Administrative Memos

200701

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jan 04, 2007
SUBJECT: Criteria for IPRO's Review of Medicare Cases at Long Term
IPRO CONTACTS:

Alice Vallar, Senior Director, Medicare/Federal Health Care Assessment, 516-326-7767, extension 423

The purpose of this memorandum is to make you aware that as of February 1, 2007, IPRO, the Quality Improvement Organization (QIO) for New York, will begin to utilize InterQual's Long Term Acute Care Criteria as the non-physician reviewer's screening tool for conducting Long Term Acute Care Hospital (LTCH) review.

As you know, IPRO has conducted Medicare LTCH admission necessity and coding/DRG validation reviews since February 2004 as part of the Centers for Medicare & Medicaid Services (CMS) Hospital Payment Monitoring Program (HPMP) initiative. At that time, CMS approved (but did not endorse or mandate) the use of Long-Term Care Hospital Screening Criteria that was developed by MassPRO, the QIO for Massachusetts. It should be noted that MassPRO served as the CMS-designated Support QIO (QIOSC) for implementation of LTCH review. IPRO's non-physician reviewers have used the "MassPRO LTCH Criteria" since 2004, however, MassPRO has recently notified the QIO community that it no longer plans to update or support the criteria. Therefore, effective with IPRO review dates occurring on and/or after February 1, 2007, IPRO non-physician reviewers will use InterQual long term acute care screening criteria for Long Term Care Hospital review.

Information about InterQual Criteria, proprietary criteria owned and licensed by McKesson Health Solutions, as well as a sample LTCH criteria set example is available on their website at www.InterQual.com.

Should you have any questions or require additional information, please do not hesitate to contact Alice Vallar, Senior Director, Medicare/Federal Health Care Assessment, 516-326-7767, extension 423.