Automatic Sprinkler System Requirement Now in Effect for Long-Term Care Facilities

On August 13, 2013, all nursing facilities participating in the Medicare and Medicaid programs were required to be in compliance with the automatic sprinkler systems’ regulation that was published in a final rule on August 13, 2008. The regulation provided a five-year phase-in program to allow long-term care facilities (“Facilities”) to achieve compliance by the August 13, 2013 deadline. Continue Reading →

Notification of Facility Closure Changes to State Operations Manual

On August 2, 2013, the Centers for Medicare and Medicaid Services (“CMS”) issued an update to the State Operations Manual (“SOM”) regarding the process for notification of a facility closure.  The updates to the SOM are the result of a final rule published in the Federal Register on March 19, 2013 and can be found at 42 CFR 483.75(r) and (s).  CMS noted that the August 2nd update to the SOM may differ slightly when published in the online version of the SOM. Continue Reading →

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 →

CMS Finalizes Written Agreement Requirements for Long-Term Care Providers and Hospices

The Centers for Medicare & Medicaid Services (“CMS”) recently issued the final rule for hospice agreements with long-term care (“LTC”) providers.  The rule requires LTC facilities to have written agreements specifying the respective roles and responsibilities for the hospice and LTC provider for any arrangements for the provision of hospice care within the LTC facility.   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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Rebasing Has Arrived – CMS Publishes Home Health PPS 2014 Proposed Rule

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.

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Indiana Case: Nursing Home Could Not Collect Wife’s Debt from Husband’s Estate under Doctrine of Necessaries

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 →

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