Access to Post-Acute Care for Persons who Need Rehabilitation

1. Access to Post-Acute Care for Persons who Need Rehabilitation Trudy Mallinson, Ph.D., OTR/L Rehabilitation Institute of Chicago Northwestern University

2. Post-Acute Care Providers that Provide Rehabilitation Services Inpatient Rehabilitation Facilities (IRFs) Skilled Nursing Facilities (SNFs) Home Health Agencies (HHAs) Long-Term Care Hospitals (LTCHs) Other providers: Outpatient Comprehensive Outpatient Rehabilitation Facilities Adult Day Care

3. Post-acute Care Rehab Settings Medicare certification requirements vary by PAC setting e.g. IRFs (3 hrs therapy/day, 24hr medical supervision, 75% rule), SNFs (24hr nursing, limited MD, therapy hrs not specified) However, much of the the rehabilitation care provided is similar across settings and, Many patients could potentially be treated in more than one setting IRFs Generally hospital-based but may be freestanding (often referred to as PPS-exempt) In order to be Medicare certified: Regular medical supervision 3 hours of therapy services per day Potential to benefit from rehabilitation 75% of patients must have 1 of 10 primary diagnoses SNFs Also referred to as subacute facilities May be stand alone, attached to NH, or unit of acute care hospital In order to be Medicare certified: Require 24 hour nursing care Do not need regular physician supervision Therapy hours not specified (can be paid under Part B) HHC May be stand alone, operated by SNF, or acute care hospital In order to be Medicare certified: xxxxx LTCHs Freestanding or “hospital within a hospital” In order to be Medicare certified Same conditions of participation as acute care hospitals Average LOS must be greater than 25 days No patient requirements IRFs Generally hospital-based but may be freestanding (often referred to as PPS-exempt) In order to be Medicare certified: Regular medical supervision 3 hours of therapy services per day Potential to benefit from rehabilitation 75% of patients must have 1 of 10 primary diagnoses SNFs Also referred to as subacute facilities May be stand alone, attached to NH, or unit of acute care hospital In order to be Medicare certified: Require 24 hour nursing care Do not need regular physician supervision Therapy hours not specified (can be paid under Part B) HHC May be stand alone, operated by SNF, or acute care hospital In order to be Medicare certified: xxxxx LTCHs Freestanding or “hospital within a hospital” In order to be Medicare certified Same conditions of participation as acute care hospitals Average LOS must be greater than 25 days No patient requirements

4. Medicare Expenditures In the mid 1980s, care provided in post-acute care settings was considered a cost-effective alternative to extended hospital stays By the early 1990s, care in post-acute care settings, including IRFs, SNFs, and HHAs had become the fastest growing area of the Medicare program