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.
CMS Publishes Progress Report on Review Choice Demonstration for Inpatient Rehabilitation Services, Shares ‘Helpful Hints’
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has posted to its website a report on the ongoing Review Choice Demonstration for Inpatient Rehabilitation Services (IRF RCD) — a program currently in Alabama and Pennsylvania that will expand to California in the future, though a specific time frame has not yet been established.
What else to know: Based on IRF RCD results to date, CMS has released a Helpful Hints document that could assist California providers, as it includes reasons a claim might not be affirmed, as well as best practices that may help avoid non-affirmations.
CDPH Issues Guidance on Skilled-Nursing Facility Reporting for Resident Payer Source
What’s happening: The California Department of Public Health (CDPH) has issued All Facilities Letter (AFL) 25-10, which implements new requirements for skilled-nursing facilities (SNFs) and strengthens the prohibition against facility discrimination based on a resident’s payment source, as enacted in Senate Bill 1354. What else to know: Effective Jan. 1, Medi-Cal participating SNFs must make publicly […]
Medicare Patient Reclassification Notices Now in Effect
What’s happening: Effective Feb. 14, providers are required to issue a Medicare Change of Status Notice (MCSN) to eligible patients who were admitted as hospital inpatients, but the hospital subsequently reclassified them as outpatients who are receiving observation services.
What else to know: This requirement only applies to patients with traditional Medicare as the primary payer. The form and its instructions are available to download.
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.