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The Centers for Medicare & Medicaid Services (CMS) has released important updates on post-acute care quality reporting programs, including training opportunities, public reporting and reminders about data submission and review deadlines. 

Inpatient Rehabilitation Facility/Long-Term Care Hospital Updates

Inpatient rehabilitation facilities and long-term care hospitals may preview performance data on each quality measure based on the second quarter of 2016 through first quarter of 2017. For more information:

IRF Quality Public Reporting LTCH Quality Public Reporting

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The Centers for Medicare & Medicaid Services has issued Survey & Certification Letter 18-09, outlining revised guidance to state survey agency directors about the state operations manual for rural health clinics, intended to clarify existing rural health clinic regulations. While the Medicare conditions for certification have not changed, the updated document includes a new section detailing specific survey process guidance and reorganizes interpretive guidelines, along with the associated survey procedures. CHA encourages members with rural health clinics to review the updated guidance.  

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The California Department of Public Health has issued a provider alert on influenza antiviral recommendations and strategies to obtain influenza antivirals, reporting there does not appear to be a nationwide antiviral shortage. Pharmacies are encouraged to contact their wholesaler’s customer service desk to request drop shipments of antivirals from the manufacturers if the wholesaler is unable to supply needed medications in a timely manner. More information about influenza activity is available at www.calhospital.org/infection-control.

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The California Department of Public Health has released the attached All Facilities Letter 18-02, informing facilities that AB 1014 (Chapter 145, Statutes of 2017) took effect Jan. 1. The new law continues to clarify that facilities are required to test and maintain each of their diesel backup generators and standby systems in conformance with the National Fire Protection Association 110: Standard for Emergency and Standby Power Systems, which is an extension of a current requirement. The bill does not change the regulation of diesel backup generator testing by the state’s Air Resources Board or local air quality districts.

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Today, the Department of Health Care Services sent hospitals invoices covering the first six fee-for-service cycles of the 2017-19 Hospital Fee Program. The first invoice has a due date of Feb. 5 and covers Jan 1. 2017 – March 31, 2017. Hospitals will receive the first fee-for-service payment on Feb. 26. The estimated implementation schedule for the 10 fee-for-service cycles is attached.

CHA is in the process of updating the fee and payment model to reflect final invoice amounts, as well as the fee-for-service payment amounts recently approved by the Centers for Medicare & Medicaid Services. The updated 2017-19 Hospital Fee Program model is scheduled for release next week, with hospital-specific schedules to be distributed soon after.

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The California Department of Public Health (CDPH) has released the attached All Facilities Letter 18-09, detailing requirements for requesting a temporary program flex for increased patient accommodations, such as medical tents, during a disease outbreak or unexpected events such as a disaster or mass casualty incident. The department reminds providers that requests for program flex must include justification and supporting documentation that patient care will not be compromised. Program flex requests are intended for a temporary increase in patient accommodations, surge tent use or space conversions related to emergencies; they are not to be used as long-term solutions for chronic problems such as emergency department overcrowding. Facilities that wish to request a program flex should contact their CDPH district office.

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The Centers for Disease Control and Prevention (CDC) now has an expanded-access investigational new drug protocol in effect with the Food and Drug Administration to make miltefosine available directly from CDC for treatment of free-living ameba infections in the U.S. A recent update issued by the Health Alert Network — including background information, recommendations and links to additional resources — is available on the CDC website at http://emergency.cdc.gov/HAN/han00354.asp.

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To help providers as they transition to the ICD-10 diagnosis and procedural coding system on Oct. 1, 2014, the Centers for Medicare & Medicaid Services last week presented the attached overview, including information about benefits and structure, coding examples and suggested training strategies. For additional resources, FAQs and more information on the transition to ICD-10, visit www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10.

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The Centers for Medicare & Medicaid Services (CMS) has issued the attached Survey & Certification Letter 18-08 describing an initiative to address facility-initiated discharges from skilled-nursing facilities that violate federal regulations. CMS notes that while federal law protects skilled-nursing facility residents, including their right to remain in the facility except under certain specific circumstances, state long-term care ombudsmen report frequent complaints of facility-initiated discharge or eviction. 

CMS notes that the most commonly reported reasons for facility-initiated discharge or eviction are behavioral, mental or emotional expressions or indications of resident distress. In some cases, residents become homeless or remain in hospitals for extended periods. 

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The California Department of Public Health (CDPH) released the 2016 health care-associated infection (HAI) report this week. Overall, California hospitals perform better than the national baseline on three types of infections — surgical site infections (SSI), central line-associated bloodstream infections (CLABSI) and methicillin-resistant staphylococcus aureus  bloodstream infections (MRSA BSI). California hospitals perform worse on Clostridium difficile diarrheal infections(CDI). Data are reported using a standardized infection ratio (SIR), with the national average of 1. The CDPH Licensing and Certification Program considers high HAI rates when prioritizing hospitals for surveys.

CDPH is publishing reports in a more streamlined format and has updated its website to include a web page for HAIs in each hospital that allows users to compare results for two or more hospitals side-by-side. Detailed infection-specific data tables, as published in prior years, are available only via the California Health and Human Services Open Data Portal. CDPH has also provided an interactive map. To assist hospitals in responding to inquiries about the data, CHA has developed the attached talking points.