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.
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:
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.