On June 27, 2013, CMS released the proposed home health prospective payment rule (the “PPS Rule”) for calendar year 2014. While refinements to the ICD-9-CM and discussions of ICD-10-CM implementation are of interest, the most notable change to the PPS Rule for 2014 is CMS’s long-awaited proposal for rebasing home health payments. Once it is in effect, rebasing will have a severe impact on home health reimbursement over the next four years. In addition to rebasing, the proposed PPS Rule addresses several other areas of the home health payment system. The proposed PPS Rule outlines certain home health quality reporting requirements beginning in 2014 and provides clarification regarding state Medicaid programs’ financial responsibility for state survey agency activities.
In Indiana, a spouse can be obligated to pay for medical care received by the other spouse under the doctrine of necessaries. The modern version of the doctrine of necessaries imposes limited secondary liability upon the financially superior spouse when the other spouse is unable to pay for his or her necessary expenses using their separate funds. The liability is secondary in the sense that it exists only if the debtor spouse is unable to satisfy his or her own personal needs or obligations. Continue Reading →
On July 1, 2013, a new law comes into effect in Indiana that dramatically impacts an individual’s ability to provide greater certainty with respect to his or her end of life care planning and offers a new advance directive to individuals. Indiana recently enacted a law, Indiana Code Section 16-36-6, that establishes the use of a Physician Orders for Scope of Treatment (“POST”) form. The POST form is intended to document a patient’s treatment preferences into medical orders that health care providers can follow.
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 →
In November 2011, the Office of Inspector General (“OIG”) initiated a study regarding the use of atypical antipsychotic drugs in nursing homes. The findings from the study indicated these types of drugs were being overprescribed to high-risk nursing home residents suffering from dementia; were being prescribed for uses not approved by the FDA; and were being inappropriately billed to Medicare. In an effort to reverse these trends, CMS has partnered with the Partnership to Improve Dementia Care in Nursing Homes, as well as other similar organizations, to protect and optimize the quality of life for this select nursing home population.
Please find below the frequently asked questions (“FAQs”) the Centers for Medicare & Medicaid Services (“CMS”) recently released concerning therapy caps and advanced beneficiary notice of noncoverage (“ABNs”).
Recently, the Centers for Medicare & Medicaid Services (“CMS”) released the results of a study of hospice general inpatient care (“GIP”) based on an analysis of Medicare Part A hospice claims for beneficiaries who received GIP in 2011. The intent was to identify suspected abuse of GIP in hospice inpatient facilities by hospice providers because this is the second most expensive level of hospice care. Continue Reading →
The Centers for Medicare & Medicaid Services (“CMS”) recently released a Survey & Certification Letter acknowledging the change in nomenclature for the professionals working in Intermediate Care Facilities for Individuals with Intellectual Disabilities (“ICF/IID”). Formally known as Qualified Mental Retardation Professionals (“QMRPs”), these professionals are now Qualified Intellectual Disabilities Professionals (“QIDPs”). QIDPs are required to integrate, coordinate and monitor the treatment programs for ICF/IID clients. Continue Reading →
The Centers for Medicare & Medicaid Services will publish the proposed fiscal year (“FY”) Medicare payment rate in the Federal Register later today. Announced last week, the proposed rate includes a 2.3% market basket increase; however, a forecast error correction and other mandated adjustments will reduce the market basket increase to 1.4%. This will still result in an estimated $500 million increase in the aggregate payments to skilled nursing facilities during FY 2014. The complete proposed payment rate rule is available in the Federal Register. Continue Reading →
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.