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.
Proposed Rule Would Increase Medicare Advantage Plan Oversight
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for contract year 2026 that would increase oversight of Medicare Advantage (MA) plans.
What else to know: The rule includes additional proposed changes to the prior authorization process and guardrails for artificial intelligence use.
DEA, HHS Extend Telehealth Prescribing Flexibilities
What’s happening: The U.S. Drug Enforcement Administration (DEA) and federal Department of Health and Human Services (HHS) extended existing waiver flexibilities for prescribing controlled substances via telemedicine through Dec. 31, 2025.
What else to know: This is the third extension.
Members-Only Summary on CMS 2025 Home Health PPS Final Rule Now Available
What’s happening: A summary of the Centers for Medicare & Medicaid Services’ calendar year (CY) 2025 home health (HH) prospective payment system (PPS) final rule, prepared by Health Policy Alternatives, Inc., is available solely to CHA members.
What else to know: The regulation is effective Jan. 1, 2025.
CHA Letter Shares Support, Feedback on Annual Data Submission Requirements for MA Plans
What’s happening: In a Nov. 12 letter to the Centers for Medicare & Medicaid Services (CMS), CHA conveyed its strong support for proposed implementation of additional data collection and audit procedures for Medicare Advantage (MA) plans’ utilization management policies and tools — and shared additional comments.
What else to know: CHA has consistently advocated for greater oversight of MA plans by CMS to ensure beneficiary access to medically necessary services.
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.