Administrative Memos

200301

FROM: Theodore O. Will, Chief Executive Officer
DATE: Dec 05, 2003
SUBJECT: Criteria For IPRO's Review of Medicare Cases At Long-Term Care Hospitals
IPRO CONTACTS:

Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment, extension 364
Alice Vallar, Senior Director, Medicare/Federal Health Care Assessment, extension 423

As you may already know, on August 30, 2002, the Centers for Medicare and Medicaid Services (CMS) published the Prospective Payment System for Long-Term Care Hospitals (LTCHs): Implementation and FY 2003 Rates Final Rule. One of the provisions of this final rule requires Quality Improvement Organizations (QIOs) to perform admission and quality reviews in LTCHs.

Beginning February 2004, CMS will begin to select Medicare cases for retrospective review for all QIOs including IPRO. An administrative memorandum describing the retrospective review categories will be provided shortly. IPRO is also planning a training session in January 2004 (details to follow) to help LTCH staff understand the clinical aspects of the QIO review process.

In anticipation of these review activities, enclosed please find a copy of CMS approved Long-Term Care Hospital Screening Criteria that was developed by MassPRO, the support QIO for this program. This criteria will be used by IPRO's non-physician reviewers (i.e., Registered Nurses) when conducting review.

Should you have any questions or require additional information, please do not hesitate to contact Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment, extension 364 or Alice Vallar, Senior Director, Medicare/Federal Health Care Assessment, extension 423.