Transitional Care Unit - Frequently Asked Questions
1. DOH's original TCU demonstration solicitation, issued August 5, 2005, included rehabilitation services language that required important clarification, which DOH provided in a subsequent August 16, 2005 letter. Unfortunately, in the 2010 solicitation, DOH repeats the original rehabilitation language, without the necessary clarifying language. The clarifying language in the August 16, 2005 DOH letter stated, "Please be advised that the program does not mandate the provision of rehabilitative services. However, patients in a TCU who require rehabilitative services as part of their treatment plan should actively participate in therapy, and those services should be provided in combination with other specialized medical, nursing, or other hospital ancillary services that cannot be delivered in another health care setting." Does DOH intend that the 2010 solicitation reflect the clarification stated in the August 16, 2005 letter?
Response:This solicitation is consistent with the August 16, 2005 clarification letter. The TCU must ensure that the Medicare beneficiary receives all necessary care and services consistent with the Conditions of Participation for skilled nursing facilities as defined under Title XVIII of the Federal Social Security Act (Medicare).
2. The August 5, 2005 solicitation outlined that each patient in the TCU must "have a length of stay of not less than 5 days and not in excess of 21 days." The 2010 solicitation included this requirement as outlined in the August 5, 2005 solicitation, even though the August 16, 2005 DOH letter clarified that "The expected average length of stay for patients served in a TCU ranges from 5 to 21 days, following a qualifying acute care stay." The TCUs' experience since 2005 demonstrates that these fragile and complex patients' circumstances and discharge plans can change unexpectedly, extending their length of stay in the TCU. Although unexpected circumstances can cause an individual patient's stay to fall outside of the 5- to 21-day range, a unit's average length of stay can be within this range. Will DOH provide written clarification to the 2010 solicitation that the length of stay criteria is "an expected average length of stay of not less than 5 days and not in excess of 21 days?"
Response: TCU average stays are expected to range between 5 and 21 days. Reimbursement for each stay is based solely on the Medicare per diem SNF rate. TCUs will not be reimbursed under Medicaid.
3. Can you provide the names of those general hospitals that have submitted applications to participate in the TCU demonstration?
Response: The Department is accepting applications through November 1, 2010. At this time, we are unable to identify interested TCU applicants.
4. We are considering applying for the TCU project. Do the beds physically have to be located at the hospital? Could, for example, we partner with a nursing home and place the TCU unit at the nursing home?
Response: Subdivision 1 of section 2802-a of the Public Health Law, as added by section 87 if Part B of Chapter 58 of the Laws of 2005, is amended to read as follows: 1. Notwithstanding any other provision of the law to the contrary, the Commissioner is authorized to approve up to eighteen general hospitals with the state to operate transitional care units by and within such general hospitals. For purposes of this section, "transitional care" shall mean sub acute care services provided to patients of a general hospital who no longer require acute care general hospital inpatient services, but continue to need specialized medical, nursing and other hospital ancillary services and are not yet appropriate for discharge.
5. The schedules requested from applicants for this solicitation are different from the 2005 solicitation. Please clarify.
Response: The schedules requested were changed.
6. If a person is admitted to the TCU and later requires long term care placement for continued sub acute, will the person enter the skilled nursing facility with Medicare Day 21 – 100. Or will the person's stay start at Day 1 in a skilled nursing facility?
Response: If transferred to a SNF, the Medicare Beneficiary's stay will begin with the remaining number of Medicare allowable days following the TCU stay. The admission to the SNF will not constitute a new 100-day benefit period.
7. Presently our hospital has a 40 bed SNF. Are we eligible to apply for this program with an existing SNF?
Response: Hospitals with a SNF may apply for the TCU program. TCU beds must be contiguously located within a distinct unit/space within the hospital. The TCU unit must be separate and apart from the SNF.
8. Our hospital is interested in applying for a TCU but will not have sufficient space in the hospital for this service until we complete our building expansion plan in another 3 years. Would it be possible to receive a temporary exemption on this requirement and allow us to rent space in a nearby SNF to house the TCU? We would move it back on campus once the expansion is completed.
Response: The Department will not be providing exemptions to the requirement for the TCU project. When your facility's project is near completion, please feel free to contact the Department with respect to future solicitations involving the TCU project.
9. Are medical surgical beds required to be decertified in order to utilize them as transitional care beds?
Response: The provider must assure that the TCU beds are located contiguously within a distinct unit/space within the hospital. A decision to decertify medical surgical beds is a hospital's operational decision but is not required.
10. Can you identify the five (5) original TCUs approved by the State?
Response: The 5 original TCUs include:
- John T. Mather Memorial Hospital;
- Champlain Valley Physicians Hospital Medical Center;
- The Richard and Barbara Naclerio Transitional Care Unit at the Mount Vernon Hospital;
- United Health Services – Binghamton General Hospital; and
- Medisys Health Network operating the TCU at Jamaica Hospital Medical Center.
11. Must all patients have Medicare only as their primary payer, or could they be in a Managed Medicare program but disenrolled? [Added 09/2011]
Response: The TCU must ensure the Medicare beneficiary receives all necessary care and services consistent with the Conditions of Participation for skilled nursing facilities as defined under Title XVIII of the Federal Social Security Act (Medicare). Reimbursement for each stay is based solely on the Medicare per diem SNF rate. TCUs will not be reimbursed under Medicaid.
12. If patients meet the criteria for specialized medical, nursing services but they could not participate in 3 hours of rehab. daily, would they still meet the criteria for admission to the TCU? [Added 09/2011]
Response: Yes. For purposes of this section, "transitional care" shall mean sub-acute care services provided to patients of a general hospital who no longer require acute care general hospital inpatient services, but continue to need specialized medical, nursing and other hospital ancillary services and are not yet appropriate for discharge. The expectation is 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, but this is not explicitly required.
13. In what way does the concept of the TCU differ from the LTACH that are more common outside of NYC? [Added 09/2011]
Response: In accordance with Federal regulations, hospitals seeking to be excluded from the Medicare Hospital Inpatient Prospective Payment System for the first time as an LTACH must have a provider agreement with Medicare and must have an average Medicare inpatient length of stay (LOS) greater than 25 days, as provided under the existing regulations at 42 CFR 412.23(e)(1) and (e)(2)(i), which implement section 1886(d)(1)(B)(iv)(I)of the Social Security Act,. The Medicare Administrative Contractor (MAC) or Fiscal Intermediary (FI), as applicable, verifies whether the hospital meets the average LOS requirement.
The primary difference between the LTACH and the TCU are length of stay requirements. As noted above, the LTACH length of stay is greater than 25 days while the TCU requirement is less than 21 days. Secondly, the LTACH is considered an acute care hospital whereas the TCU is a skilled nursing facility under Medicare certification.
14. Are there any exclusionary diagnoses or treatments, such as patients requiring ongoing radiation therapy or hemodialysis? [Added 09/2011]
Response: The intent of the TCU is to provide services to individuals who are post acute but in need of treatment and services not typically available in nursing homes. The individual's prognosis is such that the TCU resident can be stabilized or rehabilitated within the prescribed length of stay requirements and transferred to a community setting or discharged to a traditional nursing home. Exclusionary diagnoses would be those for which these goals are not expected to be met.
15. Will there need to be an identifiable SNF or home care partner before the patient would be admitted to the TCU? [Added 09/2011]
Response: Hospitals submitting an application for a TCU must be able to demonstrate a synergistic relationship with long term care providers in the community. Additionally, collaboration between hospitals and nursing homes in local service areas will help bring about more efficient allocation of patients between the two settings. A function of discharge planning is to ensure that services are available and appropriate to meet the individual's needs prior to discharge from any inpatient setting.