Category: Long-Term Care

Daughter Not Liable for Mother’s Skilled Nursing Facility Expenses Because She Had No Authority Over Finances or Access to Mother’s Finances

The Indiana Court of Appeals (“Court”) ruled that a daughter who signed a skilled nursing facility admissions agreement as her mother’s “responsible party” was not liable for her mother’s unpaid skilled nursing facility bill because the daughter did not have authority over her mother’s finances or access to her mother’s finances…. Continue Reading →

Indiana Changing the Way Indiana Residents Will Obtain Medicaid Coverage Beginning June 1, 2014 – Some Indiana Residents Need to Establish Certain Trusts to Maintain Benefits


On June 1, 2014, Indiana will change the way Indiana residents obtain Medicaid coverage in the age, blind or disabled categories.  Currently, when Indiana residents apply for Medicaid coverage, they are subject to state-specific restrictive criteria.   After June 1, 2014, Indiana residents will automatically be enrolled in Medicaid if the Federal Social Security Administration determines they are eligible for Supplemental Security Income.  This transition will eliminate Indiana’s Medicaid Spend Down Program.

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Proposed SGR Legislation Includes Significant Impact on Long-Term Care Hospitals


Last night the House passed, as part of the Ryan-Murray budget, a three-month patch to the Sustainable Growth Rate (“SGR”) formula that includes policy changes that significantly impact long-term care hospitals (“LTCHs”). The current SGR patch expires December 31, and this proposed legislation, titled the Pathway for SGR Reform Act of 2013 (the “Act”), is expected to pass the Senate shortly. Continue Reading →

CARES Act Introduced: Would Waive Three-Day Stay for Certain SNFs

The Creating Access to Rehabilitation for Every Senior Act of 2013 (“Bill”) was introduced this week by Representative James Renacci (R-OH) to the House.  This Bill proposes to waive the three-day qualifying stay requirement for admission to a skilled nursing facility (“SNF”) under Medicare.  … Continue Reading →

CMS Revises Citation Guidelines for Facilities Working Towards Sprinkler Compliance

The Centers for Medicare & Medicaid Services (“CMS”) just released a revision to their August Survey and Certification letter concerning the August 13, 2013 deadline for the installation of automatic sprinkler systems in nursing facilities. Originally, facilities that did not meet the deadline were subject to deficiencies at scope and severity (“S&S”) levels of D, E or F. Recognizing that some facilities are still in the process of compliance, CMS has enumerated 10 protections that, if in place, may permit the deficiency citation to be reduced to an S&S level of C…. Continue Reading →

Medicare Administrative Contractors Announce Intent to Review Hospice Claims


On October 30, two Medicare Administrative Contractors, Palmetto GBA and CGS, announced their intent to focus on certain hospice claims for patients located in Skilled Nursing Facilities (“SNFs”).

Palmetto GBA announced that it has identified top providers with a large number of beneficiaries receiving hospice services in SNFs, and it intends to initiate a service-specific investigation of claims for beneficiaries with non-cancer diagnoses.  While the claim’s timeframe is unknown, the investigation will be initiated in Jurisdiction 11, which covers home health and hospice services in Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, Tennessee and Texas.  Once complete, review results will be posted on the Palmetto GBA website and individual providers may be contacted for one-on-one education…. Continue Reading →

Filial Responsibility Law (Part 2) – Another Tool for Nursing Homes to Get Paid – Son Liable for Parents’ $104,276 Nursing Home Bill Under North Dakota Law


Recently, the North Dakota Supreme Court found a son liable for his parents’ $104,276 unpaid nursing home bill under North Dakota’s filial responsibility law. … Continue Reading →

CMS Deletes Certain Citations Under §483.70(a), Associated Tag F-454


Effective October 25, 2013, CMS deleted citations for tag F-454 under 42 C.F.R. §483.70(a) pertaining to Physical Environment—Life Safety From Fire.  CMS noted, because these requirements are covered under the Life Safety Code (“LSC”), there was a duplication of findings and, therefore, only needed to be cited under the appropriate LSC K Tag requirements.  This change will benefit providers in that survey deficiencies will be more accurately and more appropriately cited for alleged LSC violations…. Continue Reading →

CMS Issues Guidance on Survey and Certification Activities During Government Shutdown


Executive Summary

On October 1, 2013, the Centers for Medicare & Medicaid Services (“CMS”) released a Survey and Certification Letter (“S&C Letter”) that identified how the governmental shutdown (“Shutdown”) will affect state survey agency (“SA”) functions for all providers and suppliers. The S&C Letter delineates what SA functions are essential to ensure the protection of Medicare and Medicaid beneficiaries against immediate dangers to life and health and to prevent providers and suppliers from experiencing harm that would threaten their ability to provide vital health care services to Medicare and Medicaid beneficiaries. Continue Reading →

Revised RAI Manual Effective October 1

The most recent revisions to the Resident Assessment Instrument (“RAI”) User’s Manual became effective yesterday for all assessments with an assessment date on or after October 1.  The significant portion of the revisions addresses changes to therapy coding and swallowing and nutrition.  … Continue Reading →