Tag Archives: Nursing Homes

Medicare/Medicaid Requirements for Long-Term Care Facilities

On July 13, 2015, CMS issued a much-anticipated proposed rule seeking to consolidate the long-term care (LTC) facility participation requirements for the Medicare and Medicaid programs. This major proposal marks the first comprehensive changes to the LTC conditions of participation since 1991. As noted by CMS, the revisions are designed to align with current clinical … Continue Reading

CMS Guidance on Beneficiary MA Drug Plan Disenrollments by Long Term Care Facilities

CMS has released guidance for long term care (LTC) facilities, including nursing facilities and skilled nursing facilities, on beneficiary disenrollments. According to the guidance, “CMS continues to see an unacceptable practice of LTC facilities disenrolling beneficiaries from Medicare Advantage prescription drug plans (MAPDs) and enrolling them into stand-alone drug plans (PDPs) without the beneficiary’s or … Continue Reading

GAO Calls for Expanded HHS Efforts to Reduce Antipsychotic Drug Use in Community Settings

The Government Accountability Office (GAO) has issued a report examining the extent to which antipsychotic drugs are prescribed for older adults with dementia in nursing homes and other settings. The GAO found that, according to Medicare Part D data, about one-third of older adults with dementia who spent more than 100 days in a nursing … Continue Reading

CMS Raises the Bar for Nursing Home Quality Ratings under “Nursing Home Compare 3.0″

CMS has made revisions to the measurements used in the Nursing Home Compare Five Star Quality Rating System that have resulted in a decline in the star rating for about one-third of nursing homes. Specifically, on February 20, 2015, CMS added quality measures regarding the use of antipsychotics, revised the calculation of nursing home staffing … Continue Reading

CMS Schedules Provider Calls on Medicare Payment, Quality, Coding & Program Integrity Topics

CMS has scheduled a series of provider calls in February and March on the following topics: February 3: Special Open Door Forum on the upcoming Prior Authorization of Non-Emergent Hyperbaric Oxygen Therapy model to be implemented in March in Illinois, Michigan, and New Jersey. February 4: Special Door Forum on the introduction of star ratings on … Continue Reading

CMS Call: National Partnership to Improve Dementia Care in Nursing Homes (Dec. 9).

On December 9, 2014, CMS is hosting a call to provide an update on the CMS National Partnership to Improve Dementia Care in Nursing Homes. The partnership focuses on continuing to reduce the use of unnecessary antipsychotic medications and other potentially-harmful medications in nursing homes and eventually other care settings.… Continue Reading

CMS to Revise Five Star Quality Rating System for Nursing Homes

CMS has announced that it will make a series of improvements to the Nursing Home Five Star Quality Rating System, including additional quality measures, new data verification processes, and a revised quality scoring methodology. Among other things: CMS will add a new quality measure on antipsychotic medication use starting January 2015, and include claims-based data … Continue Reading

OIG Reviews Nursing Facility Abuse/Neglect Reporting Practices

The OIG has issued a report reviewing the extent to which Medicare- and Medicaid-certified nursing facilities comply with federal requirements related to reporting allegations of resident abuse or neglect. For the purposes of this report, the OIG uses the term “nursing facility” (NF) to refer to both Medicare skilled nursing facilities and Medicaid nursing facilities. … Continue Reading

GAO Reviews Financial Characteristics of Applicants for Medicaid Nursing Home Coverage

The GAO has issued a report entitled “Medicaid: Financial Characteristics of Approved Applicants and Methods Used to Reduce Assets to Qualify for Nursing Home Coverage.”  The report highlights ways applicants in Florida, New York, and South Carolina reduce their countable assets to qualify for Medicaid nursing home coverage, including (1) spending countable resources on goods … Continue Reading

CMS Call: National Partnership to Improve Dementia Care in Nursing Homes (May 20)

On May 20, 2014, CMS is hosting another call to discuss the National Partnership to Improve Dementia Care in Nursing Homes, which includes as a goal reducing the use of unnecessary antipsychotic medications in nursing homes. This call will focus on efforts to monitor enforcement rates and track surveyor training completion; the role that activity … Continue Reading

Highlights from Reed Smith’s Post-Acute Care Conference

In early April, Reed Smith hosted an enlightening conference entitled "Reed Smith 2014 Washington Health Care Conference: Focus on Post-Acute Care" in Washington, D.C. The conference brought together a panel of experts to discuss episodic care, bundling models, and alternative payment and delivery systems, as well as other speakers to present from the perspective of investors and Capitol Hill. The conference was capped with a stimulating keynote address from American Enterprise Institute resident scholar Dr. Norman Ornstein on the current polarized nature of American politics, particularly in regards to national health policy.… Continue Reading

HHS OIG Identifies “Top 25″ Priorities

The OIG has released its “Compendium of Priority Recommendations,” which lists 25 priority issues for which the OIG has open recommendation and that, if implemented, would best protect the integrity of HHS programs. The 25 top priorities are as follows: Medicare Policies and Payments: address wasteful Medicare policies and payment rates for clinical laboratories, hospitals, and … Continue Reading

Reed Smith Hosting Washington Health Care Conference: Focus on Post-Acute Care on April 4, 2014 – One Week Left to Register

On April 4th, 2014, Reed Smith will host its inaugural Washington Health Care Conference at The Mayflower Renaissance Hotel in Washington, D.C. With a keynote from Dr. Norman Ornstein, this year's conference will focus on post-acute care, bringing together leading industry professionals for a discussion on several important issues. Limited seating is still available for this complimentary program. If you are interested in registering, please email Lindsay Korenich at lkorenich@reedsmith.com.… Continue Reading

OIG Assesses Adverse Events Among Medicare Beneficiaries in SNFs

The OIG released a report on March 3, 2014, “Adverse Events in Skilled Nursing Facilities: National Incidence among Medicare Beneficiaries,” that examines the national incidence rate, preventability, and cost of adverse events in skilled nursing facilities (SNFs). This report is an outgrowth of a series of studies about hospital adverse events. For purposes of this report, the … Continue Reading

CMS Call on Partnership to Improve Dementia Care in Nursing Homes (Feb. 26)

On February 26, 2014, CMS is hosting a call to discuss the National Partnership to Improve Dementia Care in Nursing Homes, which includes as a goal reducing the use of unnecessary antipsychotic medications in nursing homes. This call will focus on the role of surveyors in the implementation of the partnership, the importance of leadership, … Continue Reading

OIG Focuses on Hospitalization of Nursing Home Patients

A recent OIG report, "Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring,” examines the extent to which Medicare nursing home residents are hospitalized. The OIG found that in FY 2011, nursing homes transferred one quarter of their Medicare residents to hospitals for inpatient admissions in FY 2011, and Medicare spent $14.3 billion on these hospitalizations. Septicemia … Continue Reading

CMS Call on Dementia Care in Nursing Homes (Nov. 25)

CMS is hosting a call on November 25, 2013 to discuss progress to date in implementing the National Partnership to Improve Dementia Care in Nursing Homes. The partnership is focused on delivering person-centered, comprehensive, and interdisciplinary care and reducing the use of unnecessary antipsychotic medications in nursing homes. The target audience for the call is … Continue Reading

CMS Finalizes Medicare/Medicaid Requirements for Long Term Care Facilities Providing Hospice Services

On June 27, 2013, CMS published a final rule that revises the requirements that an institution must meet to qualify as a skilled nursing facility (SNF) in the Medicare program, or as a nursing facility (NF) in the Medicaid program with regard to hospice services. Specifically, the rule requires SNFs and NFs that chose to … Continue Reading

CMS Call on Improving Dementia Care in Nursing Homes (July 10)

On July 10, 2013, CMS is hosting a provider call on its National Partnership to Improve Dementia Care in Nursing Homes. This initiative focuses on delivering person-centered, comprehensive, and interdisciplinary dementia care, while reducing the use of unnecessary antipsychotic medications in nursing homes (and eventually other care settings).… Continue Reading

CMS Finalizes ACA Nursing Facility Closure Notification Rules

On March 19, 2013, CMS published a final rule that adopts, with technical changes and a few clarifications, a February 18, 2011 interim final rule implementing an ACA provision imposing notification requirements in connection with closure of a Medicare skilled nursing facility (SNF) or Medicaid nursing facility (NF). Under the rule, in the case of … Continue Reading

CMS Proposes Reforms to Reduce Provider Regulatory Burdens

The Centers for Medicare & Medicaid Services (CMS) published a proposed rule on February 7, 2013 that it estimates would save health care providers $676 million annually by streamlining unnecessary, obsolete, or excessively burdensome regulations and making reforms to the Clinical Laboratory Improvement Amendments of 1988 (CLIA). The provisions of the wide-ranging proposal would affect … Continue Reading

CMS Call to Focus on Improving Dementia Care in Nursing Homes (Jan. 31)

On January 31, 2013, CMS is hosting a call on its National Partnership to Improve Dementia Care in Nursing Homes. The partnership is focused on improving dementia care through the use of individualized, person-centered care approaches, which CMS hopes will reduce the use of unnecessary antipsychotic medications in nursing homes and eventually other care settings. … Continue Reading
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