Archive | Medicaid/Medicare Enrollment and Regulatory Compliance

Medicaid/Medicare enrollment and regulatory compliance

CMS Clarifies Qualifying Stay in VA Hospital

One of the main admission requirements for a skilled stay in a skilled nursing facility (“SNF”) is a three-day qualifying stay in an inpatient hospital.  In response to a question discussed on a recent Open Door Forum, the Centers for Medicare & Medicaid Services (“CMS”) released a memorandum discussing if a stay in a Department of Veterans Affairs Hospital (“VA Hospital”) can count as a qualifying stay for Medicare purposes.    Continue Reading →

CMS Five-Star Rating Report Shows Nursing Home Quality Rising

The Centers for Medicare & Medicaid Services (“CMS”) has rated nursing facilities since 2009 for three areas of performance: Health Inspections, Staffing, and Quality Measures. From 2009 through 2011, more than 40% saw an improvement in overall rating, while only around 27% had a most recent rating that was lower than the first.  Continue Reading →

CMS Issues Reminder Regarding 24-Hour Visitation

The Centers for Medicare & Medicaid Services (“CMS”) issued a Survey and Certification Letter as a reminder of current regulations (42 C.F.R. 483.10(j)) delineating the rights of long term care (“LTC”) residents to receive family and non-family visitors.  The current guidelines grant broad discretion to the residents with respect to visitation.  Facilities must provide 24-hour visitation rights to all individuals with the resident’s consent.  Continue Reading →

OCR Online

On July 12, 2013, CMS issued S&C: 13-46-ALL regarding changes for State Survey Agency (“SA”) obtaining OCR information from providers seeking initial enrollment in the Medicare program or for providers undergoing a change of ownership (“CHOW”).  In the past, the SAs would send the provider an OCR clearance request with the initial Medicare enrollment packet.  The SA must now offer the provider the option to answer all OCR clearance questions online.  These changes are effective July 15, 2013.

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CMS Publishes QAPI Toolkit and Other Resources

Originally due last Fall, the Centers for Medicare & Medicaid Services (“CMS”) has published the Quality Assessment and Performance Improvement (“QAPI”) Provider Toolkit and Provider Resources for skilled nursing facilities (“SNFs”).  These items have been published on a new CMS website dedicated to helping SNFs develop and implement a QAPI program, as required by the Affordable Care Act (“ACA”).   Continue Reading →

CMS Revises Policy as to Surveys to Be Conducted Following Complaint Investigations Resulting in Condition-Level Noncompliance

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.

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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. Continue Reading →

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: Continue Reading →

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.   Continue Reading →

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