Category: Long-Term Care

Indiana Changing the Way Residents Will Obtain Medicaid Coverage Beginning June 1, 2014 – Part 4: Indiana Publishes Final Rule on Changes to Indiana’s Administrative Code

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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…. Continue Reading →


Indiana Changing the Way Residents Will Obtain Medicaid Coverage Beginning June 1, 2014 – Part 3

On April 21, 2014, Indiana’s Family and Social Services Administration (“FSSA”) offered a webinar for nursing facilities to provide additional information on Indiana’s Medicaid changes and Qualified Income Trusts (also known as Miller Trusts). … Continue Reading →


Indiana Changing the Way Residents Will Obtain Medicaid Coverage Beginning June 1, 2014 – Part 2

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Indiana’s Family and Social Services Administration continues its efforts to communicate, address and refine questions and issues related to the upcoming Medicaid coverage changes. … Continue Reading →


Obama Budget Contains Numerous Post-Acute Care Cuts

President Obama introduced his fiscal year (“FY”) 2015 budget yesterday, and there are many proposed cuts to post-acute care providers.  Some of the highlights include a number of bundled payment initiatives, a $100 co-pay for home health patients not discharged from a hospital and re-admission penalties for skilled nursing facilities (“SNFs”) with high hospital re-admissions.  This information was provided to the Hall Render Post-Acute Practice Group from John Williams, who leads Hall Render’s Federal Advocacy Practice Group from the firm’s office in Washington, D.C. … Continue Reading →


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

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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

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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

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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 →