SNF/Rehab/LTAC Facility Review

The concurrent review and discharge planning process for members admitted to a skilled nursing facility (SNF), rehabilitation (rehab) facility and long-term acute care (LTAC) facility is based upon a review of the provider treatment plan and member progress reports.

• The concurrent review process provides for an exchange of information with appropriate facility staff, practitioners and providers¹ regarding the member’s clinical status, progress and care during the inpatient stay. The information gathered assists with early identification of the member’s specific continuing care needs upon discharge.

Follow-up calls are made to members who are discharged home from the SNF/rehab/LTAC facility with home health care (HHC) needs to verify that:

• The member/caregiver received appropriate education prior to discharge.
• The member obtained all ordered equipment.
• The physician-ordered ambulatory services (HHC or outpatient services) were initiated.
• The member obtained all prescriptions and is taking the medications as ordered.
• The member has scheduled all physician follow-up appointments.
• The member/caregiver understands the provider’s treatment plan.
• The member/caregiver understands the benefits plan, including benefits for outpatient services.
• The identified community resource referrals were initiated.
• There is a plan (when appropriate) for the member’s return to work.
  

¹The term "provider", as defined in the Aetna Care Management Program description and National Care Management policy/procedure, is used collectively to mean a practitioner/professional who provides health care services and is usually required to be licensed, as defined by applicable law or regulation, and/or an organizational provider, an institutional provider and/or supplier of health care services, including behavioral health care organizations. Organizational providers include, but are not limited to, hospitals, nursing homes, skilled nursing facilities (SNFs), home care agencies and freestanding surgical centers (including freestanding abortion centers). Behavioral health organizations include, but are not limited to, mental health and chemical dependency hospitals, residential treatment facilities, and ambulatory settings, including partial hospital programs, intensive outpatient programs, crisis stabilization centers, clinics and community mental health centers. Behavioral health organizations can be freestanding or hospital based. Additionally, in networks where the Medicare Advantage products are offered, the organizational providers include laboratories, rehabilitation agencies (comprehensive outpatient rehabilitation facilities, outpatient physical therapy and speech pathology providers), renal disease services, outpatient diabetes self-management training providers, portable X-ray suppliers, rural health clinics and federally qualified health centers.