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.
2025 Behavioral Health Care Symposium
Registration opens June 3, 2025. The 2025 Behavioral Health Care Symposium returns to Sacramento! Join us at the Sawyer Kimpton in Sacramento on December 8-9 for rich conversations on behavioral health care in California from speakers you want to hear. If you thought the 2024 Symposium in Long Beach was good – just wait ’til […]
Care Transitions Forum
Join case managers and case workers from hospital and post-acute care settings for a collaborative day focused on enhancing care transitions. This event provides an opportunity to connect, share best practices, and explore strategies for success in patient care coordination. Attendees will also take a guided tour of the Capitol, offering insights into health care policy and advocacy. Don’t miss this chance to network and brainstorm with colleagues on ways to advance care transitions and patient outcomes.
New Resource Available on Assisted Living Waiver, CalAIM Community Supports
What’s happening: The California Health Care Foundation has issued an Explainer document that describes and compares two key Medi-Cal programs: the Assisted Living Waiver (ALW) and Community Supports (a component of California’s Medi-Cal reform initiative, California Advancing and Innovating Medi-Cal (CalAIM)). What else to know: The document provides an overview of the ALW and the […]
CMS Provides Additional Guidance on Beneficiary Observation Status Appeals
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has issued additional information, including billing instructions, for the Medicare Change of Status Notifications (MCSN).
What else to know: Beginning Feb. 14, CMS will require giving MCSNs to patients who are reclassified from inpatient to observation (outpatient) status.
Federal Funding Will Bolster Medi-Cal Reimbursement for Inpatient Psychiatric Care
What’s happening: On Dec. 16, California was approved for the large BH-CONNECT behavioral health demonstration project, which is estimated to bring $5 billion of new federal Medicaid dollars for California over the next five years.
What else to know: During this time, BH-CONNECT will use the funds to test new approaches to behavioral health treatment, housing, and workforce development.
CMS Responds to Congressional Letter Urging Adequate IRF Access
What’s happening: The Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure has responded to a congressional letter, signed by several members of the California delegation, that urged 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, Ms. Brooks-LaSure notes several recent rules issued by CMS that seek to ensure that MA plans adhere to CMS requirements, including network adequacy, prior authorization, and data collection. Ms. Brooks-LaSure also agrees to take the writers’ comments into consideration for future policy development.
HCAI Updates Policy on Alternate Power Requirements for Skilled-Nursing Facilities
What’s happening: The Department of Health Care Access and Information (HCAI) has issued updated information on requirements for alternate sources of power in skilled-nursing facilities (SNFs).
What else to know: The revised Policy Intent Notice provides guidance for the implementation of alternate sources of power to maintain safe temperatures, availability of lifesaving equipment, and oxygen-generating devices for SNF buildings as required by state law.
CMS Makes Additional Updates to Medicare Advantage Provider Complaint Submission Form
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has provided additional updates to the Medicare Advantage Provider Complaint Submission form as it continues to refine the process,.
What else to know: As previously reported, CMS has developed a process that allows providers to submit questions and complaints related to Medicare Advantage (MA) plan appeals or claims payment issues.
DHCS Releases Updated List of Medi-Cal Managed Care Plan Liaisons for Long-Term Care Providers
What’s happening: The Department of Health Care Services (DHCS) requires Medi-Cal managed care plans (MCPs) to identify a liaison to serve as a single point of contact for long-term care providers. These liaisons are listed in an updated DHCS document.
What else to know: The long-term services and supports (LTSS) liaison provides support to LTC providers, including skilled-nursing facilities (SNFs) with addressing claims and payment inquiries and care transitions to support Medi-Cal members’ needs.
CMS Memos Clarify Policies for Providers, State Survey Agencies
What’s happening: In four new memos, the Centers for Medicare & Medicaid Services (CMS) clarifies survey policies for critical access hospitals (CAHs), long-term care facilities (LTC), and laboratories.
What else you need to know: New and revised guidance addresses time-share and leased space arrangements in CAHs, immediate jeopardy in laboratories, and LTC policies.