Category Archives: Continuing Care

Spring Cleaning – Dust Off Your Compliance Program Manual and Take Some Practical Steps to Reinvigorate Your Program.

Compliance program fatigue is nothing new. Over at least the last 15 years, health care organizations have jumped in head first, put together detailed manuals and taken the plunge. However, reimbursement cuts, quality initiatives, RACs, ZPICs, whistleblowers, physical plant renovations and simply significant industry challenges got in the way of sustaining an efficient and effective compliance effort. Health care organizations have also become desensitized to the barrage of compliance education, enforcement press releases, audits and reviews and other shock-value communications on the importance of regulatory compliance. In that vein, this very article may get lost in the shuffle, although, we hope it doesn’t.

An efficient and effective compliance effort with your organization is extremely important, if only as an insurance policy against government scrutiny. Additionally, the Patient Protection and Affordable Care Act of 2010, H.R. 3590 (“ACA”) includes requirements that CMS implement mandatory compliance program requirements for all providers and suppliers. In a distinct section of ACA, nursing home mandatory compliance programs were given a specific implementation timeline. Continue reading

OIG Issues Report Critical of SNF Care and Discharge Planning

On February 27, 2013, the Office of the Inspector General of the Department of Health and Human Services (OIG) released the results of a study of care and discharge planning by Skilled Nursing Facilities (SNFs).  The report found that over one-third of patient stays in 2009 failed to meet Medicare requirements in these areas.

SNFs are required to develop and provide services in accordance with a plan of care for each Medicare patient.  This must be a customized plan describing how the SNF will meet each patient’s medical, nursing and psychosocial needs, including measurable objectives and time tables for care.  However, the OIG survey found that SNFs either did not develop an adequate care plan or did not provide care in accordance with the plan 37% of the time.  Continue reading

New Proposed Rule Allows VA to Enter into Provider Agreements Exempt from FAR Requirements

On February 13, 2013, the Department of Veteran Affairs issued a proposed rule authorizing VA centers to enter into agreements for extended care services under existing Medicare and Medicaid provider agreements, thus exempting such providers from onerous federal contracting requirements. Extended care services include geriatric evaluation, nursing home care, domiciliary services, adult day health care, non-institutional palliative care, non-institutional hospice care, certain home health care services and respite care. Continue reading

OIG Report: Home and Community-Based Services in Assisted Living Facilities – Federal and State Compliance Deficiencies

On December 10, 2012, the US Department of Health and Human Services Office of the Inspector General’s (OIG) Office of Evaluation and Inspections issued a report (OEI-09-08-00360) entitled “Home and Community-Based Services in Assisted Living Facilities”.

The OIG conducted a review of 35 State Medicaid programs  from 2009 that are covered under 1915(c) waivers.  The 1915(c)  waiver allows State Medicaid programs flexibility through CMS’s waiver of certain State plan requirements.   The review identified the types of home and community-based services (HCBS) that are furnished for Medicaid beneficiaries, the number of beneficiaries that receive HCBS while residing in assisted living facilities (ALF), the annual cost of furnishing the HCBS, and whether the documentation of provider standards existed.  Continue reading

Connect with Benesch’s Health Care Practice at the NYSHFA’s 17th Annual Fall Education Conference, November 13-14, 2012

Members of our Health Care Practice will be attending and speaking at NYSHFA’s 17th Annual Fall Education Conference, November 13-14, 2012 in Troy, NY

Ari J. Markenson, J.D.,M.P.H. will be speaking in a session entitled – Negotiating Managed Care Contracts on Tuesday, November 13 at 1:15PM Continue reading

Veterans On Waiver Programs Get Larger Personal Allowance

On June 18, 2012, Judge Sandra Beck of the US District Court for the Southern District of Ohio sided with a group of  Veterans Affairs (VA) pension recipients in Ledford, et al., vs. Michael B. Colbert, director, Ohio Department of Job and Family Services, Case No. 1:10-cv-706.

Judge Beck  found that the Ohio Department of Job and Family Services (ODJFS) violated federal law by not providing recipients of the Medicaid assisted living waiver a $90 Personal Needs Allowance (PNA) in the patient liability calculation of their Medicaid budget when the individual is a recipient of VA Aid and Attendance benefits. Continue reading

OSHA – New Nursing Home and Residential Care Facility National Emphasis Program

On April 5, 2012, OSHA announced its new national emphasis program targeting nursing home and residential care facilities. This program is similar to the program OSHA embarked on in 2003-2004. However, the new program will also focus on workplace violence. The program is designed to address the protection of workers from serious safety and health hazards that are common in medical industries. National emphasis programs target specific hazards in an industry for a three-year period. This program will target nursing homes and residential care facilities in an effort to reduce occupational illnesses and injuries. Continue reading