The Centers for Medicare & Medicaid Services (“CMS”) recently released a Survey and Certification letter updating the State Operations Manual (“SOM”) guidelines on surveys of deemed status long-term care (“LTC”) providers when the provider has been found to have a condition level instance of noncompliance, including immediate jeopardy (“IJ”), in a complaint survey. This change in policy only applies to “deemed status providers.” Deemed status is available when an approved accrediting organization (“AO”), separate from CMS, determines the provider is in compliance with Medicare conditions. This “deemed status” will largely exempt the provider from routine surveys by the State Agency (“SA”) but still requires the provider to comply with all applicable Medicare conditions. Nursing facilities are largely not eligible for deemed status; however, home health agencies (“HHAs”) and hospice and rehabilitation agencies are eligible.
Archive for the ‘Hospice’ Category
CMS Revises Policy as to Surveys to Be Conducted Following Complaint Investigations Resulting in Condition-Level Noncompliance
Sequestration Cuts Impact Nursing Homes and Post-Acute Care Providers
In a transmittal issued on April 5, 2013, CMS provided guidance on survey activities that will be affected by the sequestration cuts. The transmittal provides guidance on several areas that will have an immediate and potentially negative effect on nursing homes and post-acute care providers. These changes will affect the survey process as conducted by the state survey agencies.
MedPAC Releases Report to Congress, Suggests Broad Reforms to Post-Acute Landscape
The Medicare Payment Advisory Commission’s (“MedPAC”) March 25th Report to Congress outlines inefficiencies they believe exist in the post-acute world and lead to excessive Medicare payments to providers. MedPAC recommendations include Congress evaluate post-acute provider reimbursement and encourage use of the lowest cost mix of services necessary to achieve the best outcomes.
Sixth Circuit Determines Nursing Facility Must Prove Lack of Negligence with Missing Documents
In a suit brought against an Ohio nursing facility related to improper medication administration, the U.S. Court of Appeals for the Sixth Circuit allowed the use of res ipsa loquitur in finding a facility responsible for lapses in a resident’s medication regime. (more…)
HHS Announces First Settlement of HIPAA Breach Affecting Less Than 500 Individuals
On January 2, 2013, the Department of Health and Human Services (“HHS”) announced that it had reached a settlement with a hospice provider (“Hospice”) arising from potential violations of the Security Rule under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). HHS learned of the circumstances giving rise to the enforcement action through the notification provided by the Hospice to HHS under the Breach Notification provisions of the Health Information Technology for Economic and Clinical Health Act (“HITECH”). This is the first settlement for a breach affecting less than 500 individuals.
CMS Extends “Extraordinary Circumstances” Hospice Exemption
While hospices are required to ensure that substantially all core hospice services, including nursing services, are performed by hospice employees, hospices have been permitted to utilize contracted staff members to supplement hospice employees during periods of peak patient loads or extraordinary circumstances.
The Centers for Medicare & Medicaid Services (CMS) agrees the nation-wide shortage of hospice nurses has proven to be an “extraordinary circumstance” for many hospices, and has adopted a policy to permit the exemption for individual hospices that can demonstrate the impact of the shortage on their ability to provide care. Originally set to expire September 30, 2012, the ongoing nursing shortage has caused this policy to extend to September 30, 2014. (more…)
OIG Publishes Findings of Nurse Aide Criminal History Investigation
As part of the Patient Protection and Affordable Care Act (PPACA), the Office of the Inspector General (OIG) was mandated to submit a report to Congress evaluating the Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long Term Care Facilities and Providers (commonly referred to as the “Background Check Program”, herein the “Program”). The OIG recently published the findings of the first year of this investigation, establishing a baseline figure for future years. (more…)
OIG Publishes 2013 Work Plan
The Office of the Inspector General (OIG) has published their annual Work Plan for 2013. The Work Plan continues to identify compliance risk areas that subject Medicare and Medicaid providers to audit and enforcement initiatives. The Work Plan specifically targets skilled nursing facilities (SNFs), hospices, and home health agencies (HHAs). For all types of providers, the main goal of this Work Plan is to focus on measuring and quantifying the cost and quality of care. A brief overview of the OIG’s target areas for each provider type is listed below. (more…)
Internet-Based PECOS Improvements Increase Access to Information
The Centers for Medicare & Medicaid Services (CMS) implemented changes to Internet-based PECOS to allow providers easier access to information. The following enhancements are now available: (more…)
CMS Publishes Provider Compliance Map
Need a quick reference to find specific contacts at Medicare organizations that service your state? The Centers for Medicare & Medicaid Services (CMS) recently published an interactive Provider Compliance Group Map.
Should you have any questions, please contact:
Todd Selby at 317.977.1440 or tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com,
or your regular Hall Render attorney.
Topical Index
- Home Health (44)
- Hospice (40)
- Litigation and Risk Management (38)
- Long-Term Care (140)
- Medicaid/Medicare enrollment and regulatory compliance (70)