Stanford Med · Unit 5B Medicine·Day shift·Mon · 9:42 AM

Post-acute services library

Orthogonal care layers that attach to a disposition (setting)
A service is care that follows the patient to their chosen setting. Multiple services can attach to one disposition — a patient going Home may receive Home Health + Home DME + Outpatient Pharmacy + Remote Monitoring all at once. Each service has its own coverage, latency, and ordering rules. Unlike place of disposition, there is no single UB-04-equivalent service list, so this library groups services by CMS post-acute/provider concepts, benefit rules, and operational ownership.

A — Skilled clinical at home

Home Health
Skilled home visits under a home health plan of care
3 compatible settings

Skilled home visits (RN, PT/OT, SLP, MSW, HHA) per CMS-485 plan of care.

Attaches to dispositions
Home / self-care01Assisted Living FacilityMemory care / dementia unit
Who orders
Hospitalist + certifying physician (F2F)
Owns referral
Case Manager
Time to activate
24–48h (start-of-care visit within 48h of DC)
Documents
HH referral · F2F encounter note (CMS-485 elements) · Plan of care
Coverage at a glance
Medicare FFS
Part A — covered when homebound + skilled need (intermittent) + F2F encounter
Medicare Advantage
Covered with PA; benefit varies by plan
Medicaid
Covered in most states; auth required
Commercial
Covered per plan; visit limits + PA typical
Risk if missedStart-of-care lapse → CMS audit risk + readmit climb
cite: 42 CFR §424.22 (homebound + skilled + F2F)
Home Infusion
Specialty pharmacy and home infusion vendor
2 compatible settings

Specialty pharmacy + home-infusion vendor for IV antibiotics, chemo, immunoglobulin, TPN, hydration.

Attaches to dispositions
Home / self-care01Assisted Living Facility
Who orders
Hospitalist / Specialist (ID, Onc) + Pharmacy
Owns referral
Case Manager + Pharmacy
Time to activate
24–72h
Documents
Infusion order · PICC documentation · Auth packet
Coverage at a glance
Medicare FFS
Part B for drugs + DME pump; nursing visit limited
Medicare Advantage
Coverage varies; auth common
Medicaid
State-dependent; often requires PA
Commercial
Specialty pharmacy carve-out common (Accredo, CVS Specialty)
Risk if missedDischarge slips waiting for first home-infusion visit
cite: Medicare Part B DME + drug coverage · Specialty pharmacy network rules
Home dialysis
Peritoneal dialysis or home hemodialysis
2 compatible settings

Peritoneal dialysis or home hemodialysis — preferred modality for many ESRD patients per KDIGO. Avoids 3x/week clinic transport.

Attaches to dispositions
Home / self-care01Assisted Living Facility
Who orders
Nephrology + Dialysis home program
Owns referral
Case Manager + Nephrology + Dialysis training nurse
Time to activate
2–4 weeks (training + home setup) — accelerated for urgent starts
Documents
Dialysis prescription (PD or home HD) · Vascular access (HD) or peritoneal catheter (PD) documentation · ESRD form 2728 · Home assessment + caregiver training completion
Coverage at a glance
Medicare FFS
ESRD benefit (Part A/B); home dialysis training reimbursed at higher rate; supplies + cycler covered
Medicare Advantage
ESRD parity rules apply; home modality emphasized post-2021
Medicaid
Covered; state-specific supply coverage
Commercial
Per plan; home modality often preferred for cost
Risk if missedPatient routed to in-center HD despite home suitability; lifestyle / transport burden + cost.
cite: 42 CFR §494 (ESRD facility conditions) · KDIGO 2024 + Advancing American Kidney Health Initiative (2019 EO)
Palliative care
Symptom management without hospice election
4 compatible settings

Symptom-management + goals-of-care support delivered at home without hospice election. Patient can still pursue curative treatment — distinguishes from HOSPICE_OVERLAY which requires forgoing curative coverage.

Attaches to dispositions
Home / self-care01Assisted Living FacilityMemory care / dementia unitSkilled Nursing Facility03
Who orders
Hospitalist + Palliative care team
Owns referral
Palliative + Case Manager + Social Worker
Time to activate
3–10 days
Documents
Palliative consult note · Goals-of-care discussion · POLST if appropriate
Coverage at a glance
Medicare FFS
Limited (some MA SDOH benefits cover); MSSP ACO may fund
Medicare Advantage
Growing coverage 2024+ as palliative supplemental benefit
Medicaid
Some state Medicaid waivers (CalAIM Enhanced Care Mgmt in CA)
Commercial
Some plans cover; many require home health vehicle
Risk if missedPatient cycles through ED for symptom crises; no continuity of GOC conversation.
cite: Center to Advance Palliative Care (CAPC) standards · CalAIM Enhanced Care Management (CA-specific)

B — Ambulatory clinical

Outpatient PT / OT
Clinic-based therapy after discharge or after SNF
5 compatible settings

Post-acute therapy delivered in an outpatient clinic. Often continues after SNF or as alternative to home HH-PT.

Attaches to dispositions
Home / self-care01Skilled Nursing Facility03Assisted Living FacilityMemory care / dementia unitMedical respite / shelter
Who orders
Hospitalist or PCP + PT/OT clinic
Owns referral
Case Manager + PT/OT scheduler
Time to activate
3–7d (first appt)
Documents
Therapy order · First-visit plan of care
Coverage at a glance
Medicare FFS
Part B; threshold + medical necessity attestation past KX modifier
Medicare Advantage
Per plan; PA + visit limits common
Medicaid
Per state; visit limits
Commercial
Per plan; visit limits + PA
Risk if missedFunctional gains lost; readmission risk
cite: CMS Outpatient Therapy Cap rules + KX modifier
Outpatient pharmacy
Retail, specialty, refills, MTM, and meds-to-beds
7 compatible settings

Specialty pharmacy for high-cost drugs (PA-required tier 3-4) plus retail pharmacy refills. Meds-to-beds is the bridge.

Attaches to dispositions
Home / self-care01Assisted Living FacilityMemory care / dementia unitSkilled Nursing Facility03Custodial / Medicaid Nursing Facility04 / 64Hospice · home50Medical respite / shelter
Who orders
Hospitalist + Pharmacy
Owns referral
Pharmacy + Case Manager
Time to activate
Same day (meds-to-beds) to 72h (specialty pharmacy)
Documents
Discharge prescription · PA packet (if required) · Pharmacy of patient choice
Coverage at a glance
Medicare FFS
Part D (oral) + Part B (injectables); LIS for low-income
Medicare Advantage
MAPD plans; PA per formulary
Medicaid
Covered; preferred drug lists; PA per state
Commercial
Per plan; tier-based copay
Risk if missedPatient leaves without meds → ED return within 7d
cite: NCPDP SCRIPT 2017071 · Medicare Part D formulary rules · CMS-0057-F (PA streamlining)
Recurring NEMT
Non-emergency medical transportation for repeated visits
5 compatible settings

Wheelchair van / sedan for recurring outpatient visits (dialysis, infusion clinic, PT/OT, behavioral IOP). Single-trip NEMT for discharge is in the Logistics library; this is the recurring overlay.

Attaches to dispositions
Home / self-care01Assisted Living FacilityMemory care / dementia unitMedical respite / shelterCustodial / Medicaid Nursing Facility04 / 64
Who orders
Case Manager + transport broker
Owns referral
Case Manager
Time to activate
24–48h (first ride booking)
Documents
Recurring transport schedule · Broker authorization
Coverage at a glance
Medicare FFS
Generally not covered for routine outpatient (some MA SDOH benefits)
Medicare Advantage
SDOH benefit for transport common in 2024+ plans
Medicaid
Mandatory NEMT benefit in most states
Commercial
Generally not covered
Risk if missedMissed dialysis / IV abx / behavioral session → ED return
cite: 42 CFR §440.170(a) (Medicaid NEMT)
Behavioral outpatient
IOP, PHP, therapy, or SUD step-down care
5 compatible settings

Step-down behavioral services — Intensive Outpatient Program, Partial Hospitalization, or individual therapy after a behavioral inpatient stay or as standalone.

Attaches to dispositions
Home / self-care01Assisted Living FacilityMemory care / dementia unitMedical respite / shelterCustodial / Medicaid Nursing Facility04 / 64
Who orders
Psychiatrist + behavioral health team
Owns referral
Social Worker + Behavioral health CM
Time to activate
1–2 weeks (first appt; faster for IOP)
Documents
Behavioral health PA · ASAM assessment (SUD) · Therapy referral
Coverage at a glance
Medicare FFS
Part B + Mental Health Parity
Medicare Advantage
Carved-out behavioral health managed care
Medicaid
Covered; carved-out behavioral health managed care
Commercial
MHPAEA parity required; plan PA
Risk if missedRelapse → behavioral readmission
cite: Mental Health Parity Act (MHPAEA) · ASAM Levels of Care
Remote monitoring
Connected devices watched by a clinical team
3 compatible settings

Connected devices (CHF weights, CGM, BP cuff, pulse-ox) reporting back to a clinical team. Drives day-by-day re-evaluation post-discharge.

Attaches to dispositions
Home / self-care01Assisted Living FacilityMemory care / dementia unit
Who orders
Hospitalist or PCP + RPM vendor
Owns referral
Case Manager + Care coordinator
Time to activate
3–7d (device delivery + onboarding)
Documents
RPM enrollment · Device delivery confirmation · Patient education ack
Coverage at a glance
Medicare FFS
CPT 99453/99454/99457/99458 covered when initiated by qualified provider
Medicare Advantage
Per plan; supplemental benefit common
Medicaid
State-dependent
Commercial
Per plan; growing coverage
Risk if missedEarly decompensation invisible; readmission spike
cite: CMS RPM CPT codes 99453–99458
Wound care center
Specialty outpatient wound care and procedures
5 compatible settings

Specialty wound center — NPWT, hyperbaric oxygen, complex wound dressings, debridement. Distinct from HH skilled wound care for higher-complexity cases.

Attaches to dispositions
Home / self-care01Assisted Living FacilityMemory care / dementia unitSkilled Nursing Facility03Medical respite / shelter
Who orders
Hospitalist or PCP + Wound care specialist
Owns referral
Case Manager + Wound care RN
Time to activate
3–7d (first appt; faster for active infection)
Documents
Wound photo + Wagner/Wagner-Meggitt grade · Underlying condition documentation · Prior treatment course
Coverage at a glance
Medicare FFS
Part B; HBOT requires LCD-supported diagnosis (diabetic ulcer Wagner 3+, osteomyelitis, etc.)
Medicare Advantage
PA + medical necessity; HBOT often denied without diabetic foot ulcer criteria
Medicaid
Per state; wound center coverage variable
Commercial
PA + LCD-equivalent criteria
Risk if missedWound progresses to osteomyelitis or amputation; readmit.
cite: CMS LCD for HBOT (L33718) + wound care center accreditation standards
Community paramedicine
Mobile integrated health visits after discharge
4 compatible settings

Paramedic home visits for high-risk discharges — CHF weight checks, COPD assessments, post-op wound checks. Reduces ED return for low-acuity decompensation. Growing in CA post-2020.

Attaches to dispositions
Home / self-care01Assisted Living FacilityMemory care / dementia unitMedical respite / shelter
Who orders
Hospitalist or PCP + EMS agency
Owns referral
Case Manager + EMS coordinator
Time to activate
24–48h (first visit)
Documents
CP referral order · Standing protocol agreement (EMS agency) · Patient consent
Coverage at a glance
Medicare FFS
ET3 model demonstration (2020-2024); some MA plans cover
Medicare Advantage
Growing coverage as supplemental benefit
Medicaid
CA Medi-Cal CP program (Health & Safety §1797.18) — Bay Area pilots in SF, Alameda, Contra Costa
Commercial
Per plan; growing
Risk if missedPatient calls 911 for low-acuity issue; ED return.
cite: CMS ET3 model + CalEMSA Community Paramedicine Pilot (Health & Safety §1797.18)
Outpatient dialysis
In-center dialysis continuation after discharge
5 compatible settings

Hemodialysis or peritoneal dialysis at an outpatient unit (3x/week typical). Coordinates with NEMT_RECURRING for transport.

Attaches to dispositions
Home / self-care01Assisted Living FacilityMemory care / dementia unitSkilled Nursing Facility03Custodial / Medicaid Nursing Facility04 / 64
Who orders
Nephrology + Dialysis unit
Owns referral
Case Manager + Nephrology
Time to activate
Immediate (transition from inpatient HD) to 1–2d
Documents
Dialysis prescription · Vascular access documentation · ESRD form 2728
Coverage at a glance
Medicare FFS
ESRD benefit (Part A/B); 100% coverage after Medicare entitlement
Medicare Advantage
Per plan; ESRD parity rules
Medicaid
Covered; state-specific managed care
Commercial
Per plan; some plans carve-out ESRD
Risk if missedMissed session = uremia + ED return within 48h
cite: 42 CFR §494 (ESRD facility conditions) · KDIGO 2024 guideline

C — Equipment & supply

Home DME
Durable equipment delivered to the discharge setting
5 compatible settings

Oxygen, hospital bed, wheelchair, walker, CPAP, commode — anything the patient takes home as equipment.

Attaches to dispositions
Home / self-care01Assisted Living FacilityMemory care / dementia unitHospice · home50Medical respite / shelter
Who orders
Hospitalist + DME supplier
Owns referral
Case Manager + DME coordinator
Time to activate
1–3d (delivery window)
Documents
F2F encounter note · DME order · DMEPOS supplier accreditation
Coverage at a glance
Medicare FFS
Part B; F2F encounter required ≤6 months before order; 20% copay after deductible
Medicare Advantage
Per plan; PA common for high-cost items (vents, custom wheelchairs)
Medicaid
Covered; auth required for high-cost items
Commercial
Per plan; F2F + PA
Risk if missedDischarge slips waiting for O2 delivery / bed setup
cite: 42 CFR §410.38 (DMEPOS F2F + coverage)

D — Facility-level wrap

Hospice · all settings
Hospice services at home, ALF, SNF, or inpatient unit
7 compatible settings

Hospice services delivered wherever the patient is — home, ALF, memory care, SNF, or hospice IPU. The setting is the disposition; hospice is the service overlay.

Attaches to dispositions
Home / self-care01Assisted Living FacilityMemory care / dementia unitSkilled Nursing Facility03Custodial / Medicaid Nursing Facility04 / 64Hospice · home50Hospice · Inpatient Unit51
Who orders
Hospitalist + Hospice medical director (two certifications)
Owns referral
Palliative team + Social Worker
Time to activate
Same day with capacity
Documents
Hospice election · Two MD certifications · POLST
Coverage at a glance
Medicare FFS
Hospice benefit covers MD, RN, MSW, chaplain, meds, DME (42 CFR §418)
Medicare Advantage
Carved back to Original Medicare for hospice
Medicaid
Hospice benefit per state
Commercial
Per plan; carve-out common
Risk if missedPatient dies in acute setting; family / staff trauma
cite: 42 CFR §418 (Hospice benefit)
How this screen works
Services attach orthogonally to a setting — multiple per discharge plan
Inputs
What this screen reads
  • Disposition (setting) from the discharge plan
  • Skilled need + homebound status (HH)
  • F2F encounter note (DME, HH)
  • Comorbidity profile (DIALYSIS, RPM, behavioral overlay)
  • Cost & coverage funding paths (insurance vs charity vs manufacturer)
Engine
What it computes
  • Filters services by setting compatibility for the chosen disposition
  • Composes a discharge plan = { disposition, services[], fundingPaths[] }
  • Trigger rules library suggests services based on dx + comorbidity (CHF → RPM + DME + Outpatient Pharmacy)
Outputs
What it writes / routes
  • Cockpit DischargePlan card shows setting + attached services
  • Coverage matrix runs eligibility per service per funding path
  • Each service auth packet routes to its owner (HH agency, DME vendor, infusion pharmacy)
Refresh trigger
When it updates
  • Service eligibility changes (PA decisions)
  • Setting (disposition) changes (e.g. SNF → Home)
  • New comorbidity surfaces (e.g. AKI → dialysis)
Partners involved:Home Health agenciesSpecialty + retail pharmaciesDME vendors (Lincare / Apria / Parachute)Outpatient PT/OT clinicsHospice agenciesDialysis units (DaVita / Fresenius)Behavioral health (IOP / PHP providers)RPM platforms
Demo data · no PHI · mocked Epic + payer endpoints