Medicare Advantage Final Rule Includes Expedited Determination Process Changes for SNFs

See the section “Enhance Enrollees’ Rights to Appeal a Medicare Advantage Plan’s Decision to Terminate Coverage for Non-Hospital Provider Services” for details on expedited determination changes for Medicare Advantage residents. Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F) On April 4, 2024, the Centers for Medicare & …

CMS Survey Process Notice: Testing Risk-Based Survey Approach

Update: April, 2024 CMS consistently strives to improve the effectiveness and efficiency of our nursing home oversight and compliance programs to protect residents’ health and safety. In 2017, CMS implemented a new nursing home survey process across all states, in conjunction with the implementation of revised Requirements for Participation for …

OIG Takes a Close Look at Facility-Initiated Discharges With Two Reports

Report 1: Concerns Remain About Safeguards To Protect Residents During Facility-Initiated Discharges From Nursing Homes Issued on 03/29/2024 | Posted on 04/03/2024 | Report number: OEI-01-18-00251 Report Materials Why OIG Did This Review Facility-initiated discharges that do not follow Federal regulations can be unsafe and traumatic, leading to resident harm. CMS and State Long-Term Care Ombudsmen …

LTCSP Survey Resources: Surveyor Tools Updated

This ZIP file contains resources for surveyors conducting initial surveys under the Long-term Care Survey Process (LTCSP). It is a one-stop shop containing a multitude of reference materials that are provided to the surveyors going into facilities, including, for example, a document detailing their principles of documentation, a document showing …

HIPAA Alert: NJ Nursing Home Hit With $100,000 CMP for Not Providing Timely Access to Patient Records

Essex Residential Care, LLC, to pay $100,000 after failing to comply with HIPAA Right of Access The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR), announced a $100,000 civil monetary penalty against Essex Residential Care, LLC, doing business as Hackensack Meridian Health, West Caldwell Care …

FY 2025 SNF PPS Proposed Rule: CMS Seeks More Enforcement Power With CMPs

A survey finding of noncompliance with the Medicare and Medicaid requirements of participation may soon be a little more difficult for nursing homes to navigate without significant financial burden. In the March 28, 2024 Fiscal Year (FY) 2025 Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule, the Centers …

FY 2025 SNF PPS Proposed Rule: Four Key Proposals for NACs to Keep an Eye on

In the March 28, 2024 Fiscal Year (FY) 2025 Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) doesn’t propose the dizzying number of changes that ended up in the FY 2024 SNF PPS final rule. However, nurse assessment coordinators (NACs) …

MDS 3.0 Quality Measures: Start with the Basic Ingredients

Members: Free |  Non-members: $109Continuing Education: 1.25 CE hours Date: May 2, 2024Time: 2 pm ET, 1 pm CT, Noon MT, 11 am PTDuration: 75 minutesSpeaker: Jessie McGill, RN, BSN, RAC-MT, RAC-MTA Achieving desired Quality Measure (QM) outcomes is a lot like baking a loaf of sourdough bread—it takes time and patience, and so …

Maximizing Resident Wellness and Facility Compliance: Exploring Restorative Nursing Programs – March 28, 2024

Members: $22 |  Non-members: $44Continuing Education: 1.25 CE hours Recording Date: March 28, 2024Duration: 75 minutesSpeaker: Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC Restorative nursing isn’t solely focused on physical health; it’s also about enriching quality of life, preserving dignity, and fostering independence. Explore the transformative potential of restorative nursing programs (RNPs) and tap …