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.
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.
CMS Issues Updated Medicare Advantage Complaint Form
What’s happening: As previously reported, the Centers for Medicare & Medicaid Services (CMS) has developed a process that allows providers to submit questions and complaints related to Medicare Advantage (MA) plan appeals or claims payment issues.
What else to know: The form serves as a mechanism for Medicare providers seeking CMS assistance to resolve specific MA claims issues; CMS will enter complete complaint forms into the complaints tracking module and direct the MA to investigate the case.
CMS Issues Report on Acute Hospital Care at Home
What’s happening: As required by the Consolidated Appropriations Act (CAA) of 2023, the Centers for Medicare & Medicaid Services (CMS) has issued a report on several aspects of the Acute Hospital Care at Home (AHCaH) initiative, which provided waivers that allowed individual hospitals to give inpatient-level care in the home environment.
What else to know: The waiver program launched during the COVID-19 public health emergency (PHE), and the CAA extended it beyond the PHE’s end, allowing it to continue through Dec. 31 of this year.
Behavioral Health Policy Updates: What Case Managers Need to Know
CHA Disaster Planning Conference Focuses on Lessons Learned
What’s happening: CHA held its annual Disaster Planning Conference in Pasadena on Sept. 10 and 11. Topics included best practices for communication and collaboration in an emergency, treatment of special pathogens, enhancing health care cybersecurity, and fundamentals of radiation protection.
What else to know: More than 500 people attended the conference, including emergency preparedness directors and coordinators; members of hospital disaster planning teams; compliance, nurse, and case managers; and quality and safety executives.
DHCS Takes Steps to Expedite Access to Enhanced Care Management
What’s happening: Effective Jan. 1, 2025, Medi-Cal managed care plans (MCPs) must implement presumptive authorization arrangement with select providers of enhanced care management (ECM).
What else to know: The Department of Health Care Services (DHCS) is releasing updates to the ECM presumptive authorization policy parallel to the ECM Referral Standards that, together, are designed to ease the administrative burden of the referral and authorization process on ECM providers and community referral partners.
CMS Updates Training on Post-Acute Care and More
What’s happening: The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course on the post-acute care (PAC) patient assessment instruments (PAI) and quality reporting programs (QRPs) for all PAC settings.
What else to know: The updated training provides a high-level overview of data elements within the patient/resident assessment instruments across PAC settings, including inpatient rehabilitation facilities (IRFs), skilled-nursing facilities (SNFs), long-term care hospitals (LTCHs), and home health (HH) agencies, and discusses the relationship between these data elements and the QRP for each setting.
Mental Health Parity Rules Finalized
What’s happening: The departments of the Treasury, Labor, and Health and Human Services have finalized rules to improve access to mental health services by requiring health plans to make changes when inadequate access is provided.
What else to know: The final rule reinforces the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which requires health plans to ensure that access to mental health or substance use disorder care is not more restrictive than access to medical and surgical benefits.
Update: Court Determines CHA Lawsuit Against Anthem is a “Complex Case”
What’s happening: A Los Angeles Superior Court Judge has designated a lawsuit brought by CHA against Anthem Blue Cross a “complex case,” requiring exceptional judicial management.
What else to know: CHA’s suit challenges Anthem’s failure to authorize and arrange for access to timely and appropriate post-hospital health care services for its members. The next activity in the case will be an initial status conference on Oct. 3.
CHA Comments on CY 2025 Home Health Payment Rule
What’s happening: CHA submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to the calendar year 2025 home health prospective payment system proposed rule.
What else to know: CHA thanks members for their feedback, which helped to inform comments.