LongTerm Care Hospitals Questions

1
Long-Term Care Hospitals Questions Answers

• A Presentation of
• MassPRO
• The Health Care Quality
• Improvement Organization
• Presented by Janet Moroney, RN
• March 9, 2004

2
LTCH QAs

• Questions to date
• Approximately 50 submitted by e-mail
• More in informal phone calls
• None submitted to QUEST
• Written question statistics
• 33 about review
• 11 about random sample
• 13 about billing / other issues unrelated to
  review

3
LTCH QAs

• Q Will the results of the random sample review
  be used for CMS evaluation purposes in some way?

4
LTCH QAs

• A
• CMS has not shared intended use of results
• Previously stated, Evaluating this new program

5
LTCH QAs

• Q HINNs will be selected going back to October.
  Is that based on the discharge date?
• Q Will the selection of HINNs be based on
  beneficiary liability?

6
LTCH QAs

• A
• Selected for discharge dates back to October
• Based on beneficiary liability

7
LTCH QAs

• Q Should an acute care hospital issue a HINN if
  the patient needed to go to a LTCH but did not
  want to ?

8
LTCH QAs

• A No, because the patient still needed acute
  care.

9
LTCH QAs

• Q Should an LTCH issue a HINN if the patient
  needed to go to a SNF but did not want to ?

10
LTCH QAs

• A
• Yes.
• Same rules apply as with short-term acute care
• Patient may stay until SNF bed found
• Notice appropriate if patient refuses

11
LTCH QAs

• Q Please confirm the length of stay review.
• Should it be conducted on every case?

Q Is it CMS' expectation that we will do a
length of stay review?
12
LTCH QAs

• A Length of stay reviews are not mandated for
  LTCHs.

13
LTCH QAs

• Q What will the QIO be reviewing / validating in
  an interrupted stay review?

14
LTCH QAs

• A
• No specific review for interrupted stays
• You may see an interrupted stay during a random
  sample or any other type of review
• Key considerations
• Patient re-admission appropriate
• Principal diagnosis appropriate to 1st admission

15
LTCH QAs

• Q If the facility is a multi-type facility, what
  screening criteria should we use?

16
LTCH QAs

• A Use the criteria appropriate to the patients
  admission.

17
LTCH QAs

• Q Would the interrupted stay rule apply in
• this situation
• The patient is discharged to a SNF, doesnt like
  that SNF and is transferred to another SNF before
  being sent back to the LTCH (in fewer than 45
  days)? Since the level of care is the same
  between the 2 SNFs, wouldnt the interrupted rule
  apply?

18
LTCH QAs

• A The "interrupted stay" rule applies to
  FACILITIES, not level of care.

LTCH?SNF?LTCH Interrupted stay rule
applies LTCH?SNF?SNF?LTCH Interrupted stay rule
does not apply

• The return would be considered a second
  admission.
• Two separate DRG payments would be made.

19
LTCH QAs

• New Questions
• MassPRO is happy to answer questions
• E-mail to Janet at jmoroney_at_maqio.sdps.org or
  Sissie Friedman at sfriedman_at_maqio.sdps.org
• Submit to QUEST
• To locate existing LTCH questions, use LTCH as a
  search criteria
• Use the submit new question function to ask
  your question