Category: Regulations

SNF PPS final rule published, new payment model to begin October 1, 2019

It’s official: According to CMS’ Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule published in the Federal Register yesterday evening, the Patient-Driven Payment Model (PDPM)—the new case-mix methodology to replace RUG-IV)—is effective October 1, 2018. Facilities will have a year to transition to PDPM from RUG-IV by the October 1, 2019 implementation date. […]

Interoperability and post-acute implications

Editor’s note: This post has been republished with permission from the author, Reg’s blog. CMS stance/policy on interoperability among providers and the resultant debate are rather interesting. I encourage clients and readers to tune-in on this subject as the positive and negative implications are sweeping. Interoperability in this context means the ability of computer systems […]

CMS updates quality measure table to align with revised CoPs

Brought to you by Home Health Line. CMS has recently posted an updated home health process quality measure table as a result of the revisions made to the timely initiation of care measure. The document was modified to further align with the revised Home Health Conditions of Participation (CoPs), which took effect Jan. 13. Under […]

CMS plans IMPACT Act frequently asked questions call for post-acute providers

Brought to you by Home Health Line. Learn more about the IMPACT Act and ask your questions of CMS officials during an upcoming Medicare learning call. CMS will address frequently asked questions on quality measures, standardized data elements, the CMS data element library and future directions of the IMPACT Act, according to the event description. […]

CMS asks Medicare insurance providers to monitor prescriptions of Neudexta

CMS is warning insurance providers to watch prescriptions of Neudexta for off-label use. Neudexta is a prescription meant to treat symptoms of pseudobulbar affect (PBA), which can cause uncontrollable laughter or crying. As CNN reports, prescribing for off-label use is not illegal, but creating a false diagnosis in order to secure coverage of the prescription […]

Equip your leadership teams to achieve compliance and navigate CMS regulatory changes

The evolving post-acute care industry landscape introduces greater accountability, a heightened focus on patient outcomes, and significant payment reform for skilled nursing facilities (SNFs). Building solid processes and systems is critical for staying compliant under the numerous Centers for Medicare & Medicaid Services (CMS) regulatory changes effective at the beginning of each new fiscal year. […]

Skilled nursing facility fined for denying opioid-dependent patient

A Massachusetts skilled nursing facility was fined $5,000 after denying admission to a potential resident because he was taking Suboxone, a medication for the treatment of people who are dependent on opioids. Although the facility, Charlwell House located in Norwood, MA, created policies in December 2016 stating that the facility would maintain the use of […]

Top 10 F-Tag citations in long-term care

According to Harmony Healthcare, the top 10 F-Tags in the January 2018 CASPER are the following. This list is based on standard surveys of nursing homes, and does not include complaint or special focus surveys. For help on survey compliance and citation avoidance, check out Survey Success for Long-Term Care: Reducing Citation Risk. Top 10 […]

CMS outlines some soon-to-be covered services in memo on Medicare Advantage

Brought to you by Home Health Line. In-home support services and adult day care services are on the list of supplemental benefits to be allowed under Medicare Advantage plans in 2019, according to a recent CMS memo. Home-based palliative care, support for caregivers of enrollees, medically-approved non-opioid pain management, stand-alone memory fitness benefit, home bathroom […]

CMS releases FY 2019 proposed rule, includes RCS-1 replacement

CMS has posted a proposed rule for FY 2019. The proposal not only changes payment rates, but also proposes a new case mix grouping called the Patient-Driven Payment Model, or PDPM. This model replaces the RCS-1 that was proposed in May of last year. According to CMS, this new system has 80% fewer groupings and […]