In 2003, two fires in long-term care facilities resulted in 31 resident deaths. As a result of these two events, CMS analyzed the fire safety precautions in place in these facilities and determined that resident safety could be greatly improved by requiring that all long-term care facilities have automatic sprinkling systems installed throughout the buildings. Consequently, on August 13, 2008, CMS published a final rule that required all buildings with long-term care facilities must have automatic sprinkler systems installed throughout the facilities no later than August 13, 2013.

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The Patient Protection and Affordable Care Act (PPACA) requires all skilled nursing facilities (SNFs) and nursing facilities (NFs) to have an effective compliance and ethics program in place by March 23, 2013.  Unfortunately, the Centers for Medicare & Medicaid Services (CMS) has failed to publish final regulations covering these programs, as required under PPACA, by March 2012.

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Under the Bundled Payments for Care Improvement initiative, organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. The Centers for Medicare & Medicaid Services (CMS) hopes these models may lead to higher quality and more coordinated care at a lower cost to Medicare.   (more…)

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…)

On January 30, 2012, the Centers for Medicare & Medicaid Services (“CMS”) announced the new, lower prices that will go into effect July 1, 2013 in the substantial expansion of the Durable Medical Equipment, Prosthetics, Orthotics and Supplier (“DMEPOS”) Competitive Bidding Program. The Competitive Bidding Program prices will replace Medicare’s existing fee schedule amounts in selected areas with prices based on suppliers’ bids.  Medicare beneficiaries in 91 major metropolitan areas are expected to save an average of 45% for certain DMEPOS items as a result of these new prices. (more…)

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…)

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.

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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…)

The Federal Communications Commission (FCC) has just issued a release detailing the establishment of the Healthcare Connect Fund (the “Fund”) to reform and modernize its universal service program for health care.  Recognizing the importance of high-speed data connectedness for quality patient care and burgeoning  health care practices such as telemedicine, the FCC is expanding and reforming its existing Rural Health Care program.   (more…)

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.