About Continuum of Care
Post-acute care — often provided at inpatient rehabilitation facilities, long-term care hospitals, skilled-nursing facilities, and at patients’ homes — is vital to the health care delivery system. These providers deliver essential medical and rehabilitative services following hospital care. Hospital case managers help support, and connect patients, families, and caregivers through communication and coordination with post-acute care providers and home and community-based services. This includes the development of a discharge or transition plan that addresses the patient’s goals, needs and treatment preferences, and prepares patients and caregivers for post-discharge care.
CMS Initiates Collection of SNF Ownership Information
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has begun notifying skilled-nursing facilities (SNFs) of new requirements to report detailed information about ownership and management.
What else to know: SNFs must disclose this information on the updated Medicare Enrollment Application (CMS-855A) form attachment, for which CMS has provided additional guidance. Over the next few months, CMS will give all SNFs, including hospital-based SNFs, direction on submitting a revalidation application with the information.
CMS Reduces Medicare Payments to Physicians in Final Rule
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 Medicare physician fee schedule (PFS) final rule, in which the final CY 2025 PFS conversion factor is $32.35 — a decrease of 2.8% from CY 2024.
What else to know: CMS published a fact sheet on the CY 2025 Medicare PFS that shares the rate setting and conversion factor, and much more.
CMS Finalizes Medicare Payments for Home Health, Dialysis Services
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued final rules for the calendar year 2025 home health prospective payment system (PPS) and end-stage renal disease PPS.
What else to know: CMS estimates a 0.5% increase in payments for home health agencies and dialysis providers treating end-stage renal disease (ESRD) patients will see an increase of 2.7%.
California Health Care Foundation Publishes Playbook for Complex Discharges
What’s happening: The California Health Care Foundation’s new playbook shares actionable recommendations to help leadership and frontline staff effectively coordinate, collaborate, and partner on managing the discharge of patients who remain in hospitals for extended stays.
What else to know: Using four vignettes of fictional patients with complex needs who are awaiting discharge, the playbook demonstrates how Medi-Cal benefits and services can be used to “facilitate a person-centered discharge.”
CHA Webinar Covers Key Developments in Behavioral Health Policy
What’s happening: A complimentary, CHA members-only webinar on Oct. 30 from 9-10 a.m. (PT) will tackle the current “state of the state” around behavioral health care policy updates and how they’re affecting care delivery and patient outcomes.
What else to know: Registration is open.
Senate Subcommittee Issues Scathing Report on Medicare Advantage Plans
What’s happening: The U.S. Senate Permanent Subcommittee on Investigations (PSI) released a report revealing that the three largest Medicare Advantage (MA) plans intentionally target costly stays in post-acute care facilities to increase profits.
What else to know: These MA plans denied prior authorization (PA) requests for post-acute care requests at far higher rates than they did for other types of care, resulting in diminished access to post-acute care for MA beneficiaries and an increase in the number of post-acute care services subject to PA. The PSI’s investigation also provided insight into automation and predictive technologies in the PA process.
Noridian Shares Resource for Outpatient Therapy Providers
What’s happening: Noridian, the Medicare administrative contractor (MAC) for California, has provided a one-page resource for outpatient therapy service providers, including physical therapy, occupational therapy, and speech/language pathology services.
What else to know: The resource includes information on coding and claim processing, therapy accruals, certification for therapy plan of care, advance beneficiary notice of noncoverage and more.
CMS Finalizes Medicare Observation Appeals Processes
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has established appeals processes for Medicare beneficiaries who were admitted as inpatient but whose status changed to outpatient observation during their hospital stay.
What else to know: The appeals processes only apply to patients enrolled in traditional Medicare, not patients enrolled in Medicare Advantage.
California Representatives Advocate for Access to IRF Care
What’s happening: Several California representatives joined fellow members of Congress in urging the Centers for Medicare & Medicaid Services (CMS) to take steps that will ensure Medicare Advantage (MA) plan beneficiaries have access to medically necessary inpatient rehabilitation facility (IRF) care.
What else to know: In the letter, the authors observe that, by statute, MA must cover all services included under traditional Medicare, including inpatient rehabilitation — an essential service for many beneficiaries when recovering from a major medical event.
DHCS Issues Resource for CalAIM Transitional Care Services Care
What’s happening: The Department of Health Care Services (DHCS) has issued a new technical assistance resource to support Medi-Cal managed care plans (MCPs) and others in implementing transitional care services (TCS) for Medi-Cal members who need long-term services and supports (LTSS) needs.
What else to know: Under the CalAIM population health management program, MCPs are responsible for delivering TCS to enrollees before, during, and after their transition from one care setting to another.