Continuum of Care

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.

DMHC Provides Overview of Complaint and Appeals Process

What’s happening: A recording of the March 26 Department of Managed Health Care (DMHC) Complaint and Appeals Process Webinar is now available.     

What else to know: This complimentary, members-only webinar includes information about DMHC’s role in the independent medical review and complaint process. DMHC staff provided an overview of their jurisdiction and the consumer and provider complaint processes.  

CMS Issues Post-Acute Care Payment Proposed Rules

What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its proposed payment policies for inpatient rehabilitation facilities (IRFs), skilled-nursing facilities (SNFs), and hospices for federal fiscal year (FFY) 2025.  

What else to know: Comments on the proposed rules are due to CMS by 2 p.m. (PT) on May 28. 

CMS Revises Informed Consent Guidance for Hospitals

What’s happening: The Centers for Medicare & Medicaid Services (CMS) updated its Hospital Interpretive Guidelines for Informed Consent.  

What else to know: The guidance clarifies the need to obtain informed consent from patients to perform important surgical tasks, and sensitive or invasive procedures, as well as examinations outside of the medically necessary procedure.  

CHA Participates in DHCS Population Health Management Summit

What’s happening: CHA recently participated in the Population Health Management Transitional Care Services Summit hosted by the Department of Health Care Services. 

What else to know: The summit provided an opportunity for Medi-Cal Managed Care leaders to provide updates on the implementation of transitional care services and share best practices. Several panels included representatives from CHA member hospitals, including Watsonville Community Hospital, Dignity Health, and the University of California, San Francisco.

Recording of IRF Review Choice Demonstration Webinar Available

What’s happening: In August 2023, the Centers for Medicare & Medicaid Services (CMS) initiated the Inpatient Rehabilitation Facility Review Choice Demonstration (IRF RCD) Program in Alabama. CMS plans to expand the program to several other states, including California.    

What else to know: On Feb. 13, CHA hosted a webinar on the IRF RCD; a recording is now available.  

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.  

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.