Tag Archives: Skilled Nursing Facilities

GAO Calls for Easier Public Access to SNF Expenditure Data

The Government Accountability Office (GAO) recently issued a report highlighting concerns with the public accessibility and reliability of skilled nursing facility (SNF) expenditure data collected by CMS. While CMS has posted raw SNF cost report data in accordance with a statutory mandate, the GAO believes the data’s format, volume, and organization makes it difficult for … Continue Reading

New OIG Investigations to Look at Wide Range of Medicare, Medicaid Services in FY 2017

The HHS Office of Inspector General (OIG) has issued its FY 2017 Work Plan, which lays out the OIG’s current audit, evaluation, and other legal and investigative priorities. The largest number of new initiatives by far target Medicare Parts A and B, including reviews focusing on the following: Skilled nursing facility (SNF) issues, including:  complaint investigations; … Continue Reading

CMS Finalizes Major Changes to Medicare/Medicaid Requirements for Long-Term Care Facilities

On September 28, 2016, the Centers for Medicare & Medicaid Services (CMS) released a highly-anticipated final rule to strengthen requirements that long-term care (LTC) facilities must meet to participate in the Medicare and Medicaid programs.  The sweeping rule – more than 700 pages – is intended to improve the safety, quality, and effectiveness of care … Continue Reading

CMS Finalizes Emergency Preparedness Requirements for Medicare/Medicaid Providers

The Centers for Medicare & Medicaid Services (CMS) has released a long-awaited final rule establishing emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers to ensure that they can meet the needs of patients and residents during emergency situations, both natural and man-made. According to CMS, the final requirements “establish a comprehensive, consistent, flexible, … Continue Reading

HHS Inflation Adjustment Rule Hikes CMPs Across Department Programs

The Department of Health and Human Services (HHS) is increasing maximum civil monetary penalty (CMP) amounts applicable to HHS agencies and programs, in compliance with the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 (which was part of the Bipartisan Budget Act of 2015).  The magnitude of the individual CMP increases varies depending … Continue Reading

CMS Adopts Final SNF PPS Rates and Policies for FY 2017

CMS has published its final rule to update Medicare skilled nursing facility (SNF) PPS rates and policies for FY 2017. CMS projects that the final rule will increase overall payments to SNFs by $920 million, or 2.4%, compared to FY 2016 levels (and compared to the $800 million/2.1% increase forecast in the proposed rule). The … Continue Reading

HHS Office of Civil Rights Releases Guidance for Long-Term Care Facilities Using the Minimum Data Set to Facilitate Opportunities to Live in the Most Integrated Setting

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has issued new guidance to help long-term care facilities comply with anti-discrimination obligations when they administer the Minimum Data Set (MDS) patient assessment tool so that the facilities’ residents receive care in the most integrated setting appropriate to their needs. Those … Continue Reading

CMS Releases Nursing Home Action Plan for 2016/2017

The CMS Survey and Certification Group has released its 2016/2017 Nursing Home Action Plan, which details the agency’s strategy for continuing to improve nursing home quality. The plan focuses on five strategies for quality improvement: (1) enhancing consumer awareness and assistance; (2) strengthening survey processes, standards, and training; (3) improving enforcement activities; (4) promoting quality … Continue Reading

CMS Releases Proposed Rule to Update SNF PPS Rates and Policies for FY 2017

CMS has published its proposed rule to update Medicare skilled nursing facility (SNF) PPS rates and policies for FY 2017. CMS projects that the proposed rule would increase overall payments to SNFs by $800 million, or 2.1%, compared to FY 2016 levels. This projected update is based on a proposed 2.6% market basket increase that … Continue Reading

CMS Finalizes Updated Fire Safety Standards for Health Care Facilities

On May 4, 2016, CMS is publishing a final rule amending fire safety standards applicable to the following types of Medicare- and Medicaid-participating health care facilities: hospitals, critical access hospitals, long-term care facilities, intermediate care facilities for individuals with intellectual disabilities (ICF-IIDs), ambulatory surgery centers (ASCs), hospices that provide inpatient services, religious nonmedical health care … Continue Reading

New DOJ “Elder Justice Task Forces” to Focus on Nursing Home Care Quality

The Department of Justice has created 10 regional Elder Justice Task Forces “to coordinate and enhance efforts to pursue nursing homes that provide grossly substandard care to their residents.”  The Task Forces are comprised of representatives from the U.S. Attorneys’ Offices, state Medicaid Fraud Control Units, state and local prosecutors’ offices, and various agencies that … Continue Reading

MedPAC Releases Annual Recommendations to Congress on Medicare Policy

The Medicare Payment Advisory Commission (MedPAC) has released its annual recommendations to Congress on Medicare policies, including Medicare fee-for-service (FFS) payment updates and a status report on the Medicare Advantage and Medicare Part D programs.  The following are highlights of the recommendations for 2017 (some of which were recommended previously):… Continue Reading

OIG Interim Evaluation of ACA LTC Employee Background Check Grant Program

The HHS Office of Inspector General (OIG) has issued an interim evaluation report on an Affordable Care Act (ACA) program that provides grants to states to implement background check programs for prospective long-term care employees.  According to OIG, 25 states currently are participating in the program at different stages (for instance, some have not yet … Continue Reading

CMS Call on IMPACT Act: Connecting Post-Acute Care across the Care Continuum (Feb 4)

On February 4, 2016, CMS is hosting a provider call on Improving Medicare Post-Acute Care Transformation (IMPACT) Act requirements regarding the reporting of standardized patient assessment data by post-acute care (PAC) providers (skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals). During this call, CMS and the Office of the National … Continue Reading

GAO Recommends Improved CMS Nursing Home Quality Oversight

The Government Accountability Office (GAO) recently issued a report, “Nursing Home Quality: CMS Should Continue to Improve Data and Oversight,” examining changes in reported nursing home quality and related CMS oversight activities. According to the GAO, three nursing home data sets—standard survey deficiencies, reported staffing levels, and clinical quality measures—indicate potential improvement in nursing home … Continue Reading

OIG Again Calls for Reforms to Medicare SNF Reimbursement Policy

The HHS Office of Inspector General (OIG) continues to question the appropriateness of payments to skilled nursing facilities (SNFs) under the Medicare SNF prospective payment system (PPS). Based on Medicare Part A SNF claims data and cost reports over the last decade and beneficiary assessments for fiscal years (FYs) 2011 to 2013, the OIG concluded … Continue Reading

CMS Corrects FY 2016 Medicare Payment Rules

CMS has released corrections to a number of fiscal year (FY) 2016 final Medicare payment rules. Specifically, on October 5, 2015, CMS is publishing corrections to: The final FY 2016 hospice payment update (to correct the hourly rate for continuous home care); The final FY 2016 hospital inpatient prospective payment system/long-term care hospital prospective payment … Continue Reading

CMS Extends Comment Period on Proposed Rule to Reform LTC Requirements

On September 15, 2015, CMS is publishing a notice extending by 30 days the comment period for its July 16, 2015 proposed rule entitled “Reform of Requirements for Long-Term Care Facilities.”  Specifically, the comment period has been extended from September 14, 2015 until October 14, 2015.  CMS notes that it is taking this step in response … Continue Reading

OIG Recommends Improvements to SNF Billing for Changes in Therapy

In FYs 2011 and 2012, CMS adopted new patient assessments for skilled nursing facilities (SNFs) that were intended to capture when beneficiaries start therapy, end therapy, and decrease or increase therapy. The HHS Office of Inspector General (OIG) has questioned the effectiveness of these complex policies, however, noting that SNFs reviewed often used the start … Continue Reading

CMS Publishes Final FY 2016 Update to SNF PPS Rates, Policies

On August 4, 2015, CMS published its final rule updating Medicare skilled nursing facility (SNF) PPS rates and policies for FY 2016.  CMS projects that the final rule will increase overall payments to SNFs by $430 million, or 1.2%, as compared to FY 2015 levels.  This update reflects a 2.3% market basket increase that is … Continue Reading

Final FY 2016 Medicare Payment Rules on the Horizon

Despite the recent flurry of activity on Medicare payment rules, more are in the pipeline. CMS has sent the final fiscal year (FY) 2016 Medicare skilled nursing facility, hospice, inpatient rehabilitation facility, and inpatient psychiatric facility payment rules to the White House Office of Management and Budget for final regulatory clearance. The FY 2016 final … Continue Reading
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