All new consumers requesting or being referred for behavioral health services will, at the time of first contact, receive a preliminary screening and risk assessment to determine acuity of needs. That screening may occur telephonically. This point is not directly addressed in the guidance. A state may elect to count this as a visit when the service is delivered by a qualified practitioner. Under this demonstration, federal financial participation will continue to be provided only when there is a corresponding state expenditure for a covered Medicaid service provided to a Medicaid recipient.
Costs associated with care coordination are in direct expenses during the PPS rate development process, and therefore, are included in the PPS rate. To the extent HIT costs related to electronic health records are directly attributable to CCBHC services, the costs should be included as a direct, non-personnel cost. PPS includes the cost of the scope of services covered by the demonstration, including designated collaborating organization DCO costs.
PPS 2. No payment shall be made for inpatient care, residential treatment, room and board expenses, or any other non-ambulatory services, as determined by the Secretary; and. No payment shall be made to satellite facilities of [CCBHCs] if such facilities are established after [April 1, ]. To sign up for updates or to access your subscriber preferences, please enter your contact information.
Skip to main content. Mono Bar U. Main menu. PPS determines payment based on a classification of service. This patient classification method indicates groups of patients that would incur similar resource consumption, length of stay, and the costs generally incurred with this diagnosis to classify inpatient groups for payment.
Hospice has a per diem rate for each level of care such as routine home care, continuous home care, inpatient respite care, and general inpatient care.
Inpatient Psychiatric Facility IPF PPS classifications are based on a per diem rate with adjustments to reflect statistically significant cost differences.
A l ong-term care hospital LTCH is a hospital whose average inpatient length of stay is greater than 25 days. There is a potential for add-on payment adjustments for PPS classifications. Payment adjustments can be based on area wage adjustments, outliers in cost, disproportionate share adjustments, DRG weights, case mix and geographic variation in wages.
Hospitals may be eligible for an add-on payment if they are considered a disproportionate share hospital DSH , in that they care for a large percentage of low-income patients, or if they are an approved teaching hospital for indirect medical education IME.
Currently, PPS is based upon the site of care. Units of payment and payment adjustments may also result in different rates for similar patients depending upon where they are treated. This may influence providers to focus on patients with higher reimbursement rates. It is true that patients discharged in unstable condition had a higher likelihood of dying within 90 days of discharge 16 percent than did patients in stable condition 10 percent.
There was also a significant increase 43 percent in the number of patients discharged home in unstable condition, suggesting a potentially greater burden for families in providing home care.
However, the impact on mortality of discharge in unstable condition did not outweigh other quality improvements, because overall mortality fell. The study made two major recommendations. RAND research briefs present policy-oriented summaries of individual published, peer-reviewed documents or of a body of published work.
Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis.
RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. Mortality rates declined for all patient groups examined, and other outcome measures also showed improvement.
However, more Medicare patients were discharged from hospitals in unstable condition after PPS was implemented. Determining the seriousness of this problem requires further monitoring and study. Rogers, Katherine L. Kahn, Emmett B. Keeler, Ellen J. Reinisch, Marjorie J. Sherwood, Maureen F. Rubenstein, Robert H.
Brook, Carol P.
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