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 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. 

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

Home Health Quality Reporting Program Materials Available

The Centers for Medicare & Medicaid Services has posted to its website materials from a recent training on the Home Health Quality Reporting Program, including presentation materials as well as answers to provider questions. The materials also include pre-training information and documents used to facilitate training exercises.  

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 Issues QRP Non-Compliance Notices for Post-Acute Care Providers

The Centers for Medicare & Medicaid Services (CMS) has notified post-acute care facilities — including inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs) and skilled-nursing facilities (SNFs) — that were determined to be non-compliant with Quality Reporting Program requirements for calendar year 2016. The determination will impact those facilities’ annual payment update. CMS issued the notices through both the Medicare administrative contractors and the Quality Improvement and Evaluation Systems – Certification and Survey Provider Enhanced Reporting earlier this month. Facilities that received a letter of non-compliance may submit a request for reconsideration via email by 11:59 p.m. (PT) on Aug. 17 for IRFs and LTCHs, and by 11:59 p.m. (PT) on Aug. 13 for SNFs. Additional information on reconsideration requests is available on CMS’ IRF, LTCH and SNF quality reporting web pages.  

CHA News Article

Fact Sheets Available on IRF, LTCH Compare

The Centers for Medicare & Medicaid Services (CMS) has developed the attached fact sheets about the public quality reporting websites for inpatient rehabilitation facilities (IRFs) and long-term care hospitals (LTCHs) — IRF Compare and LTCH Compare. The websites were launched in 2016 to support public reporting and sharing of standardized data for post-acute care providers, as required by the Improving Medicare Post-Acute Care Transformation Act of 2014 . The fact sheets suggest approaches for communicating with patients and families on how the data can assist in their decision-making process and can serve as a resource to providers in understanding their current quality ratings.    

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.

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 Issues QRP Non-Compliance Notices for Post-Acute Care Providers

The Centers for Medicare & Medicaid Services (CMS) has notified post-acute care facilities — including inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs) and skilled-nursing facilities (SNFs) — that were determined to be non-compliant with Quality Reporting Program requirements for calendar year 2016. The determination will impact those facilities’ annual payment update. CMS issued the notices through both the Medicare administrative contractors and the Quality Improvement and Evaluation Systems – Certification and Survey Provider Enhanced Reporting earlier this month. Facilities that received a letter of non-compliance may submit a request for reconsideration via email by 11:59 p.m. (PT) on Aug. 17 for IRFs and LTCHs, and by 11:59 p.m. (PT) on Aug. 13 for SNFs. Additional information on reconsideration requests is available on CMS’ IRF, LTCH and SNF quality reporting web pages.  

CHA News Article

Fact Sheets Available on IRF, LTCH Compare

The Centers for Medicare & Medicaid Services (CMS) has developed the attached fact sheets about the public quality reporting websites for inpatient rehabilitation facilities (IRFs) and long-term care hospitals (LTCHs) — IRF Compare and LTCH Compare. The websites were launched in 2016 to support public reporting and sharing of standardized data for post-acute care providers, as required by the Improving Medicare Post-Acute Care Transformation Act of 2014 . The fact sheets suggest approaches for communicating with patients and families on how the data can assist in their decision-making process and can serve as a resource to providers in understanding their current quality ratings.    

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.

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

CMS Issues QRP Non-Compliance Notices for Post-Acute Care Providers

The Centers for Medicare & Medicaid Services (CMS) has notified post-acute care facilities — including inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs) and skilled-nursing facilities (SNFs) — that were determined to be non-compliant with Quality Reporting Program requirements for calendar year 2016. The determination will impact those facilities’ annual payment update. CMS issued the notices through both the Medicare administrative contractors and the Quality Improvement and Evaluation Systems – Certification and Survey Provider Enhanced Reporting earlier this month. Facilities that received a letter of non-compliance may submit a request for reconsideration via email by 11:59 p.m. (PT) on Aug. 17 for IRFs and LTCHs, and by 11:59 p.m. (PT) on Aug. 13 for SNFs. Additional information on reconsideration requests is available on CMS’ IRF, LTCH and SNF quality reporting web pages.  

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 Provides Resources on Post-Acute QRP ‘Review and Correct’ Reports

The Centers for Medicare & Medicaid Services (CMS) has posted resources from its recent webcast training on post-acute care quality reporting program (QRP) review and correct reports. Among the resources are a video recording and post-training materials, including a question and answer document. The materials are accessible on the CMS QRP training pages for inpatient rehabilitation facilities, long-term care hospitals and skilled-nursing facilities

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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