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 ‘Medicaid/Medicare enrollment and regulatory compliance’ Category
CMS Revises Policy as to Surveys to Be Conducted Following Complaint Investigations Resulting in Condition-Level Noncompliance
DMEPOS Round 2 Contract Suppliers Announced
The Centers for Medicare and Medicaid Services (“CMS”) announced today the contract suppliers for Round 2 and the national mail-order program of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (“DMEPOS”) Competitive Bidding Program. As of April 9, 2013, there are 799 suppliers that have been awarded contracts in this round, and these contracts will affect suppliers and beneficiaries in 91 competitive bidding areas. Additionally, CMS announced 18 suppliers that accepted contracts to provide mail-order diabetic testing supplies at competitively bid prices nationwide. (more…)
Final Rule Published Regarding Nursing Facility Closure Requirements
On March 19, 2013, the Centers for Medicare & Medicaid Services’ (“CMS”) Final Rule regarding notification and relocation requirements for closing a long-term care (“LTC”) facility was published in the Federal Register.
Under the new requirements, 60 days prior to the closure of an LTC facility, the administrator must provide written notice to the following: (more…)
Details on MedPAC Report on SNFs
The Medicare Payment Advisory Commission’s (“MedPAC”) recent Report to Congress included a chapter dedicated to skilled nursing facilities (“SNFs”), which MedPAC reports received $31 billion in Medicare reimbursement in 2011. Recently, SNFs have been under pressure from repeated reimbursement cuts; however, MedPAC’s analysis states that SNF reimbursement is adequate. (more…)
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.
CMS Announces New Bundled Payments Initiative, Participating LTC Providers
Today, the Centers for Medicare & Medicaid Services (CMS) announced that over 500 organizations will begin participating in the Bundled Payments for Care Improvement initiative. Through this new initiative, made possible by the Affordable Care Act (ACA), CMS will test how bundling payments for episodes of care can result in more coordinated care for beneficiaries and lower costs for Medicare. (more…)
Two Florida Home Health Agency Owners Plead Guilty to Fraud
On December 19, 2012 the Department of Justice announced the owners and operators of two Miami health care agencies pleaded guilty for their participation in a $48 million home health Medicare fraud scheme. According to plea documents, the owners conspired with patient recruiters for the purpose of billing the Medicare program for unnecessary home health care and therapy services. The owners and their alleged co-conspirators paid kickbacks and bribes to patient recruiters in return for these recruiters providing patients to Caring Nurse Home Health Corp. (“Caring Nurse”) and Good Quality Home Health, Inc. (“Good Quality”), as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. The owners used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for home health care services, which the owners knew was in violation of federal criminal laws. (more…)
CMS Distributes Free “Hand in Hand” Toolkit to Nursing Facilities
The Centers for Medicare & Medicaid Services (CMS) will soon be distributing a free toolkit to nursing facilities, CMS Regional Offices, and State Survey Agencies. Hand in Hand is a high quality training series for nursing homes that emphasizes person-centered care for persons with dementia, as well as the prevention of abuse. Section 6121 of the Affordable Care Act requires CMS to ensure that nurse aides receive regular training on caring for residents with dementia and on preventing abuse. Hand in Hand addresses the annual requirement for nurse aide training on these important topics.
More information is available on the Hand in Hand website.
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.
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…)
Topical Index
- Home Health (44)
- Hospice (40)
- Litigation and Risk Management (38)
- Long-Term Care (140)
- Medicaid/Medicare enrollment and regulatory compliance (70)