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.

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.  

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. 

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.   

Children’s Behavioral Health Services Lack Timely Access

What’s happening: The California State Auditor recently investigated children’s access to Medi-Cal-covered behavioral health services.  

What else to know: The auditor concluded that many Medi-Cal health plans were out of compliance with state requirements for timely care and that the Department of Health Care Services (DHCS) is not adequately disciplining health plans.

Updated Guide on Final Rule Implementation Now Available

What’s happening: A members-only guide from the American Hospital Association to support hospitals in the implementation of the Medicare Advantage (MA) final rule is now available for calendar year 2024.  

What else to know: The document provides a summary of key provisions of the final rule, which seeks to align MA coverage with traditional Medicare more clearly and to increase oversight of MA plans.