program, an entity must be primarily engaged in providing diagnostic, therapeutic or rehabilitation services to inpatients. Facilities that primarily serve outpatients or skilled-nursing patients may not meet this definition.

CMS states that a hospital must have at least two inpatients at the time of a survey, or the survey will not be conducted. Instead, the surveyors will review the facility’s admission data to determine if the hospital has had an average daily census (ADC) of at least two inpatients and an average length of stay (ALOS) of at least two midnights over the past 12 months. If the ADC and ALOS are two or more, a survey will be attempted at a later date. If not, CMS will look at other factors to determine whether the facility meets the Medicare definition of a hospital. Hospitals with a low inpatient census — or that plan to build a new facility that will have a low inpatient census — should review the CMS memo with their legal counsel.

CHA News Article

CDPH Notifies Providers of Updated Minimum Data Set 3.0
Reflects change to California Section S form

The California Department of Public Health has issued the attached All Facilities Letter notifying certified Medicare and Medicaid nursing facilities that an updated California Minimum Data Set (MDS) 3.0 Section S form is now available. The form, which will take effect Oct. 1, reflects changes on the California Physician Orders for Life Sustaining Treatment form dated January 2016. MDS Section S completion is required for MDS comprehensive assessments, quarterly assessments, discharge assessments and tracking records. Facilities are not required to complete Section S for Medicare Part A prospective payment system assessments.

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 Issues Proposed Revisions to Minimum Data Set

The Centers for Medicare & Medicaid Services has proposed revisions, attached, to the Minimum Data Set, the data collection and reporting tool used in skilled-nursing facilities (SNFs). The revisions reflect the provisions of the recently released proposed rule for the SNF prospective payment system, and reflect changes and additions required by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). Additional information and a summary of the proposed rule are available on the CHA website.

CHA News Article

CDPH Issues Guidance on Automated Drug Delivery Systems
Impacts nursing, skilled-nursing and intermediate care facilities

The California Department of Public Health (CDPH) has notified providers that, as of Jan. 1, new state legislation has reinstated facilities’ ability to use automated drug delivery systems that allow personnel to access multiple drugs and are not patient-specific in their design. However, these systems must have electronic and mechanical safeguards in place to ensure that the drugs delivered to the patient are specific to that patient. As detailed in the attached All Facilities Letter, facilities must obtain authorization from the Licensing and Certification Program prior to using this type of system. 

CHA News Article

CDPH Reports High Flu Activity in California
Reiterates guidance for long-term care facilities

The California Department of Public Health (CDPH) has issued the attached All Facilities Letter reminding providers that influenza activity in California remains high and is rapidly increasing. CDPH has received numerous reports of influenza outbreaks in health care facilities, particularly long-term care facilities and skilled-nursing facilities. The attached letter reiterates important infection control measures providers should be aware of and encourages facilities to follow infection control guidance from the Centers for Disease Control and Prevention if they experience an outbreak. If an outbreak occurs, facilities should avoid new admissions or transfers to units with symptomatic residents. Facilities should also note the broad impact these outbreaks, and their effect on patient admissions, can have across the continuum of care.

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