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.
CHA Fact Sheets Show New Behavioral Health Facilities Being Built
What’s happening: To help CHA members learn about new behavioral health facilities being constructed in communities around the state, CHA has created an online document that displays the funds awarded to build various types of facilities by county.
What else to know: Close to $2 billion in state funds have been distributed throughout California during the past two years to build new behavioral health treatment locations that will serve Medi-Cal beneficiaries.
Summary: Finalized Interoperability and Prior Authorization Policies
What’s happening: A members-only summary of finalized interoperability and prior authorization processes is available.
What else to know: The final rule is scheduled for publication in the Feb. 8 issue of the Federal Register.
CHA Analysis Reveals How Insurer Practices Impede Patient Care
What’s happening: CHA developed a detailed analysis of how insurance company practices negatively affect patients, which is a key proof point supporting a comprehensive strategy to hold insurers accountable for patient care in California.
What else to know: One of CHA’s priorities this year is to create greater accountability (network adequacy, prior authorization, medical necessity, payment practices, and parity) for insurers operating in California.
IRF Review Choice Demonstration
The Centers for Medicare & Medicaid Services (CMS) recently introduced the Review Choice Demonstration (RCD) for Inpatient Rehabilitation Facilities (IRFs) in Alabama, with plans to expand the program to California in the near future.
New Federal Electronic Prior Authorization Requirements Finalized
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has finalized policies to advance interoperability and streamline prior authorization processes by using application programming interfaces (API) technology.
What else to know: The final rule also requires payers to provide a specific reason for denied prior authorization decisions and publicly report certain prior authorization metrics.
CDPH Issues Updated Guidance on Program Flex for Home Health Staff
What’s happening: The California Department of Public Health (CDPH) has issued All Facilities Letter (AFL) 24-01 on experience requirements for licensed nursing staff of a home health agency (HHA).
What else to know: This AFL provides direction on requesting program flexibility for the professional nursing experience requirements for an HHA.
CMS Provides Health Equity Reports to Post-Acute Care Providers
What’s happening: The Centers for Medicare & Medicaid Services (CMS) is providing health equity confidential feedback reports to post-acute care providers including home health (HH), inpatient rehabilitation facility (IRF), long-term care hospital (LTCH), and skilled-nursing facility (SNF) settings.
What else to know: The reports stratify outcomes for the Discharge to Community and Medicare Spending Per Beneficiary measures by dual-enrollment status and race/ethnicity.
Managed Care Plans to Face Sanctions from DHCS for Poor Performance
What’s happening: Medi-Cal managed care plans (MCPs) will face sanctions from the Department of Health Care Services (DHCS) for failing to meet quality performance standards.
What else to know: DHCS has issued All Plan Letter (APL) 23-012, which updates and clarifies the policy on the imposition of administrative and monetary sanctions to plans that fail to meet minimum performance for required quality performance measures.
Department of Health Care Services Issues Updated Enhanced Care Management Guidance
What’s happening: The Department of Health Care Services (DHCS) has issued All Plan Letter (APL) 23-032, which provides updated guidance to Medi-Cal managed care plans (MCPs) on the provision of enhanced care management (ECM).
What else to know: ECM is a component of the California Advancing and Innovating Medi-Cal initiative.
New Managed Care Plan Changes in January Help Advance Health Equity, Access, and Accountability
What’s happening: Effective Jan. 1, 2024, Medi-Cal managed care plans (MCPs) will operate under a new and revamped contract intended to better advance quality, access, accountability, health equity, and transparency.
What else to know: Also effective Jan. 1, 2024, MCPs available for enrollment in certain counties will change due to county-elected model changes, the awarding of new commercial MCP contracts, and/or the expansion of direct contracts with Kaiser Permanente.