The Affordable Care Act (ACA) and Medicare: Hospital Care Transitions

The Affordable Care Act (ACA), also known as “health care reform” was signed into law in March 2010. The law made several changes to health care, including programs to improve the quality of care that people receive when they leave the hospital. One program that is designed to do this is the ACA’s Community-Based Care Transitions Program. “Care transitions” occur when you leave a hospital and move to another place, such as your home or a skilled nursing facility. The ACA’s Community-Based Care Transitions Program (CCTP) aims to improve people’s care when they leave the hospital and to help people manage their health better and avoid going back to the hospital. If you are leaving the hospital, you may be able to get free help as you return home – see page 2 of this tip sheet for more information on CCTP services and participating hospitals in Illinois.

Hospital readmission is a major health care concern. A hospital readmission occurs when you leave the hospital and then return to the hospital for the same or related care within 30 days. One in five Medicare beneficiaries who leave the hospital are readmitted within 30 days. These readmissions cost Medicare more than $26 billion a year. Hospital readmissions can happen for many reasons, such as poor care coordination at the hospital or poor community support. The goal of the ACA Community-Based Care Transition Program is to improve patient care as people leave the hospital, so that they will not be readmitted.

The Community-Based Care Transitions Program (CCTP) was created by the ACA to improve care transitions and reduce hospital readmissions for high risk Medicare beneficiaries. A “high risk” Medicare beneficiary is someone who has medical conditions that are hard for the person to manage. (For example, some people who have conditions like heart disease or diabetes may have trouble taking care of these conditions.) In the CCTP, community-based organizations work with hospitals to help patients have a more positive experience when they leave the hospital. These organizations begin supporting patients at least 24 hours before they leave the hospital.

Who can get CCTP services?

·  Each CCTP program has its own requirements. To qualify, a person must have original fee-for-service Medicare (Part A and Part B) and may need to meet other rules, such as being a certain age.

How much will it cost?

·  There is no cost to you for the services.

Benefits you may receive

·  Follow up from a social worker or nurse

·  Help with managing your medications

·  In-home care to help you manage your conditions

·  Help developing knowledge, skills, and confidence to manage your medical conditions at home

AgeOptions is working with local community-based organizations in suburban Cook County to help older adults move safely from a hospital to their home or to a skilled nursing facility. Here are the organizations and hospitals involved in this project:

Community-Based Organizations / Hospitals
Aging Care Connections / Adventist La Grange Memorial Hospital
Kenneth Young Center / St. Alexius Medical Center
North Shore Senior Center / Advocate Lutheran General
PLOWS Council on Aging / Palos Hospital
Rush University Older Adults Programs / Rush University Medical Center
Solutions for Care / MacNeal Hospital

Three other CCTP projects exist in Illinois. Here are the organizations and hospitals involved in those CCTP Projects:

Lead Organizations / Hospitals
CJE SeniorLife (Chicago and suburban Cook County) / Northwestern Memorial Hospital
St. Joseph Hospital
St. Francis Hospital
Catholic Charities of the Archdiocese of Chicago (Chicago and suburban Cook County) / Ingalls Hospital
Little Company of Mary Hospital
Metro South Hospital
St. James Hospital
Community Research Resource Information Services for Seniors, Inc. (Central Illinois) / Carle Foundation Hospital
Provena Covenant Medical Center-Urbana
Provena United Samaritans Medical Center- Logan

For descriptions of these projects and others in each state visit this website:

http://innovation.cms.gov/initiatives/CCTP/CCTP-Site-Summaries.html

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