CMS Moves Unskilled Medical Delivery Needs From SNF To Community

The Centers for Medicare and Medicaid (CMS) under section 1115a of the Social Security Act and Affordable Care Act have began pilot programming for Skilled Nursing Facilities (SNF).   This calls on CMS at the Federal level to facilitate innovative payment and service delivery models to reduce Medicare and Medicaid expenditures.  The focus is on optimal recovery while improving coordination, quality, and efficiency. 

The basic initiative discontinues payment at the level of skilled medical care for the provision of non-medical services.  Stronger assessment criteria now must record the skilled medical need for a Medicare reimbursed nursing home stay.  One pilot program option involves bundled payment for post acute care only.

The nursing home stay is triggered by a hospital stay. This time period must begin within 30 days of discharge from an inpatient setting.  Nursing homes (SNF) participating in the pilot program are reimbursed with a bundled payment method.  Bundled payment is reimbursement on the expected costs for a medically defined episode of care.  Discharge from the nursing home must occur within 30, 60, or 90 days of admission.

The challenge is for participating nursing homes to more effectively connect discharging seniors to community health organizations (https://homecarepath.sharepoint.com/Pages/default.aspx) that can provide for necessary chores , hygiene, groceries, and outpatient visits.   This is a piece of a top down approach to integrate community and inpatient delivery providers to improve care while reducing the out flow of public funds.

Home Care Path celebrates 4 years of successfully serving seniors in South Central Wisconsin


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 Home Care Path  www.homecarepath.com and the Wisconsin PATH ALONG model deliver an advanced supportive care service.  Helping seniors in the home, with clinic visits, at the hospital, nursing home and assisted living facility.  Helping seniors downsize with a move in to an adult child's home. 2014 rates are 20.00 per hour.  Simply call 608-432-4286 to schedule an interview.  We can be there when you are working.  We accept long term care insurance.  Services can be tax deductible.  Help with resources and the transition from private payment to public funded programming.  Valuing home and human life