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CASE MANAGEMENT
COMMITTEE MEETING
Wednesday, March 22, 2017 10:00 am – 2:00 pm
CALIFORNIA HOSPITAL ASSOCIATION BOARD ROOM
1215 K Street, Suite 800 Sacramento, CA 95814
CASE MANAGEMENT COMMITTEE MEETING AGENDA
Wednesday, March 22, 2017
CALIFORNIA HOSPITAL ASSOCIATION
1215 K Street, Suite 800 – Board Room Sacramento, CA
Call-in: (888) 240-2560; Passcode: 9165527553#
Adobe Connect: http://connectpro16666225.adobeconnect.com/cmc03222017/
ITEM SUBJECT REPORTING TIME PAGE *Action Item
I. CALL TO ORDER/INTRODUCTIONS Brown 10:00
II. MINUTES OF PREVIOUS MEETING Brown 10:05
January 25, 2017 Meeting Minutes
Recommendation: approve meeting minutes
5
III. CHAIR REPORT A. Membership Update
Case Management Committee Roster
Brown
10:10 9
IV. WORKFORCE A. CSU Curriculum Update and Next Steps
Content Map
Blaisdell/Martin 10:20 13
15
V. CMC/CAL MEDICONNECT A. Discussion and Next Steps
Kemp 10:30 19
VI. DME A. Discussion and Next Steps
CMS Q&A Document
Blaisdell 10:50 21
23
CHA Case Management Committee Meeting Agenda Page 2
March 22, 2017
VII. LEGISLATIVE UPDATE
A. Federal Legislative Update
AHCA Summary
CHA Letter to the Delegation
Talking Points
B. State Legislative Update
Key State Issues
SB 481 Issue Paper
Blaisdell
Hawthorne
11:00
33
35
37
39
41
43
49
VIII. DISCHARGE DELAY
A. Discussion and Next Steps
Issue Brief
Rogers 11:15 51
53
IX. EMERGENCY CARE SERVICES INITIATIVE
ECSI Presentation
ECSI Flyer
Bartleson 11:25 55
57
73
LUNCH 12:00
X. OBSERVATION NOTIFICATION
A. Discussion
Frequently Asked Questions
Crosswalk
Rogers/All 12:30 75
76
79
XI. HOSPITAL – COMMUNITY PARTNERSHIPS
Harrison 1:00 81
XII. ROUNDTABLE All 1:30 83
XIII. ADJOURNMENT
Next Meeting:
Wednesday, June 14, 2017
10:00 AM – 2:00 PM
CHA- Board Room
1215 K Street, Suite 800
Sacramento, CA
Brown 2:00
CHA CASE MANAGEMENT COMMITTEE MEETING
California Hospital Association Sacramento, CA
Wednesday, January 25, 2017
10:00 am – 2:00 pm
Present: Elizabeth Miller, Marcy Adelman, Laura Biscaro, Michael-Anne Browne, Cindy Laughton, Martha Mleynek, Shelley Stelzner
By Phone: Mary Cummings
Staff: Dietmar Grellmann, Alex Hawthorne, Boris Kalanj, Debby Rogers, Barbara Glaser, Pat Blaisdell, Rosie Lauborough
RVPs: Judith Yates
I. CALL TO ORDER
Vice-Chair Miller called the meeting to order at 10:00 a.m.
II. MINUTES OF PREVIOUS MEETING The minutes of the September 28, 2016 meeting minutes and the November 16, 2016 meeting summary were reviewed and were approved.
III. CHAIR REPORT Vice-Chair Miller provided an update on membership.
IV. LEGISLATIVE UPDATE Staff Blaisdell provided an update on the status of federal legislative efforts to repeal and replace the Affordable Care Act. Staff Grellmann further discussed the new political landscape, alternative plans considered for action, as well as the procedural steps and tactics required to repeal and replace ACA.
5
CHA Case Management Committee January 25, 2017 Meeting Minutes 2
Staff Glaser provided an update on the California state assembly and key budget issues and impact on hospitals, including implications for Cal-MediConnect (CMC) and the Coordinated Care Initiative (CCI). CHA is currently working on the legislative agenda for the new session.
Staff Hawthorne gave an update on Unrepresented Patients and the 2015 court decision, CA Advocates for Nursing Home Reform (CANHR) v. Chapman. The members had an-in-depth discussion around this issue and need for a mechanism to support medical decision-making for unrepresented patients.
V. WORKFORCE
Staff Blaisdell gave an update on the CSU Curriculum Guidelines. Committee members have expressed interest in supporting the development of a modular training program that could be used to train and develop hospital/health system case managers. Staff Blaisdell is working with other CHA staff regarding next steps
VI. OBSERVATION NOTIFICATION Staff Rogers provided an update on the MOON and state observation requirements as well as interpretation of the form, and operational issues. Members were asked to provide the committee with their proposed hospitals’ policies associated with the implementation of the MOON form.
Committee members will share policies and procedures, and implementation
challenges in the future meetings.
CHA staff will send out the MLN matter/CMS publication on MOON to members
VII. DISCHARGE DELAY STUDY Staff Rogers shared the results of the Discharge Delay Study with the committee. Members discussed the report and implications for CHA activity. Members were asked to review the study report at length and give input at their earliest opportunity.
Staff Blaisdell provided an update regarding recent communication with Cal PACE, the association that represents programs of all-inclusive care for the elderly, and interest in collaborating on discharge planning.
CHA Case Management Committee January 25, 2017 Meeting Minutes 3
Members requested additional information regarding PACE and other Home and Community services.
VIII. DISCHARGE TO RCFE
Staff Rogers provided an update on regulation regarding Residential Care Facilities for the Elderly (RCFE) placement and directed members to the DHCS website for detailed information. The Assisted Living Waiver (ALW) Program as also discussed.
IX. CURRENT ISSUES
Staff Blaisdell and Rogers provided updates and status reports on other areas of interests including End of Life Option Act, MediCal Managed Care/Coordinated Care Initiatives, Durable Medical Equipment, PACE and pre-admission screening and resident review (PASRR).
Members were encouraged to submit their feedback updating the CCI presentation tool resource
X. ADJOURN Vice-Chair Miller adjourned the meeting at 2:00 pm.
7
CASE MANAGEMENT COMMITTEE
2017 Membership Roster
CHAIR CHAIR-ELECT
Diane Brown, PhD, RN, CPHQ, FNAHQ, FAAN Executive Director, Care Coordination Kaiser Permanente, Northern California 1950 Franklin Street, 19th Floor Oakland, CA 94612 O: 510-987-3769 [email protected]
Elizabeth Miller, RN, MSN Executive Director, Care Management Adventist Health 1025 Creekside Ridge Drive, Suite 100 Roseville, CA 95678 O: 916-783-2542 [email protected]
MEMBERS
Marcy Adelman, RN, CCM, MSN Clinical Resource Management Palomar Health 456 E. Grand Ave. Escondido, CA 92025 O: 442-281-5551 [email protected]
Regina Berman, RN, MA, Vice President, Population Health Management Memorial Care Health System 17360 Brookhurst Street Fountain Valley, CA 92708 O: 714-377-3016 [email protected]
Laura Biscaro, RN Director of Care Management Santa Barbara Cottage Hospital PO Box 689 Santa Barbara, CA 93102 O: 805-367-2115 [email protected]
Michael-Anne Browne, MD Associate CMO for Accountable Care Stanford Children’s Health 725 Welch Road Palo Alto, CA 94304 O: 310-704-2601 [email protected]
Mary Cummings, RN, MSN, ACM Manager, Case Management/Denial Recovery Unit Fresno Heart and Surgical Hospital 15 E Audubon Dr. Fresno, CA 93720 O: 559-433-8030 [email protected]
Karen Dunning Vice President, Care Management Operations Sutter Health System Offices 2890 Gateway Oaks Drive, Suite250 Sacramento, CA 95833 O: 916-649-4077 [email protected]
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Case Management Committee 2017 Membership Roster Page 2
Heather Esget, RN, BSN, ACM Director of Case Management Shasta Regional 1100 Butte St. Redding, CA 96001 O: 530-229-2841 [email protected]
Michelle Evans Case Management Manager Enloe Medical Center-Esplanade Campus 1531 Esplanade Chico, CA 95929 O: 530-332-7043 [email protected]
Cindy Laughton, RN, MA Regional Director, Care Coordination UHS 36485 Inland Valley Dr. Wildomar, CA 92595 O: 951-200-8885 [email protected]
Martha Mleynek, RN, BSN, MBA Executive Director, Case Management Services Riverside Community Hospital 4445 Magnolia Avenue Riverside, CA 92501 O: 951-788-8324 [email protected]
Elizabeth Polek, MBA, LCSW Director of Patient Transition Management UCSF Medical Center 505 Parnassus Avenue San Francisco, CA 94143 O: 415-353-2650 [email protected]
Sally Ramirez, RN, MLTCA Regional Director, Care Management Standards & Practice Providence Hospital 501 S. Buena Vista Street Burbank, CA 91505 O: 818-847-3316 C: 626-733-7449 [email protected]
Terri Scott, RN, BSN Regional Senior Director, Care Coordination Dignity Health/Greater Sacramento Service Area 10901 Gold Center Drive Rancho Cordova, CA 95670 O: 916-631-3066 [email protected]
Tonya Soroosh, RN, BS, CCM, CCP Director, Case Management/Social Work Sharp Memorial Hospital/Sharp Mary Birch 3003 Health Center Dr, San Diego, CA 92123 O: (858) 939-4003 [email protected]
Shelley Stelzner, RN, BSN, MHA, CCM, CPHM Director, Case Management NorthBay Healthcare 1200 B. Gale Wilson Blvd. Fairfield, CA 94533 O: 707-646-4241 [email protected]
Tessie Sulit Wagoner, RN-BC, MHA, BSN, CCM, IQCI Regional Senior Director, Case Management Kindred Healthcare/West Region 200 Hospital Circle Westminster, CA 92783 O: 714-899-5020 [email protected]
Case Management Committee 2017 Membership Roster Page 3
REGIONAL ASSOCIATION REPRESENTATIVES
Shauna Day Regional Vice President Hospital Council 1625 E. Shaw, Suite 139 Fresno, CA 93710 O: 559-650-5694 [email protected]
Jenna Fischer Vice President, Quality and Patient Safety Hospital Council 3480 Buskirk Ave., Ste 205 Pleasant Hill, CA 94523 O: 925-746-5106 [email protected]
Julia Slininger, RN, BS, CPHQ Vice President, Quality and Patient Safety Hospital Association of Southern California 515 Figueroa Street, Suite 1300 Los Angeles, CA 90071 O: 213-538-0766 [email protected]
Judith Yates Senior Vice President Hospital Association of San Diego & Imperial Counties 5575 Ruffin Road, Suite 225 San Diego, CA 92123 O: 858-614-1559 [email protected]
STAFF
Patricia L. Blaisdell, FACHE Vice President, Continuum of Care California Hospital Association 1215 K Street, Suite 800 Sacramento, CA 95814 O: 916-552-7553 [email protected]
Boris Kalanj Director, Cultural Care & Patient Experience Hospital Quality Institute 1215 K Street, Suite 900 Sacramento, CA 95814 O: 916-552-7694 [email protected]
Rosie Lauborough Administrative Assistant California Hospital Association 1215 K Street, Suite 800 Sacramento, CA 95814 O: 916-552-7546 [email protected]
Debby Rogers, RN, MS, FAEN Vice President, Clinical Performance and Transformation California Hospital Association 1215 K Street, Suite 800 Sacramento, CA 95814 O: 916-552-7575 [email protected]
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March 22, 2017 TO: Case Management Committee Members FROM: Pat Blaisdell, VP Continuum of Care Cathy Martin, VP Workforce Policy SUBJECT: Workforce Planning SUMMARY CHA member hospitals report significant challenges in recruiting case management personnel. Workforce development was identified as a priority issue for committee work. ACTION REQUESTED To provide an update on current status of communication with California State
University (CSU) and to identify next steps for action. To solicit suggestions and interest regarding curriculum funding.
DISCUSSION In 2016, committee members worked with key representatives of California State University to develop a framework for a modular training program that could be used to train and develop hospital/health system case managers for entry-level, specialty, and leadership positions. Based on the input of committee members, Helen McNeal, Ph.D., Executive Director, CSU Institute of Palliative Care and CSU staff developed a curriculum outline and content map, as well as an estimate of costs for program and materials development. The estimated cost for up-front program development is approximately $538,000. Once implemented, the program will be designed to be self-sustaining through registration fees. Dr. McNeal is currently seeking funding for these development costs, including from hospitals, health systems, foundations or other organizations, possibly in exchange for a limited number of employee training slots. PB: rl Attachment:
1. Hospital Case Management Content Map
13
HOSPITAL CASE MANAGEMENT CONTENT MAP
FOUNDATIONAL CM
Content
Hours
1. Care Management Principles
A. Care Management Concepts 6
B. Principles of Practice 5
C. Health Care Management and Delivery 3
D. Legal Issues and Hospitals: Acts, Regulations, Laws, and Accreditations 4
E. Peer Support, Burnout Prevention, and Safety 3
F. Critical Thinking 5
Sub‐Total 26
2. Motivational Interviewing
A. Motivational Interviewing Concepts 3
B. The Spirit of Motivational Interviewing 3
C. Applying Motivational Interviewing (Practicum) 4
Sub‐Total 10
3. Relationship Building
A. Interdisciplinary Care Teams 3
B. Patient Family Caregiver Engagement Principles 4
C. Provision of Resources: Community Support and Advocacy 3
10
4. Complex Care Coordination Skills
A. Advance Care Planning 4
B. Palliative Care 4
C. Hospice and End of Life Planning 3
D. Improving Transitional Care 2
E. Inter‐Agency and Multi‐Program Coordination 2
F. Evaluating Meaning in Communication 2
G. Assessing Capacity and Literacy 2
H. Diverse Populations Overview 4
23
TOTAL 69
FOUNDATIONAL UTILIZATION REVIEW
1. Care Management Principles
A. Care Management Concepts 6
B. Principles of Practice 0
C. Health Care Management and Delivery 3
D. Legal Issues and Hospitals: Acts, Regulations, Laws, and Accreditations 4
E. Peer Support, Burnout Prevention, and Safety 3
F. Critical Thinking 5
G. Interdisciplinary Care Teams 3
TOTAL 24
15
ADVANCED CONCEPTS
Level 1
I. PATIENT‐VALUE PERCEPTION
A. Quality of Life and Holistic Health Management 3
B. Multi‐Cultural Aspects of Case Management 4
C. Social Determinant of Health 4
D. Resource Management 3
E. Collaborative Problem Solving 3
17
II. SPECIAL POPULATONS I
A. People with Physical Disabilities 2
B. Mental Illness 2
C. Homelessness and Poverty 2
D. Substance Abuse 2
E. Pain Management & Impact of Chronic Opioid Use 2
F. Domestic Violence 2
G. Jail and Forensic Health 2
14
III. SPECIAL POPULATIONS II
A. Intellectual and Developmental Disabilities 2
B. Alzheimer/Dementia 2
C. TBI 2
D. Transplant 2
E. Pregnancy 2
F. Pediatric 4
G. LGBTQ 2
H. Farm Worker/Immigrant Populations 2
18
Subtotal ‐ Level 1 49
LEVEL 2:
I. COMPLEX CASES
A. Advanced Disease Management 5
B. Population Health Management 4
C. Denials/Appeals 2
D. High Level Communications 3
E. Utilizing Physician Advisory 2
F. Conflict Resolution 4
G. Preceptor/Mentor 4
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II. ADMINISTRATIVE FUNCTIONS
A. Monitoring Productivity and Quality 2
B. Audits and Reports 2
C. Insurers/Lead Information 2
D. Critical Thinking: Regulations, Rules, Processes 4
E. Integrating Quality Initiatives 2
F. Risk Management 4
16
Subtotal ‐ Level 2 40
TOTAL ‐ ADVANCED CONCEPTS 89
LEADERSHIP ‐ 20 hours online content 20
TOTAL ‐ ALL SECTIONS 202
17
March 22, 2017 TO: Case Management Committee Members FROM: Pat Blaisdell, VP, Continuum of Care SUBJECT: MediCal Managed Care/Coordinated Care Initiative SUMMARY CHA member hospitals have reported challenges in association with Cal MediConnect, and Coordinated Care initiative. Among the concerns reported are lack of access to care coordination services, lack of access to post-acute care, and communications with some designated plans. ACTION To provide update on current status of CMC and the CCI, and CHA communication with
Department of Health Care Services (DHCS) and with plans. To solicit feedback and input from member hospitals.
BACKGROUND At CHA’s request, Harbage Consulting developed presentation materials and a case manager “tool-kit” regarding Cal MediConnect policies and procedures, including access to care coordination, authorization procedures, and other issues. Based on the questions that they have received, Harbage has requested some additional input from CHA, and suggestions for next steps. Representatives of CHA and the Case Management Committee will participate in a “best practice” webinar with plans on the role and application of the materials. CHA continues to work with the Department of Health Care Services (DHCS) and individual health plans to address several concerns identified by member hospitals regarding care coordination, care authorizations and access to care for beneficiaries enrolled in managed care, including Cal MediConnect and the coordinated care initiative (CCI), the California dual demonstration. PB: rl
19
March 22, 2017 TO: Case Management Committee Members FROM: Pat Blaisdell, VP, Continuum of Care SUBJECT: Durable Medical Equipment/Medicare Competitive Bidding Program SUMMARY CHA members have reported concerns regarding delays and other issues encountered when ordering medically necessary durable medical equipment (DME) since the initiation of the Centers for Medicare & Medicaid Services (CMS) Competitive Bidding Program. ACTION Discuss and advise.
DISCUSSION At CHA’s request, CMS Region IX conducted a webinar in late 2016 for hospital case managers regarding policies and procedures for ordering and obtaining durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The content, which was developed in consultation with CHA, included coverage policies, documentation, identification of a supplier, and complaint/problem resolution. The webinar was part of CHA’s ongoing work to address member concerns regarding delays and other issues encountered when ordering medically necessary Durable Medical Equipment (DME) since the initiation of the Centers for Medicare & Medicaid Services (CMS) Competitive Bidding Program. CMS has provided follow up Questions and Answers document, based on inquires submitted in the webinar. CMS continues to suggest that hospitals report problems to 1-800-Medicare. PB: rl Attachment:
1. CMS R-9 DMEPOS CB Webinar Q&A
21
CMS RO9 DMEPOS CB Webinar Chat Questions and Answers
Q: Our vendor is asking that we have verbiage in our notes?
A: Medical records should specify the clinical conditions present for a Medicare beneficiary that would warrant need of any DMEPOS item or service. The record must be descriptive of each individual beneficiary. In medical review, the nurse reviewer will look for this narrative description to ensure that coverage criteria are met and it should not mimic the local coverage determination (LCD) language.
Q: If patient travels and they return equipment and get new equipment in their non-competitive bidding area, do they need new order and then who can provide new item?
A: Upon return to their home (non-CBA), the beneficiary would have to be re-qualified for the respective DME. Often times, this can occur simply by the previous supplier providing the information to the new supplier, but, also, additional information may need to come from the beneficiary’s treating provider. The new supplier is well within their rights to request this information. As the beneficiary resides in a non-CBA, any Medicare enrolled supplier may provide the item.
Q: Can a supplier determine their own guidelines regarding how far a patient can walk in order to qualify for a wheelchair?
A: It is not up to the supplier to determine a distance that a beneficiary can walk. It is up to the physician to determine and document the reasons that the beneficiary has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activity of daily living (MRADL). This can be anywhere from prohibiting an activity entirely, to putting the beneficiary at risk of morbidity or mortality through trying to perform an MRADL, to preventing them from accomplishing the MRADL in a timely fashion. An additional factor to distance would also be indication of why the mobility limitation can’t be resolved with a cane or walker.
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Q: Our DME provider for Nebulizers ships them to a patient and it takes 5-7 days. Couldn't this put patients at risk for readmission?
A: The Quality Standards do not specify a timeframe for delivery. The requirement is that the timeframe be reasonable for both the beneficiary and treating provider. If a supplier receives an order and determines that it cannot provide the item, the supplier is required to notify the treating provider and/or the beneficiary within 5 calendar days. Additionally, the CBIC recommends that referral agents utilize all of the suppliers on the locator tool, even those listed as out of the area. Winning suppliers outside of the immediate area may use local subcontractors, or arrange for shipment from their location or the manufacturer. This provision may allow for delivery times that are more suited to your needs. NOTE: I am not sure if this information will resolve your issue. It may, however, provide direction for developing additional strategies to obtain DME for beneficiaries that are pending discharge
Q: We have had local competitive bid vendors refuse to fill orders for our patients who are from outside of the competitive bid area, but became ill or injured while traveling to our area, and require DME for safe discharge back home. Can this be clarified, so local vendors are clear about their obligation to provide service for these exceptions?
A: In the instance where a contract supplier refuses service to a Medicare beneficiary, please contact 1-800-MEDICARE and report this as a complaint. In addition, please contact the CBIC with as much specific information as possible, so that an investigation may occur. We will follow-up with the offending supplier and provide a resolution as quickly as possible. Additionally, referral agents are encouraged to utilize all of the suppliers on the locator tool to select a vendor that will provide service to the beneficiary.
When a Medicare beneficiary travels from a non-CBA to a CBA and requires medical attention, inclusive of competitively bid DME, the beneficiary must obtain the DME from a contract supplier. Upon discharge, the beneficiary can take the equipment home with them and the contract supplier may continue to bill Medicare.
Q: What should a provider do if they try 1-800-Medicare and they either can't get through or the CSR is not able to help?
A: When a provider is in search of a supplier, they should first utilize the Supplier Directory found on www.Medicare.gov. If further assistance is needed in locating a supplier, the provider may call 1-800-Medicare.
• If the CSR determines that it is a Competitive Bidding issue, and is not able to resolve the issue, the CSR will escalate the issue to the Competitive Bidding Implementation Contractor (CBIC). The CBIC will investigate and notify the provider when the issue has been resolved.
• If the CSR determines that the issue is a non-Competitive Bidding issue, the CSR will escalate the issue to the appropriate resolution component.
A provider may also contact the regional CBIC Liaison, directly to file a complaint regarding a supplier’s failure to perform/provide an item, or if the supplier provides poor service. The provider should provide as much specific information as possible. This will allow for a thorough investigation and appropriate corrective action. Please be aware that if the issue involves a complaint against a specific supplier, the CBIC may not be able to share the results of the investigation.
The Regional CBIC contact for California may be contacted by telephone at (803) 763-5771, or by email at [email protected].
NOTE: When calling 1-800, please be aware that Monday and Tuesday are the two busiest days in terms of call volume and between 10-4pm is the busiest time.
Comment: If a patient has Medicare and Medi-Cal, Medicare is billed for the DME, and if it is denied, Medi-Cal will not cover it, whereas Medi-Cal would cover it if it was the primary insurance.
25
Response: If Medicare denies the claim, it should be submitted to Medi-Cal for a determination of coverage. Medi-Cal’s determination of coverage is not contingent upon whether Medi-Cal is primary or secondary.
Q: If there is a disagreement between the vendor and ordering facility with a coverage decision on a piece of DME prior to the beneficiaries discharge, is the best recourse to have the beneficiary file a complaint with 1-800-medicare ASAP?
A: In this instance, the beneficiary could contact 1-800-Medicare or the CBIC to file a complaint. The ordering facility could best assist the beneficiary by locating another supplier that can provide the item. Additionally, the ordering facility could request outreach and assistance from the DME MAC, as the issue involves qualifying documentation for the ordered DME. NOTE: Contract suppliers are not obligated to provide service for items that may not be covered by Medicare, or those for which insufficient documentation exists.
Q: How is CMS addressing delays in discharge D/T delays in delivery of medical necessary DME?
A: The Quality Standards do not specify a timeframe for delivery. The requirement is that the timeframe be reasonable for both the beneficiary and treating provider. If a supplier receives an order and determines that it cannot provide the item, the supplier is required to notify the treating provider and/or the beneficiary within 5 calendar days.
To increase access to DME providers that may be able to meet the needs of discharge planners, we recommend that referral agents utilize all of the suppliers on the locator tool, even those listed as out of the area. Winning suppliers outside of the immediate area may use local subcontractors, or arrange for shipment from their location or the manufacturer (including shipment to the beneficiary’s home).
Comment: I understand the DME company has 5 days to let us know whether they can provide the DME however this again puts patient safety at risk. Example
patient needing a Front Wheeled Walker upon discharge from a hospital can't wait 5 days. If they are discharged without a walker and fall it again can cause a re-admit to the hospital.
A: To increase access to DME providers that may be able to meet the needs of discharge planners, we recommend that referral agents utilize all of the suppliers on the locator tool, even those listed as out of the area. Winning suppliers outside of the immediate area may use local subcontractors, or arrange for shipment from their location or the manufacturer (including shipment to the beneficiary’s home). This information may not directly resolve your issue. It may, however, provide direction for developing additional strategies to obtain DME for beneficiaries that are pending discharge.
Q: What if I order item for a patient who has Medicare and Medi-Cal and the supplier states that they do not deal with Medi-Cal? it was stated in this webinar that they must supply the item correct?
A: A contract supplier cannot refuse service to the beneficiary for the reason that they are not enrolled as a Medi-Cal provider. If Medicare is the primary insurance, the supplier will still be reimbursed for providing the item. If a supplier refuses to provide service for this reason, this should be reported to 1-800-Medicare or the CBIC.
If the supplier provides an item to the patient and the patient has Medicare and Medi-Cal, the supplier must accept assignment on the claim. This means they must accept the Medicare-approved amount as payment in full for covered services.
Q: have a vendor out of our county not accepting a secondary managed Medi-Cal within our county. What should we do?
A: The provider or beneficiary could inquire with the Medi-Cal managed care plan to find a supplier within the Medi-Cal managed care plan’s network.
27
However, it may be that the beneficiary is unable to use a supplier within the plan’s network because he/she is in a Competitive Bidding Area and is required to use a contract supplier. A contract supplier cannot refuse service to the beneficiary for the reason that they are not enrolled as a Medi-Cal provider. If Medicare is the primary insurance, the supplier will still be reimbursed for providing the item. If a supplier refuses to provide service for this reason, this should be reported to 1-800-Medicare or the CBIC.
If the supplier provides an item to the patient and the patient has Medicare and Medi-Cal, the supplier must accept assignment on the claim. This means they must accept the Medicare-approved amount as payment in full for covered services.
Q: Do the progress notes showing the detail regarding why the DME is needed have to have the same physician's signature as compared to the physician order form? A: No. Beneficiaries may have more than one treating physician. The ordering physician must have access to the medical record for review. Q: Where can we find the information listing the coverage category criteria for DME?
A: The Noridian Medicare website contains detailed information on policy coverage criteria as well as providing many other resources. You can find Jurisdiction D at https://med.noridianmedicare.com/web/jddme In addition, for general questions that do not contain PHI, you may email [email protected] for further education or clarification. Comment: Our Medicare provider for Walkers and Wheelchairs often asks for more documentation than required
Response: Suppliers have the right to set internal policies. If the supplier would be open to joint education on coverage criteria requirements, Noridian would encourage you to take advantage of the electronic visit. This visit can be requested on the DME website under the education and outreach tab; “Education Request – Electronic Supplier Visit Data Collection Form.” https://med.noridianmedicare.com/documents/2230715/2240771/Electronic+Supplier+Visit+Data+Collection/459321d9-bf71-4921-a7f5-f591d21d8bae
Q: In the event that a vendor did not resolve an error in the documentation before submitting the claim, what happens when there is no other vendor that can service the patient? In other words, what happens when the service cannot be transferred to another vendor?
A: In this instance, clarification on the error needs to come from the DME MAC. Once that has been established, a new vendor should be selected and they should be informed of the error and that it has been addressed with the DME MAC so payment can be received. The new supplier can contact the DME MAC directly for more clarification if desired.
Comment: Providers sometimes will not release DME because they claim a documentation is missing and that the claim will be denied by Medicare.
Response: Contract suppliers are not obligated to provide service for items that may not be covered by Medicare, or those for which insufficient documentation exists. DMEPOS suppliers are charged with determining that the beneficiary to whom they will provide equipment or service meet the coverage criteria outlined in the LCD and Policy Article. If not the supplier can offer the beneficiary an Advanced Beneficiary Notice of Noncoverage (ABN).
It would be best to discuss with the supplier about which piece of documentation is missing. If there is a discrepancy, please follow up with the DME MAC for resolution. They can contact the supplier and provide corrective counsel or education if needed.
29
Q: Why is that we send electronic MD orders and the supplier has to have a signature on their own form. They don’t fax to us they fax to patients PCP. Never receive a call back on ETA.
A: Medicare does not require a specific format for the five element order (5EO), written order prior to delivery (WOPD) or detailed written order (DWO). There are however specific elements that must be included in each type of order and in the case of items affected by ACA section 6407, the prescribing physicians NPI must be listed. If the electronic submission of the order from the facility to the supplier contains all of the required elements, there is not a need for the physician’s signature on the supplier’s version of the order to meet Medicare standards. In addition, if the supplier has identified that all elements are not present, they should be returning to the prescribing physician for clarification if at all possible although a beneficiary may have more than one treating physician and all are eligible to complete an order.
Comment: A supplier stated they only deliver equipment once a week to our area.
Response: The Quality Standards do not specify timeframes for delivery. If one supplier is unable to meet the needs of the ordering practitioner, another supplier should be contacted.
Comment: The supplier states that they are 4-6 weeks out for FWW’s. Never receive a call back on ETA.
Response: If a supplier is experiencing a backlog on DME orders, another supplier should be contacted. For this reason, the CMS/CBIC encourages referral sources to utilize all suppliers listed, including those that are farther away or even out of state. Out of state suppliers often use local subcontractors (i.e. local suppliers that did not win contracts) or may ship directly from the manufacturer to provide order fulfillment. Again, no organization is limited to only local/proximal suppliers to provide services.
Comment: From my experience, using the Medicare website to locate providers in the competitive bidding area of LA county I have found many of the providers no longer accept Medicare. I have gone down the whole list calling providers for patients either living in Ojai or Oxnard and have been told they no longer accept Medicare. Right now that are only two companies that accept Medicare. Unfortunately they do not deliver any equipment to the hospital, but will deliver to the patient’s home at time of discharge. When there were more local companies that accepted Medicare they would deliver ambulation equipment to the hospital before a patient’s day of discharge to assist in patient’s getting home. At this time there is only one company that accepts Medicare for SB and SLO counties. (non-competitive bidding area)
Response: specific examples would be needed to investigate. If a provider is having difficulty locating a supplier or finds that contract winners are not providing services, this needs to be reported to 1-800-MEDICARE or the CBIC.
Comment: Patient has a secondary insurance that is contracted within our county. The supplier stated they can’t service patient since they aren’t contracted with secondary insurance.
Response: The contract supplier cannot refuse service to the beneficiary for the reason that they are not contracted with the secondary insurer. If Medicare is the primary insurance, the supplier will still be reimbursed for providing the item. If a supplier refuses to provide service for this reason, this should be reported to 1-800-Medicare or the CBIC. If the beneficiary uses a supplier that is non-contracted with the secondary insurer, they may be responsible for the 20% copay if the secondary has no out-of-network benefits. The beneficiary should inquire with the supplemental insurer.
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March 22, 2017 TO: Case Management Committee Members FROM: CHA Staff SUBJECT: Federal Legislative Update SUMMARY
On March 6, House Republican leadership proposed legislation to partially repeal and take steps toward replacing the ACA. The California delegation — which includes ten members of the committees of jurisdiction as well as two members in leadership positions — is well positioned to influence the outcome.
ACTION REQUESTED To provide an update regarding the current status of legislative efforts to repeal and
replace the Affordable Care Act.
To provide information to assist members in understanding the new political landscape, alternative plans that might be considered, as well as the procedural steps and tactics required to repeal, replace and/or delay ACA.
DISCUSSION
The GOP proposals will limit the Medicaid expansion population to a maximum of 138 percent of the federal poverty level (FPL), and states will only receive the enhanced 90 percent federal matching payment for those who are currently enrolled. New members of the expansion population would be required to be covered at the current federal medical assistance percentage, which is 50 percent for California. Further, the proposed legislation limits federal spending for Medicaid by imposing per capita payment caps for all enrollees. The current federal subsidies and cost sharing benefits afforded to citizens up to 400 percent of the FPL would be eliminated and replaced with refundable tax credits based on age, beginning at $2,000.
CHA prepared the attached letter to the delegation outlining CHA’s priority concerns. To assist members in their advocacy, CHA has also developed a brochure illustrating the vital role hospitals play in the nation’s complex health care system, which includes helpful data such as the number of Californians now insured, poverty rates and hospitals’ economic impact on their communities.
PB: rl
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Federal Legislative Update March 22, 2017
Page 2
Attachments:
1. AHCA Summary
2. Letter from CHA Executive Staff to California Congressional Delegation
3. AHCA Talking Points
American Health Care Act
UPDATED Summary of Proposed Legislation March 10, 2017
The Ways & Means Committee and the Energy & Commerce Committee considered and favorably reported the Republican leadership’s plans to partially repeal and replace the Affordable Care Act (ACA), legislation known as The American Health Care Act (AHCA). The committees voted along party lines. The nonpartisan Congressional Budget Office has yet to publish its score, so it is not certain if the bills would meet the prescribed budget savings targets or how many people would lose or gain health insurance coverage as compared to current law.
Of most significance to California’s hospitals, the AHCA:
Reduces the number of insured
Does not eliminate Medicare market basket cuts or productivity adjustments for hospitals in the ACA
Does not restore Medicare DSH cuts
Does not repeal the area wage index rural floor provisions
Significantly reduces federal spending for Medicaid by phasing out the Medicaid expansion enhanced match, reduces the annual growth rate and sets per capita caps for payments.
Does not limit states’ use of provider financing.
The AHCA’s key components would:
Remove the individual mandate and penalty.
Incentivize continuous coverage by allowing a surcharge of up to 30 percent for those with a coverage lapse of more than 63 days.
Create age-based refundable tax credits ranging from $2,000 to $4,000 (beginning in 2020). The credits replace the ACA’s income-based subsidies. Credits for a single household would be limited to $14,000. Credits would be phased out for individuals earning at least $75,000 and families earning at least $150,000.
Repeal essential benefit plan requirements for the Medicaid expansion population beginning December 31, 2019.
Reinstate Medicaid DSH cuts for expansion states beginning in 2018 for 2 years. Medicaid DSH cuts for non-expansion states are repealed permanently.
Cap Medicaid payments to states based on the number of Medicaid enrollees (a per capita cap) beginning with fiscal year 2019 Medicaid expenditures. The base year for these expenditures is 2016, and the growth rate will be based on the medical care component of the consumer price index, which is significantly lower than the current projected growth rate.
Eliminate the enhanced Federal Medical Assistance Percentage (FMAP) for the Medicaid expansion population who enroll after 2019. “Grandfathered” expansion population enrollees (those in prior to 2020) will continue to receive the enhanced FMAP as long as they remain continuously enrolled.
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CHA Summary: American Health Care Act March 10, 2017
Page 2
Repeal the requirement for states to allow hospitals to make presumptive eligibility determinations.
Limit retroactive Medicaid coverage to only one month prior to the eligibility application (down from three months).
Require expansion states to re-determine eligibility every six months beginning October 1, 2017. States receive a 5 percent FMAP increase until December 2019 to cover administrative costs.
Defund Planned Parenthood for one year.
Eliminate many of the ACA taxes, including but not limited to the medical device tax, the drug industry excise tax and tanning salon tax, beginning in 2018. It also delays the implementation of the “Cadillac” tax (on employer sponsored insurance health benefits) until 2025.
Include $100 billion for state innovation grants aimed at stabilizing the individual market over 10 years. States could use this money to create reinsurance programs or high-risk pools to cover the costs of the sickest, most expensive customers.
Allow insurers to charge older customers more, while dropping costs for younger customers. Currently, insurers can charge their oldest customers no more than three times as much as younger enrollees. The bill allows that to increase to a five-to-one ratio.
March 8, 2017 Dear Member of the California Congressional Delegation: On behalf of our more than 400 member hospitals and health systems, representing the full continuum of care, the California Hospital Association (CHA) is writing to express our views on the initial draft of the American Health Care Act (AHCA) legislation that takes steps to repeal and replace the Affordable Care Act (ACA). California’s hospitals are committed to working with Congress to build a health care system that supports all Americans, especially our most vulnerable residents. As Congress works to amend and modify the ACA, we believe that meaningful coverage remains a top priority. Despite having the highest poverty rate in the United States, California leads the nation in expanding health coverage, with 91 percent of all Californians now covered. One in 3 Californians depends on the Medi-Cal program for health coverage, and nearly 4 million Californians have received coverage through Medicaid expansion. In addition, 1.4 million California residents have purchased coverage through the state’s insurance marketplace, Covered California. This progress has helped working Californians, seniors and children access care they would not otherwise have had. We are proud of the fact that health care coverage makes a significant difference in the lives of low income, working families who now have access to important preventative care, routine examinations and medications. This care keeps children healthy and in school, gaining the knowledge they need to become the future of our state and our country. Many adults who once had trouble finding health coverage because of conditions like high blood pressure, asthma or diabetes are receiving the care and access to treatment they need and contributing to a more productive workforce — key to California’s growing economy. California hospitals will continue to work diligently to reduce costs while improving care coordination and clinical efficiencies. As you know, this transformation of health care delivery requires substantial investments as well as a long-term commitment to reconfiguration of infrastructure and resources as hospitals move to accepting risk and responsibility for health care in communities. We are concerned that the current version of the AHCA could threaten the financial viability of these new care models by repealing much of the funding currently dedicated to expanding coverage. We object to eliminating the funding from some sources while also retaining ACA reductions in payments to hospitals. If coverage is not maintained at the current level, we request restoration of Medicare cuts to hospitals. Otherwise, the impact to health care providers and the patients we care for could be severe and counter to the goals we all share.
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California Congressional Delegation March 8, 2017
Page 2
Finally, our goal is to be constructive and thoughtful in our review of the AHCA, but we are hindered by the lack of an analysis from the Congressional Budget Office (CBO). We urge Congress to wait until the CBO report is available before proceeding with formal consideration. California’s hospitals appreciate the opportunity to share our perspective in a spirit of constructive engagement. We look forward to working with members of the California congressional delegation to maintain optimal coverage for all Californians. If you have questions, please reach out to Anne O’Rourke, CHA’s senior vice president, federal relations, at (202) 488-4494 or [email protected]. Sincerely, //s// C. Duane Dauner President and CEO
American Health Care Act: House GOP Plan to Repeal/Replace the ACA
Will Lead to Coverage Reductions, Reduced Services
Talking Points March 8, 2017
On March 6, 2017, House Republicans released a proposed plan to partially repeal and replace the Affordable Care Act (ACA). Although the Congressional Budget Office has not yet issued its detailed financial analysis, the proposal outlined by GOP leaders raises serious concerns. For example, it will likely result in a reduction of health care coverage for hundreds of thousands — potentially millions — of Californians.
• The proposed plan to partially repeal and replace the ACA, known as the American Health Care Act, could have negative impacts on California hospitals and the patients they serve. In particular, the plan as currently drafted will likely lead to a reduction in health care coverage for millions of Californians.
• California leads the nation in expanding health care coverage, with 91 percent of all
Californians now covered. Having health care coverage helps individuals get the appropriate care they need, when they need it. Getting the proper treatment in a timely manner helps reduce health care costs.
• The plan’s proposal to restructure the Medicaid program will likely undo the important gains in coverage that California has made in the past few years. The people who will be most affected are our most vulnerable residents — low-income families, seniors and children.
• California has the highest poverty rate in the nation. An estimated 6.3 million Californians, including 1.9 million children, live in poverty. These are the people who have the greatest needs and will be most impacted by the loss of health care coverage.
• CHA believes that any viable ACA replacement plan must include continued access to affordable coverage for everyone.
• California hospitals also are disheartened by the plan’s failure to restore funding for the Medicare program. Medicare funding to California hospitals is currently being cut by more than $26 billion through 2026. Hospitals agreed to these cuts in exchange for the ACA’s
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Talking Points: American Health Care Act Page 2
promise of expanded coverage. If the ACA replacement plan results in reduced coverage, it is imperative that Medicare payments be restored. Otherwise, Californians will likely face a diminution of available health care services throughout the state.
• California hospitals have worked hard to reduce costs through delivery system reforms, care coordination and clinical efficiencies. These innovations mean patients often recover quicker and can return home sooner. This lower utilization results in lower health care costs. Many of these delivery system improvements have been encouraged by the requirements in the ACA. As elected officials consider options for repealing and replacing the ACA, it is crucial that these advancements continue.
• Hospitals have a huge impact on the economic viability of local communities. California
hospitals are often the largest employers in their communities, providing well-paid jobs to nurses, doctors, health professionals and others. Hospitals’ economic contribution is further realized through the “trickle down” impact of the purchase of goods and services, equipment, retail sales, restaurants and more. Nearly 1 million jobs in California result from hospital employment.
• As the effort to repeal and replace the ACA continues to unfold, CHA looks forward to working with members of the California congressional delegation to maintain optimal coverage for all Californians.
March 22, 2017 TO: Case Management Committee Members FROM: Alex Hawthorne, Legislative Advocate SUBJECT: State Legislative Update SUMMARY
The California Legislature returned on Jan. 4 to Sacramento for the 2017-18 legislative session. Additionally, Governor Brown released his 2017-18 budget proposal on January 10.
ACTION REQUESTED To provide an update on the current legislative session and CHA’s legislative agenda
and priorities for 2017, in particular legislation of interest to hospitals and case managers.
To solicit input on CHA -sponsored SB 481, which addresses the facility’s ability to
provide treatment to unrepresented individuals lacking capacity.
DISCUSSION Legislation CHA monitors proposed legislation and will identify and track bills of particular interest to CHA member hospitals. At this early stage of the legislative session, bill proposals are in the process of being introduced. Unrepresented Patient A 2015 court decision, California Advocates for Nursing Home Reform (CANHR) v. Chapman (Director of the Department of Public Health), declared unconstitutional a California statute that permits skilled nursing facilities (SNFs) to use an interdisciplinary team to make medical decisions for a patient who lacks capacity and has no family or other representative to make these decisions. During the 2016 recent legislative session, the California Department of Public Health (CDPH) proposed legislation on this issue, but withdrew the bill from consideration when they were unable to adequately address stakeholder concerns.
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State Legislative Update March 22, 2017
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CHA–sponsored SB 481, which addresses this issue, has been introduced by Sen. Pan (D-Sacramento). AH: rl Attachments:
1. Key State Issues 2. SB 481 Unrepresented Patients
Bill No. Author Location/Action CHA Position Staff Contact
Civil Actions
SB 33 Dodd (D-Napa)
Would prohibit a business from requiring, as a condition of entering into a contract for the provision of goods or services, that a customer waive any legal right — including right to a jury trial or to bring a class action lawsuit — that arises as a result of fraud, identity theft or other act related to the wrongful use of personal identifying information.
To be heard in Senate Judiciary and Appropriations Committees.
Oppose, Unless Amended
Lois Richardson/Connie Delgado
Closures
AB 651 Muratsuchi (D-Torrance)
Would require nonprofit health facilities to, prior to selling or disposing of assets, notify the attorney general of all languages widely spoken in the county in which the facility is located. The attorney general must consider whether the transaction will adversely impact the community’s significant cultural interests.
To be heard in Assembly Health and Judiciary Committees.
Follow, Hot Anne McLeod/Barbara Glaser
Emergency Services
AB 263 Rodriguez (D-Pomona)
Among other provisions, would require Cal/OSHA to develop workplace violence prevention regulations for emergency services. The bill would also codify the recent California Supreme Court decision on rest periods as applied to emergency services providers.
To be heard in Assembly Labor and Employment Committee March 15.
Follow, Hot Gail Blanchard-Saiger/Kathryn Scott
AB 820 Gipson (D-Carson)
Sponsored by Los Angeles County, this spot bill will be amended to establish a community paramedicine program in California.
In the Assembly. Cosponsor BJ Bartleson/Connie Delgado
AB 1650 Maienschein (R-San Diego)
Sponsored by the California Ambulance Association, this spot bill will be amended to establish a community paramedicine program in California.
In the Assembly. Follow, Hot BJ Bartleson/Connie Delgado
SB 687 Skinner (D-Berkeley)
Would require nonprofit organizations that provide emergency services to obtain the attorney general’s written consent before reducing the level of services provided.
To be heard in Senate Health and Judiciary Committees.
Oppose Anne McLeod/Kathryn Scott
Activity in the Legislature continues as bills are scheduled for their first policy committee hearings. Details on high-priority health care-related bills CHA is tracking this legislative session are provided below. Plans have been finalized for CHA’s Health Policy Legislative Day, March 14-15 in Sacramento. CHA members will meet with more than 100 state legislators about the impact of proposed legislation. For program information, visit www.calhospital.org/legislative-day. For an online version of this report that can be filtered by topic and is updated daily, visit www.calhospital.org/key-state-issues.
March 10, 2017
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California Hospital Association Key State Issues
Page 2
Bill No. Author Location/Action CHA Position Staff Contact
Labor
AB 5 Gonzalez Fletcher(D-San Diego)
Would require an employer to offer additional hours of work to an existing employee who — in the employer’s reasonable judgment — has the skills and experience to perform the work, before hiring any additional employees or subcontractors, including through a temporary employment agency, staffing agency or similar entity. The bill would not apply where it would result in payment of overtime, and would also require the employer to use a transparent and nondiscriminatory process to distribute the additional hours of work among existing employees.
To be heard in Assembly Labor & Employment Committee.
Pending Review
Gail Blanchard-Saiger/Kathryn Scott
AB 387 Thurmond (D-Richmond)
Would expand the definition of “employee” to include any individual, other than doctors or nurses, engaged in supervised work experience to satisfy requirements for licensure, registration or certification as an allied health professional. Would treat hospitals and other facilities that offer clinical experience to allied health professionals — including therapists, clinical lab scientists, technicians and technologists — as their employers, and would require them to pay those individuals minimum wage. This change could extend to other aspects of the employment relationship.
To be heard in Assembly Labor & Employment Committee.
Oppose Gail Blanchard-Saiger/Cathy Martin/Kathryn Scott
AB 402 Thurmond (D-Richmond)
Would require Cal/OSHA to convene, by June 1, 2018, an advisory committee to develop regulations requiring hospitals to evacuate or remove plume (noxious airborne contaminants generated as byproducts from specific devices used during surgical procedures). The proposed regulations must be submitted to the Cal/OSHA Standards Board by June 1, 2019, and the board must adopt regulations by July 1, 2020.
To be heard in Assembly Labor & Employment Committee March 15.
Oppose, Unless Amended
Gail Blanchard-Saiger/Kathryn Scott
SB 349 Lara (D-Bell Gardens)
Would establish ratios for nurses, technicians and social workers in outpatient dialysis clinics and minimum transition time between patients at a dialysis station, among other provisions.
To be heard in Senate Health and Judiciary Committees.
Oppose Gail Blanchard-Saiger/Kathryn Scott
Managed Care
SB 199 Hernandez(D-Azusa)
Would require certain health care entities, including providers, to provide specified information on utilization data and health care pricing information to the Secretary of California Health and Human Services for inclusion in the California Health Care Cost, Quality, and Equity Database.
To be heard in Senate Health and Judiciary Committees.
Follow, Hot Anne McLeod/Barbara Glaser
SB 538 Monning (D-Carmel)
Intends to address the implications of the court decision in UFCW & Employers Benefit Trust v. Sutter Health , which concluded that a third-party payer may obtain the benefits of a leased network’s discounted rates, but is not required to comply with other provisions of the underlying contract between the health plan and network providers.
In the Senate. Follow, Hot Dietmar Grellmann/Alex Hawthorne
SB 562 Lara (D-Bell Gardens)/Atkins (D-San Diego)
Would establish the Californians for a Healthy California Act, a comprehensive universal single-payer health care coverage program and health care cost control system.
In the Senate. Follow, Hot Anne McLeod/Barbara Glaser
California Hospital Association Key State Issues
Page 3
Bill No. Author Location/Action CHA Position Staff Contact
Managed Care (continued)
SB 647 Pan (D-Sacramento)
Intends to address the implications of the court decision in UFCW & Employers Benefit Trust v. Sutter Health , which concluded that a third-party payer may obtain the benefits of a leased network’s discounted rates, but is not required to comply with other provisions of the underlying contract between the health plan and network providers.
In the Senate. Support Dietmar Grellmann/Alex Hawthorne
Medi-Cal
AB 205 Wood (D-Healdsburg)
Would implement a recently enacted Medicaid managed care rule that allows Medi-Cal beneficiaries dissatisfied with a plan decision to file an appeal up to 120 days after the date of notice of the decision, instead of 90 days in existing state law. AB 205 also states the Legislature’s intent to implement other newly revised federal regulations governing Medi-Cal managed care. AB 205 is an identical companion bill to SB 171 (Hernandez, D-Azusa).
To be heard in Assembly Health Committee.
Follow, Hot Amber Kemp/Barbara Glaser
SB 171 Hernandez(D-Azusa)
Would implement a recently enacted Medicaid managed care rule that allows Medi-Cal beneficiaries dissatisfied with a plan decision to file an appeal up to 120 days after the date of notice of the decision, instead of 90 days in existing state law. SB 171 also states the Legislature’s intent to implement other newly revised federal regulations governing Medi-Cal managed care. SB 171 is an identical companion bill to AB 205 (Wood, D-Healdsburg).
To be heard in Senate Health and Appropriations Committees.
Follow, Hot Amber Kemp/ Barbara Glaser
Medical Records
SB 241 Monning (D-Carmel)
Would harmonize state law with certain provisions of federal health information privacy regulations adopted under the Health Insurance Portability and Accountability Act (HIPPA) of 1996.
To be heard in Senate Health and Judiciary Committees.
Support Lois Richardson/Connie Delgado
Medical Staff
AB 148 Mathis (R-Porterville)
Would lower the eligibility threshold for rural practice settings participating in the Steven M. Thompson Physician Corps Loan Repayment Program. The program provides financial incentives, including repayment of educational loans, to a physician who practices in a medically underserved area. Currently, eligible practice settings include community clinics, a clinic owned or operated by a public hospital and health system, or a clinic owned and operated by a hospital that maintains the primary contract with a county government to fulfill the county’s role to serve its indigent population. These settings must be located in a medically underserved area and at least 50 percent of patients must be from medically underserved populations. This bill would lower the eligibility threshold for serving the above described populations to 30 percent for practice settings located in rural areas.
To be heard in Assembly Health Committee March 21.
Support Peggy Wheeler/Connie Delgado
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California Hospital Association Key State Issues
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Bill No. Author Location/Action CHA Position Staff Contact
Mental Health
AB 191 Wood (D-Healdsburg)
Would amend current law to authorize a licensed marriage and family therapist or professional clinical counselor to sign a notice of certification for an extended involuntary hold. This bill would require that the therapist or counselor participated in evaluating the patient, and stipulates that he or she must be the second signature (the first must be a physician or psychologist). This authority would pertain to involuntary holds exceeding 72 hours that require an additional period of intensive treatment not to exceed 14 days, or 30 days under specified conditions.
To be heard in Assembly Health Committee March 21.
Support Sheree Lowe/Alex Hawthorne
AB 451 Arambula (D-Fresno)
Would require acute psychiatric hospitals to provide care and services for patients with an emergency psychiatric condition, regardless of whether the facility maintains an emergency department. The bill would also prohibit a general acute care hospital or an acute psychiatric hospital from requiring a patient to be on an involuntary hold as a condition of transfer or admission.
To be heard in Assembly Health Committee March 28.
Follow, Hot Sheree Lowe/Alex Hawthorne
AB 1136 Eggman (D-Stockton)
Would require the California Department of Public Health to apply for a grant established under the federal 21st Century Cures Act to develop a real-time database showing available beds in inpatient psychiatric facilities, crisis stabilization units, residential community mental health facilities and residential substance use disorder treatment facilities.
To be heard in Assembly Health Committee.
Follow, Hot Sheree Lowe/Alex Hawthorne
SB 237 Hertzberg(D-Van Nuys)
Would modify the process of arresting individuals by allowing law enforcement to, in lieu of processing them through county jail and going before a magistrate, transport the individual to a hospital or other care setting for mental health evaluation and treatment for cooccurring substance use disorder treatment.
To be heard in Senate Public Safety Committee March 21.
Follow, Hot Sheree Lowe/Alex Hawthorne
SB 565 Portantino(D-La Canada Flintridge)
Current law requires a certification review hearing before an individual may be placed on a Lanterman-Petris-Short involuntary hold exceeding 72 hours for further intensive treatment. This bill would require a hospital to make a reasonable attempt to notify family members or other person designated by the patient, with the patient’s consent at least 36 hours prior to the certification review hearing.
To be heard in Senate Health Committee March 29.
Follow, Hot Sheree Lowe/Alex Hawthorne
Nursing Services
AB 1612 Burke(D-Inglewood)
This spot bill will be amended to address full practice authority for certified nurse midwives.
In the Assembly. Follow, Hot BJ Bartleson/Connie Delgado
SB 554 J. Stone (R-Murrieta)
Would authorize the Board of Registered Nursing to certify a nurse practitioner, who holds a certification from a national certifying body recognized by the board, as an independent nurse practitioner who may perform certain nursing functions without physician supervision, if the nurse practitioner meets specified requirements and practices in underserved geographic areas, as determined by the board.
To be heard in Senate Business, Professions & Economic Development Committee.
Follow, Hot BJ Bartleson/Connie Delgado
Patients' Rights
AB 859 Eggman (D-Stockton)
Would lower the standard of evidence from “clear and convincing” to a “preponderance of evidence” for cases brought under the Elder Abuse and Dependent Adult Civil Protection Act in which spoliation of evidence has been committed by the defendant, as specified.
To be heard in Assembly Judiciary Committee.
Oppose Jackie Garman/Barbara Glaser
California Hospital Association Key State Issues
Page 5
Bill No. Author Location/Action CHA Position Staff Contact
Public Health
SB 43 Hill (D-San Mateo)
Would establish a statewide public health surveillance system for tracking antibiotic resistant infections and deaths. Specifically, the bill would require doctors to list an antibiotic resistant infection as a cause of death if it was a factor in a patient’s death. It would also require hospitals and clinical labs, beginning July 1, 2018, to conduct and submit to the California Department of Public Health (CDPH) an annual antibiogram (a summary of all the antibiotic resistant infections in the previous year); hospitals are creating antibiograms as part of their antibiotic stewardship programs. CDPH would be required to publish an annual report on the occurrence of antibiotic resistant infections and deaths, based on death certificate information. This report would analyze the data by facility type, type of resistant infection and geography; facility names would not be included.
To be heard in Senate Health Committee March 29.
Follow, Hot Debby Rogers/David Perrott/Alex Hawthorne
Skilled-Nursing Facilities
AB 275 Wood (D-Healdsburg)
Would expand notice and planning requirements that long-term health care facilities, including skilled-nursing facilities, must meet prior to a change in facility license or operations that may result in patient transfers. Includes a requirement that the attending physician and a licensed mental health professional, in addition to facility nursing staff, complete an assessment prior to giving the patient a written notice of transfer.
To be heard in Assembly Health Committee March 21.
Follow, Hot Patricia Blaisdell/Barbara Glaser
SB 481 Pan (D-Sacramento)
Co-sponsored by CHA, this spot bill will be amended to address the court decision in CANHR v. Chapman , which, if upheld on appeal, would render current law for treating unrepresented patients in skilled-nursing facilities unconstitutional.
To be heard in Senate Health and Judiciary Committees.
Cosponsor Patricia Blaisdell/Lois Richardson/Alex Hawthorne
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Issue
California’s skilled-nursing facilities (SNFs) strive to provide appropriate medical services to all residents in their care. Existing law must be updated to ensure that vulnerable SNF residents who are unable to speak for themselves and have no family to make decisions for them, have timely access to medically necessary care, and avoid unnecessary, disruptive and costly hospitalizations.
Position
CHA is a co-sponsor of SB 481 (Pan, D-Sacramento) along with the California Association of Health Facilities. SB 481 will update previous law by including a new requirement that the physician, SNF or intermediate care facility — prior to implementing a medical intervention that requires informed consent — notify a patient/resident that it has been determined that the resident lacks capacity, that no family can be found to make decisions for them and that treatment has been recommended to them. SB 481 will protect the patient/resident’s rights by establishing a clear process for patient notification.
Analysis
Current law provides a process for SNFs to use an interdisciplinary team to make medical decisions for patients who lack capacity and have no family or other representative to make decisions. However, a 2015 court decision, California Advocates for Nursing Home Reform v. Chapman (Director of the Department of Public Health) declared the current legal process to be unconstitutional. Among the court’s findings was the determination that the current law does not include adequate patient/resident notification.
The lack of a legal process to facilitate or authorize decisions for unrepresented patients can delay access to medically necessary services and undermines the long-term outcomes for our most vulnerable patients. When there is a delay in care, SNFs often send patients to hospitals. Unnecessary hospitalization is not in the best interests of the patient and leads to increases in hospital readmissions and greater congestion in hospital emergency departments. In addition, SNFs may decline to admit unrepresented patients lacking capacity because of the lack of a clear legal process for medical decision making. When this happens, patients may remain in the hospital unnecessarily, increasing lengths of stay.
Ensure Medically Necessary Care for Unrepresented Patients
• Existing law regarding patient notification was found deficient by a court ruling.
• SB 481 would address deficiencies in current law regarding care for thousands of vulnerable patients who cannot speak for themselves.
• SB 481 will protect patient/resident rights and assure timely access to medically necessary care.
Support SB 481
Contact:
Pat Blaisdell CHA vice president, continuum of care (916) 552-7553 or [email protected]
Lois Richardson CHA vice president and counsel, privacy and legal publications/education (916) 552-7611 or [email protected]
Alex Hawthorne CHA legislative advocate (916) 552-7673 or [email protected]
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March 22, 2017 TO: Case Management Committee Members FROM: Pat Blaisdell, VP, Continuum of Care Debby Rogers, VP Clinical Performance and Transformation SUBJECT: Discharge Delay Study Results SUMMARY The CHA Case Management Committee has previously identified delayed discharge as a significant problem for patients who are unable to access post-hospital services, but have continued medical and other care needs. ACTION REQUESTED
To provide update on survey results and analysis. DISCUSSION The Committee developed a survey and queried committee member hospitals in a one-day, point-in-time survey in July 2016. The study focused on patients whose inpatient discharge was delayed greater than seven days beyond what was deemed medically necessary. The results of this limited survey suggested that a significant number of patients remain in acute hospital beds for extended stays, secondary to the inability to access appropriate post-hospital medical and/or residential care. The most frequently reported barrier to discharge was the presence of behavioral issues and/or a mental health or substance use disorder. The majority of patients suffering significant discharge delay were Medi-Cal beneficiaries. PB: rl Attachment:
1. Discharge Delay Issue Brief
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March 22, 2017 TO: CHA Case Management Committee Members FROM: Pat Blaisdell, VP Continuum of Care Debby Rogers, VP Clinical Performance and Transformation SUBJECT: Discharge Delay Issue Brief CHA member hospitals report significant difficulty securing appropriate post-hospital care for patients who no longer require a hospital level of care and may have specialized needs. As a result, these individuals may remain in hospital beds beyond the time required to treat their medical condition, often for extended periods. In order to assess the scope and impact of this problem, the CHA Case Management Committee developed a survey and queried committee member hospitals in a one-day, point-in-time survey in July 2016. Background Following a hospitalization for injury or illness, many patients require continued care either at home or in a specialized facility. A key role of hospital-based case managers and discharge planners is to work with patients and their families to identify an appropriate post-acute care setting, based on the individual’s medical needs and available resources.
Some patients require continued specialized care that is provided in skilled nursing facilities (SNFs), Institute for Mental Disease (IMD), and/or residential treatment, but hospital personnel are unable to locate a facility that has the capability and capacity to accept the patient. In other cases, individuals may be able to go home or to another community setting with support, but the necessary reimbursement or ongoing care coordination may not be available.
Study Results The survey focused on patients for whom discharge was delayed greater than seven days beyond what was deemed medically necessary. Seven days was selected as the determining timeframe to eliminate operational barriers that could briefly delay discharge, such as lack of available transportation.
Twenty acute care hospitals, representing 8% of California’s hospital beds, participated in the survey. For a specific date in July, 2016 hospitals were asked to report:
• # of patients with > 7 excess hospital days
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Discharge Delay Issue Brief March 22, 2017
Page 2
• Total # of excess days attributable to those patients • Payer status • Barrier(s) to discharge
The 20 hospitals reported:
• # of patients with > 7 excess hospital days: 78 • Average delay: 52 days; Median delay: 17 days; Range: 10 – 399 days • > 75% were reported to require skilled nursing or custodial residential care • Over half were MediCal beneficiaries
The most frequently reported barrier to transition was the presence of a behavioral health or behavioral issue. Additional barriers reported included; patient/family disagreement with plan; homelessness; undocumented status; lack of capacity and unrepresented; presence of a tracheotomy; need for dialysis; high caregiver burden, including obesity; and age related issues. Many patients evidenced multiple barriers.
If the incidence of delayed discharges for the reporting hospitals is characteristic across the state:
• On a daily basis 1,004 persons with > 7 excess days remain in hospital beds • At an estimated cost of $3.2 million/day, or $ 1.17 billion/year • Hospitals receive little to no reimbursement for these extra days or care, and often
provide additional unreimbursed care to facilitate discharge.
Implications Lengthy hospital stays have significant negative implications for individuals, including negative impact on medical and functional outcome and independence, a need for excess or unnecessary long term care or institutionalization, and deterioration of existing community support.
In hospitals, these excess stays divert costly and limited inpatient resources, resulting in delays in hospital admissions and ED crowding. Hospitals receive little to no reimbursement for these extra days or care, and often provide additional unreimbursed care to facilitate discharge, such as paying for necessary equipment or transportation, leasing SNF beds for timely access, or funding care at a board and care facility.
Summary Lack of access to post-hospital care is having a significant impact on hospital length of stay, and has serious implications for patients and hospitals alike. The impact of this issue extends far beyond a single care setting or provider type. Effective action will require sustained and comprehensive action involving multiple provider groups.
March 22, 2017 TO: Case Management Committee Members FROM: BJ Bartleson, VP Nursing & Clinical Services SUBJECT: Emergency Care Systems Initiative (ECSI) SUMMARY CHA and the regional associations are actively preparing for ECSI and will look to this committee to provide support, information and feedback. ACTION REQUESTED Information and discussion.
DISCUSSION The attached PowerPoint and flyer describes the Emergency Case Systems Initiative to your colleagues and interested parties. We are breaking down work based on barriers and how to address them. See below for examples of barriers identified:
• lack of data • poor care coordination • lack of clarity around EMTALA • lack of post-acute resources • lack of behavioral health care • lack of housing • privacy and consent • defining a low acuity non urgent patient
Can you give us more detail on care coordination barriers? Thoughts on solutions to care coordination barriers? Other suggestions?
BJB:br Attachments:
1. ECSI Presentation 2. ECSI Flyer
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What will the Emergency Care Systems Initiative do?
1 Convene a Consortium All stakeholders must come together. This work will require the support
of LEMSAs, hospitals, doctors, ambulance companies, behavioral health providers, police, community partners, post-acute care providers and others. Hospitals cannot and should not try to solve the problem alone.
2 Gather Data and Information Who is coming to the emergency departments and why? Where are
there gaps in services in our communities? How do we connect people to the right care and services? We must get to the root of the problem and gather objective data.
3 Find Solutions Examining the findings and having input from all stakeholders will lead
us to solutions. There won’t be an easy answer. We must be innovative and consider new ways of doing things.
4 Take Action Our conclusions will help us drive policy. Armed with data, and the
consensus and support of stakeholders, we can promote changes to improve California’s overburdened emergency care system.
Emergency Care Systems Initiative
Californians Deserve the Right Care, at the Right Time, at the Right Place
Caring for patients in the appropriate setting can lower costs and improve patient well-being. It is the right thing to do for Californians.
Will you join in this work?
The Emergency Care Systems Initiative will require the commitment and participation of providers, thought leaders, advocacy groups, government agencies and others. We invite you to join California’s hospital associations in this important work.
Contact:BJ Bartleson, RN, MS, NEA-BC
Vice President, Nursing & Clinical ServicesCalifornia Hospital Association(916) [email protected]
Californians are turning to hospital emergency departments in
record numbers, often because they cannot get the care or
assistance they need elsewhere. These people are in need of
help, but many do not need emergency medical treatment.
How do we get people appropriate care and preserve emergency
departments for those truly needing life saving care?
It is a daunting question that demands our attention. It is a
societal problem that is compromising patient care, increasing
health care costs, and crippling hospital emergency services.
The time for action is NOW. 14 Million Visitswere made to California EDs in 2015
ED
Representing California’s 400 hospitals and health systems and 95 percent of patient beds
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The Solution: Open the door to accessCaring for patients in the appropriate setting can lower costs and improve patients’ well-being. Help preserve EDs for those truly needing emergent, life-saving treatment.
Emergency Care Systems Initiative
AvailableHealth Care
OptionsPatients
Primary Care
Behavioral Health/Substance Abuse
Supportive Services
AvailablePost-Hospital
Options
ED/Hospital
ED/H
Post-Acute and Rehabilitative
Services
Home and Community-Based
Services
Californians deserve the right care, at the right time, at the right place.
The Problem: Poor access, impacted Emergency DepartmentsWhen patients can’t get the care they need, they often turn to hospital emergency departments (EDs) as a last resort. However, hospital EDs are not the right place for many patients — particularly for individuals in need of behavioral health or substance abuse treatment. In addition, some patients stay in hospitals longer than necessary due to the lack of available post-acute care and supportive services in the community.
EmergencyDepartment
Health CareAccess Barriers
Post-Hospital CareAccess Barriers
Patients
Hospital
Community
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March 22, 2017 TO: Case Management Committee Members FROM: Debby Rogers, VP Clinical Performance and Transformation SUBJECT: Medicare Outpatient Observation Notice (MOON) and State Observation
Requirements Operational Issues/Questions SUMMARY Beginning March 8, 2017, the Centers for Medicare & Medicaid Services (CMS) hospitals, acute psychiatric hospitals, and CAHs are required to provide all Medicare eligible patients who receive outpatient observation services for more than 24 hours with a written Medicare Outpatient Observation Notice (MOON) and oral notification. CMS has posted frequently asked questions about the MOON, which provide more information about how to complete the MOON’s “free text field,” to address the reason patients are in outpatient observation care rather than inpatient care (attached). The FAQs also address alternate languages, modifying the form, and whether the form should be provided to Medicare Advantage enrollees. CMS has additional information posted on the CMS Beneficiary Notices Initiative (BNI) website and on page 2 of this memo): https://www.cms.gov/Medicare/Medicare-General-Information/BNI/index.html?redirect=/bni In addition, beginning January 1, 2017, state law requires hospitals to provide a written notice to a patient on observation status who is cared for in a hospital’s inpatient unit or in an observation unit, or following a change in a patient’s status from inpatient to observation. The notification must be provided as soon as practicable and must indicate that the patient’s care is being provided on an outpatient basis, which may affect his or her health care coverage reimbursement, but does not mandate a specific form. CHA has not identified conflicts between the state and federal requirements. Members are encouraged to share implementation experiences, challenges and triumphs, as well as policies and procedures. ACTION REQUESTED: Discuss and advise.
DR:br Attachment:
1. Medicare Outpatient Observation Notice Frequently Asked Questions 2. Medicare and State Requirements Crosswalk
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Observation Notification March 22, 2017
Page 2
Medicare Outpatient Observation Notice Frequently Asked Questions
March 8, 2017
Q1. How should hospitals and critical access hospitals (CAHs) complete the “You’re a
hospital outpatient receiving observation services. You are not an inpatient because:” free-text field?
A. The purpose of the MOON free-text field is to provide a clinical rationale for why the
beneficiary is receiving observation services as an outpatient and is not an inpatient.
Observation care is a well-defined set of specific, clinically appropriate services, which include ongoing short term treatment, assessment, and reassessment, that are furnished while a decision is being made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital. Observation services are commonly ordered for patients who present to the emergency department and who then require a significant period of treatment or monitoring in order to make a decision concerning their admission or discharge. The language provided in the free-text field should be reasonably understandable to the beneficiary and generally explain that:
• The physician has ordered outpatient observation services in order to evaluate the
beneficiary’s symptom(s) and diagnosis, if known; and • The beneficiary’s condition and symptoms will continue to be evaluated to assess
whether they will need to be admitted as an inpatient of the hospital or whether they may be transferred or discharged from the hospital.
Q2. Does CMS plan to provide specific language or examples for the free-text field? A. CMS does not plan to provide specific language or examples for the free-text field. We
reiterate that hospitals and CAHs are responsible for populating the free-text field with a clinical rationale specific to each beneficiary’s circumstances, based on the treating physician’s clinical judgment. The clinical rationale should be reasonably understandable to the beneficiary.
Q3. Are hospitals and CAHs permitted to use pre-populated check boxes for the “You’re a
hospital outpatient receiving observation services. You are not an inpatient because:” free-text field?
A. Yes, hospitals and CAHs may develop and use pre-populated check boxes with common
clinical explanations so long as a free-text field is retained for circumstances that do not fit within the pre-populated check boxes.
Observation Notification March 22, 2017
Page 3
Q4.Are psychiatric hospitals subject to the NOTICE Act requirement to deliver the MOON? A. Yes. Q5. Is the MOON available in an alternate language or format? A. The notice is available on the CMS website/Beneficiary Notices Initiative (BNI) webpage in
both English and Spanish and pdf and Word formats.
With regard to translating the MOON into additional languages and presenting the MOON in alternate formats, such as braille, we believe –
• Based on hospitals’ and CAHs’ responsibility to provide language assistance to limited
English proficiency (LEP) individuals, and consistent with section 1557 of the Affordable Care Act and section 504 of the Rehabilitation Act of 1973, hospitals and CAHs already have in place various procedures to ensure beneficiaries are able to understand Medicare notices.
• Hospitals and CAHs can further utilize those existing procedures to deliver the MOON. Q6. Is it permissible to adjust or modify the format of the MOON? A. Because the language in the MOON has been approved by the Office of Management and
Budget (OMB), providers may only modify the document text as per CMS guidance (e.g., the free text field). Providers also may not change standardized OMB-approved notice formatting, such as moving a signature line from the back to the front page of the MOON or continuing the MOON on a 3rd page.
Q7. Are hospitals and CAHs required to issue the MOON to Medicare Advantage enrollees? A. Yes, hospitals and CAHs must issue the MOON to beneficiaries in Original Medicare (fee-
for-service) and Medicare Advantage enrollees, in accordance with CMS guidance. Q8. What is the implementation date for the MOON? A. When CMS posted the finalized MOON and form instructions on the CMS website on
January 8, 2017, hospitals and CAHs were directed to begin using the MOON, no later than March 8, 2017.
Please refer to the CMS BNI page for the latest MOON implementation information: www.cms.gov/Medicare/Medicare-General-Information/BNI/index.html?redirect=/bni.
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Medicare and State Requirements for Observation Status Officiation
2.15.17
Subject CMS California
Facility type
Hospital, Acute Psychiatric Hospitals and Critical Access Hospitals
General Acute Care Hospitals
Definition of observation services
Observation services are “a well-defined set of specific, clinically appropriate services, which include ongoing short-term treatment, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital” (Section 20.6, Chapter 6, of the Medicare Benefit Policy Manual (Pub. 100–2).
“Observation services” means outpatient services provided by a general acute care hospital and that have been ordered by a provider, ‘to those patients who have unstable or uncertain conditions potentially serious enough to warrant close observation, but not so serious as to warrant inpatient admission to the hospital’ HSC 1253.7 (a).
Which patients need notification
Notification must be given to every eligible Medicare patient who stays in observation longer than 24 hours; even if the services provided are not covered by Medicare.
Notification given to all patients on observation status (which has been ordered by a provider) and are cared for in an inpatient unit or in an observation unit (not required for patients cared for in the emergency department).
Timely notification to patients
Required to be given to patient receiving observation services for over 24 hours but before 36 hours and must be given sooner if the patient is discharged, transferred or admitted before the 36 hours. CMS allows notification of patients who are in observation less than 24 hours (to be consistent with state laws), but does not require it.
Notification is required to be provided to patients cared for in an inpatient unit or in an observation unit as soon as practicable. Practicable is not defined in the law, but might be interpreted as feasible; give the notice as soon as feasible.
Verbal notice required Yes No
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Medicare and State Requirements for Observation Status Officiation
2.15.17
If an inpatient is determined to be an outpatient
Notification only applies to those patients when a provider orders observation, which could include following a change in a patient’s status from inpatient to observation. If the change occurs after the patient is discharged, then no notification is required because the patient’s status was inpatient.
Notification only applies to those patients when a provider orders observation, which could include following a change in a patient’s status from inpatient to observation.
Mandated form
Federal law requires the use of the Medicare Outpatient Observation Notice (MOON) form to notify Medicare eligible patients of their outpatient status. The MOON form must be used.
State law states “The notice shall state that while on observation status, the patient’s care is being provided on an outpatient basis, which may affect his or her health care coverage reimbursement.” State law does not prescribe a specific form. CMS states hospitals can use the MOON to notify non-Medicare patients.
Effective date March 8, 2017 January 1, 2017
State requirements for observation unit and corresponding nurse to patient ratio
MOON does not address
Observation unit are authorized but not mandated. Observation unit must have signs indicating it is an outpatient unit. Observation unit: 1:4 (same as ED). Patients receiving observation services in another hospital inpatient unit: the ratio for that unit applies (i.e. Med/surg 1:5; ICU 1:2). Hospital may care for patients receiving observation services on an inpatient unit or in the Emergency Department.
March 22, 2017 TO: Case Management Committee Members FROM: Pat Blaisdell, VP, Continuum of Care
Debby Rogers, VP Clinical Performance and Transformation SUBJECT: Hospital & Community Partnerships SUMMARY Committee members have expressed a strong interest in receiving information regarding non-hospital medical and home, and community-based services, and to discuss best practices and potential for effective partnerships, especially in the context of discharge planning. ACTION
For informational purposes. BACKGROUND During previous committee meetings, members have discussed the transition of patients to assisted living, including what kinds of patients can/cannot be cared for in assisted living, and issues affecting successful discharge. Heather Harrison, Sr., Vice President, Public Policy & Public Affairs, of the California Assisted Living Association (CALA), will attend the meeting to provide an overview of assisted living in California, and respond to questions. PB: rl
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March 22, 2017 TO: Case Management Committee Members FROM: Pat Blaisdell, VP Continuum of Care Debby Rogers, VP Clinical Performance and Transformation SUBJECT: Roundtable SUMMARY A goal of the CHA case management committee is to foster information sharing and discussion/identification of issues facing members ACTION REQUESTED To provide an opportunity for members to exchange and solicit feedback on issues of
shared interest.
To provide an opportunity for members to provide updates of interest. DISCUSSION Members are encouraged to bring questions and topics of interest for discussion at this meeting. PB: rl
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