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 Offers Training for PAC Quality Reporting
What’s happening: The Centers for Medicare & Medicaid Services (CMS) released a web-based training course on post-acute care (PAC) quality reporting programs (QRPs) for the 2025 fiscal and calendar years.
What else to know: The course provides an overview of key updates to PAC QRPs for all PAC settings, including inpatient rehabilitation facilities (IRFs), long-term care hospitals, skilled-nursing facilities, and home health agencies.
Summary: CY 2025 Home Health PPS Proposed Rule
What’s happening: A members-only summary, prepared by Health Policy Alternatives, Inc., of the calendar year (CY) 2025 home health prospective payment system (PPS) proposed rule is available.
What else to know: Comments on the proposals are due to the Centers for Medicare & Medicaid Services by Aug. 26.
CHA to Host Webinar on Preparing for Extreme Heat and Smoke Impact in Clinical Settings
What’s happening: CHA will host the members-only Preparing for Extreme Heat and Smoke Impact in Clinical Settings webinar on Aug. 19 at 1 p.m. (PT).
What else to know: The webinar addresses heat-related emergency response plans and protocols and leads into the 2024 Disaster Planning Conference on Sept. 10-11. Registration is open.
HQI Quality Quarterly Highlights Data-Driven Patient Safety Strategies
What’s happening: The July edition of Quality Quarterly explores why effective patient safety strategies are grounded in the timely collection and analysis of data and examines the rise in sepsis mortality rates in hospitals.
What else to know: Quality Quarterly is intended to support the work of patient safety professionals by providing information on clinical developments, new technologies, and peer learning opportunities.
CHA Comments on DMHC Network Adequacy Standards
What’s happening: CHA continues its work to hold insurance companies accountable for providing timely, comprehensive patient care. Last week, CHA submitted a letter to the Department of Managed Health Care urging it to expand network adequacy standards to reflect patients’ current health care needs and hold plans accountable for making those life-changing, lifesaving services available. […]
CMS Issues CY 2025 Physician Fee Schedule Proposed Rule
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 proposed rule for the physician fee schedule (PFS).
What else to know: Comments on the proposed rule are due Sept. 9.
Office of Inspector General to Examine Medicare Advantage Use of Prior Authorization for Post-Acute Care
What’s happening: The U.S. Health and Human Services Agency has announced that the Office of Inspector General (OIG) will investigate the use of prior authorization for post-acute care services by Medicare Advantage (MA) plans.
What else to know: CHA members have reported that they encounter significant challenges in obtaining authorizations from MA plans for access to the most appropriate level of post-acute care (PAC).
DMHC Provides Additional Guidance Regarding Post-Stabilization Care Requests
What’s happening: The Department of Managed Health Care (DMHC) has issued All Plan Letter (APL) 24-012, which reminds plans that they may not require a hospital to make more than one telephone call to request authorization to provide post-stabilization care to plan members.
What else to know: The APL reiterates the requirements of Health & Safety Code 1371.4, which states that plans must provide hospitals with one telephone number to serve as the point of contact for 24-hour access for post-stabilization authorization requests. Plans may not require a hospital to contact the plan in any way other than the plan’s designated phone number.
Congress Reintroduces Legislation to Streamline Prior Authorization
What’s happening: Congressional leaders have reintroduced bipartisan legislation to address concerns regarding prior authorization (PA) and timely access to care for beneficiaries enrolled in Medicare Advantage (MA) plans.
What else to know: The Improving Seniors’ Timely Access to Care Act would establish an electronic PA standard, reduce the amount of time a health plan is allowed to consider a PA request, and require MA plans to report on their use of PA, including rates of approvals and denials.
CMS Issues Guidance on New Staffing Requirements
What’s happening: The Centers for Medicare & Medicaid Services (CMS) has issued updated guidance to state survey agencies and providers regarding facility assessment requirements for long-term care facilities.
What else to know: The revised guidance updates the survey and assessment process as implemented under the Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting final rule.