DAL Hospitals 15-10: Transitional Care Unit Demo Program

January 5, 2016

Dear CEO/CFO/Administrator:

This is a solicitation pursuant to Section 2802-a of the Public Health Law (PHL) for applications by general hospitals to operate transitional care units (TCUs) on a demonstration basis. A maximum of eight applications may be approved in addition to those previously approved. This letter explains the purpose of the demonstration program, the application process, and what will be required of providers selected to operate a TCU under the demonstration program. All applications and applicable fees shall be received by the Department by 5:00 PM February 5, 2016. Should eight applications for this demonstration program not be approved pursuant to this solicitation, an additional solicitation is contemplated.

Transitional Care Unit Purpose:

Section 2802-a of the PHL defines "transitional care" as sub-acute care services provided to inpatients of a general hospital who no longer require acute care inpatient services, but continue to need specialized medical, nursing and other hospital ancillary services and are not yet ready for discharge. TCUs should be limited in length of stay and designed to meet and resolve patients' specific sub-acute medical care needs. Discharges from these units are to be timely and appropriate.

The improvement of quality outcomes for the TCU population, through the provision of appropriate services delivered in the most efficient manner, is the primary goal of the TCU demonstration program. Hospitals selected for this program will be required to demonstrate an overall decrease in length of stay, quantify the clinical benefits of the program for TCU patients, and illustrate a synergistic relationship with long term care providers in the community. Collaboration between hospitals and nursing homes in local service areas will facilitate more efficient allocation of patients between the two settings.

In accordance with Section 2802-a of the PHL, all providers applying to participate in this demonstration program must meet all Conditions of Participation (COP) for skilled nursing facilities (SNFs), as defined under Title XVIII of the Federal Social Security Act (Medicare). In order to qualify for Medicare certification, providers must comply with Part 415 of Title 10 of the New York Compilation of Codes, Rules and Regulations (10 NYCRR).

As part of this demonstration program, specific State SNF regulations that may impede the development of TCUs or their ability to provide appropriate services to patients may be subject to waiver, at the discretion of the Department. Requests for waivers will be reviewed on an individual basis. In addition, the Department will periodically request information concerning the implementation of this section of the Public Health Law and the operation of transitional care units participating in the demonstration.

Applicants must demonstrate the need for any services proposed within the TCU and emphasize the benefits of such a program to a specific community, including, but not limited to, addressing the absence of sufficient post-discharge services in nursing homes and community-based care.

Transitional care units should be limited in length of stay and designed to meet and resolve specific sub-acute medical care needs. The expected average length of stay for patients served in a TCU ranges from five to not over 21 days, following a qualifying acute care stay. TCU services will be reimbursed at the applicable Medicare per diem SNF rate.

Transitional Care Unit Criteria and Requirements:

Section 2802-a requires that all providers applying to participate in this demonstration program meet all applicable requirements as defined under Title XVIII of the Federal Social Security Act (Medicare). Additionally, a TCU must:

  • Have a length of stay of not less than five days and not in excess of 21 days for
  • any individual patient;

  • Have a pre-opening survey, separate Medicare Number, and skilled nursing facility (SNF) certification;
  • Be staffed by qualified staff dedicated to the TCU;
  • Serve patients who will benefit from active rehabilitation. (It is expected that patients will actively participate in three hours or more of Occupational Therapy/Physical Therapy/Speech Therapy, every day, either three hours consecutively or in combination between rehabilitative sessions); and
  • Collect information and submit reports to the Department on an annual basis to demonstrate an overall decrease in length of stay; quantify the clinical benefits of the program for TCU residents and illustrate a synergistic relationship with long term care providers.

Applications must address the configuration of the TCU. The Department will consider a range of bed size not to exceed 25; however the applicant must adhere to the following requirements:

  • Beds must be located at a single geographic location; and
  • Beds must be located contiguously within a distinct unit/space within the hospital.

Transitional Care Unit Application Process:

As provided for under PHL Section 2802-a, the Department is hereby soliciting applications from general hospitals to participate in the TCU Demonstration Program. Applicants shall complete relevant schedules of the Certificate of Need application, as indicated in attachments A and B, and upload the application via the New York State Electronic Certificate of Need system (NYSE-CON). The application must be submitted as a Full Review – Construction application. The Certificate of Need application can be found at http://www.health.ny.gov/facilities/cons/.

  • Attachment A lists the schedules required to demonstrate the applicant meets basic eligibility requirements.
  • Attachment B includes additional schedules required for review and instructions for completing such.

Those applicants with a cooperative agreement or Memorandum of Understanding with one or more skilled nursing facilities will be given priority in the review process.

Please note all applications should emphasize the benefits of a TCU demonstration to a specific community, including, but not limited to, the absence of sufficient post-discharge services in nursing homes and in home and community-based care; a detailed strategy for treating patients in TCUs and for achieving measurable outcomes; staffing patterns for the proposed TCU program or detailed plans for recruitment of staff upon approval of this project; and the discharge policies or procedures that will illustrate a purposeful discharge process.

Applications should be submitted via NYSE-CON by February 5, 2016. If you have any questions regarding submitting your application via NYSE-CON, please contact the Division of Planning and Licensure at NYSECON@health.ny.gov. Should you have any questions regarding the requirements for TCUs, please contact Michelle Louy at the Division of Nursing Homes and Intermediate Care Facilities (518) 408-1267.

Sincerely,

Keith W. Servis
Deputy Director
Office of Primary Care and Health Systems Management