Category Archives: Post Acute Care

CMS Issues Guidance on CPR in Nursing Facilities

The first Survey & Certification memo for nursing facilities was issued for Fiscal Year 2014 on October 1, 2013. S&C 14-01-NH requires nursing facilities to adopt a policy that implements basic life support measures such as basic CPR for residents in accordance with the individual resident’s advance directives. Some nursing facilities have previously adopted a policy that when a resident is found without vital signs and the resident was a full code, the facility called 911 and waited for a response from the emergency personnel. CMS has affirmatively stated that the facility implement CPR when cardiac arrest occurs for residents in accordance with their advance directives and merely waiting for emergency personnel to respond to the 911 call is inadequate. CPR certified staff must be available at all times to provide CPR when necessary. Facilities will be cited under F155 for violating a resident’s right to formulate an advance directive if the facility does not develop and successfully implement policies and procedures to assure that residents will be resuscitated in accordance with their individual advance directives.

You can find a copy of  the letter here —> S&C 14-01-NH

For more information on the Survey Letter or related issues, please feel free to contact Janet Feldkamp or any member of our health care practice group for a further discussion.

CMS Announces Discontinuance of the HHABN in Transmittal 2782

On September 6th, 2013, in its Transmittal 2782, CMS announced the discontinuance of the use of the HHABN.  Advance Beneficiary Notices of Noncoverage or ABNs are required to be issued by providers in order to inform medicare beneficiaries about possible non-covered services/charges. Transmittal 2782 announces that home health agencies (HHAs) will  discontinue the use of HHABNs (Form CMS-R-296, the specific form for HHAs) and starting in December will use the ABN (Form CMS-R-131) for liability notification. The transmittal provides instructions for HHAs on the use of the ABN and also provides some clarification to the manual instructions on ABNs  in Medicare Claims Processing Manual (Pub. 100-04), Chapter 30, Section 50.

You can find a copy of the transmittal at here –> CMS Transmittal 2782

New Regulation Imposes Requirements on Agreements between Nursing Homes and Hospice Partners

Nursing facilities and skilled nursing facilities (collectively, “Nursing Homes”) will need to enter into written agreements, or revise existing agreements, with hospice providers, as well as implement new policies and procedures to meet the requirements of a final rule promulgated by the Centers for Medicare & Medicaid Services (“CMS”). The final rule, which can be found in the Federal Regulations at 42 CFR § 483.75(t), requires agreements between Nursing Home facilities and hospice providers to specifically address the roles and responsibilities of each entity and designate individuals responsible for oversight of related policies and procedures. Continue reading

CMS Proposed Rules for Immediate Jeopardy Situations for Providers Other than SNFs and NFs

In the April 5th Federal Register, the Center for Medicare and Medicaid Services (CMS) proposed new rules relating to immediate jeopardy situations for providers or suppliers that are not Skilled Nursing Facilities (SNFs) or Nursing Facilities (NFs). The proposed rules were published in April of 2013 in the Federal Register and generally apply to the oversight of accrediting organizations, but CMS also proposed a changed to the rule on providers and suppliers, other than SNFs and NFS, with deficiencies. Continue reading

OIG Issues Report Finding Inconsistencies in Medicare Billing for Hospice Inpatient Stays

On May 3, 2013, the US Department of Health and Human Services Office of the Inspector General’s (OIG) Office of Evaluation and Inspections (OEI) issued a report (OEI-02-10-00490) entitled “Medicare Hospice:  Use of General Inpatient Care.”  The report found that while Medicare paid $1.1 billion for hospice general inpatient care (“GIP”) in 2011, there were unusual Medicare billing patterns for hospice inpatient stays, raising concerns about whether the stays were billed appropriately and whether the patients received the right level of care. Continue reading

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