Skilled-nursing facilities (SNFs) have the staff and equipment to provide skilled nursing, medical management and therapy services to individuals, on a 24-hour basis, who do not require high-intensity services provided in the hospital setting.
The Department of Health and Human Services’ Office of Inspector General (OIG) has issued a report reviewing hospital admission rates for Medicare beneficiaries who live in nursing homes. According to the OIG, nursing homes transferred one-quarter of their Medicare residents to hospitals for inpatient admissions in fiscal year 2011, costing $14.3 billion.
Based on the results, the OIG recommended that the Centers for Medicare & Medicaid Services (CMS) develop a quality measure to capture the rate of nursing home residents who are hospitalized, and instruct state survey agencies to review the proposed quality measure as part of the survey and certification process. CMS agreed with the recommendation.
The Centers for Medicare & Medicaid Services (CMS) has issued to state survey agency directors information regarding CPR in nursing homes. CMS Survey & Certification memo 14-01-NH disallows nursing home policies that prohibit employees from administering CPR to residents. Effective Oct. 18, nursing facilities must provide basic life support to a resident who experiences cardiac arrest, in accordance with that resident’s advance directives or a do-not-resuscitate order. CPR-certified staff must be available at all times and must administer CPR prior to the arrival of emergency medical personnel. A copy of the memo is attached.
CHA has released a video statement from President/CEO C. Duane Dauner, thanking Governor Brown and the State Legislature for their leadership in enacting SB 239
(Hernandez, D-West Covina/Steinberg, D-Sacramento). The new law eliminates Medi-Cal cuts for non-rural hospital-based skilled-nursing facilities (rural facilities were exempted in August) and lifts a rate freeze that was harming health care providers struggling to treat some of the most medically complex patients. It also delivers more than $10 billion in new federal Medicaid funds to California hospitals over the next three years and will provide $2.4 billion in additional revenue to the state General Fund.
“SB 239 creates protections for the state, for patients, and for hospitals without any tax increases,” Dauner explains in the video. “In all, patients and Californians are the real winners.”
The California Department of Public Health has issued an All Facilities Letter (AFL) concerning Minimum Data Set 3.0 discharge assessments that have not been completed and/or submitted. The AFL provides information about recent communication from the Centers for Medicare & Medicaid Services, which is providing an opportunity for facilities to rectify any missing and/or incomplete discharge assessments. Beginning Oct. 1, 2013, MDS assessments older than three years will not be accepted. For more information, see the attached AFL.
The Department of Health Care Services (DHCS) announced yesterday that, under its planned implementation of the AB 97 rate reductions, rural distinct-part skilled-nursing facilities (DP/SNFs) will be partially exempted from pending Medi-Cal cuts. The facilities will not face the rate freeze at 2008-09 levels or a looming 10 percent reduction.
CHA President/CEO C. Duane Dauner commended the decision, saying, “The announcement will protect the state’s most vulnerable patients who live in rural areas by sparing these hospitals from previously announced 25 percent or greater cuts, and halting a rate freeze based on 2008-09 payment levels.”
CHA continues to work with DHCS to address the rate cut for non-rural DP/SNFs as well as the impact of the clawback, or retroactive recoupment, for all DP/SNF providers. The DHCS announcement is attached.
The California Department of Public Health (CDPH) has issued a reminder to skilled-nursing facilities (SNF) that optional services provided must be approved by the Licensing and Certification (L&C) program. SNFs must post a copy of the facility’s license, including a list of its optional services, in a location accessible for public view. Optional services are units within the SNF that provide specific types of care such as physical therapy, occupational therapy, speech pathology, audiology, social work services and special treatment program services. See the attached All Facilities Letter for more information on special approvals and requirements that must be met whenever a SNF adds, deletes or modifies an optional service.
The U.S. House of Representatives Ways and Means Committee has released draft legislation that includes several provisions affecting payment policy for post-acute care (PAC) services. The committee held a hearing on the topic on June 14.
The latest legislative proposals mirror PAC proposals put forth by President Obama in his FFY 2014 budget, as well as discussions by Simpson-Bowles and the Bipartisan Policy Commission. The committee’s draft legislation specifically addresses the following changes:
Reducing market basket updates for home health agencies, skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs) and long-term care hospitals;
Creating site-neutral payments between IRFs and SNFs for certain procedures;
Modifying the criteria required for IRF status (the so-called “75 percent rule”);
The Centers for Medicare & Medicaid Services (CMS) has issued the final rules for the inpatient rehabilitation facility (IRF) and skilled-nursing facility (SNF) prospective payment systems (PPS) for federal fiscal year (FFY) 2014. Provisions of the final rules go into effect Oct. 1.
Under the IRF final rule, CMS estimates that payments to IRFs will increase by 2.3 percent. In an improvement over the proposed rule, CMS makes some changes to its proposal to update the list of codes that may count toward an IRF’s “60 percent rule” compliance assessment using the presumptive test. CMS will remove fewer codes than originally proposed, and the shortened list of eligible codes will not take effect for one year. CMS also finalizes proposals and adds several new measures to the IRF Quality Reporting Program, and makes changes to the IRF patient assessment instrument.
The California Department of Public Health (CDPH) has issued a reminder that the California Minimum Data Set newsletters (California MDS Nuggets) are posted on the CDPH website. The MDS is a powerful tool offered by the Centers for Medicare & Medicaid Services (CMS) for implementing standardized assessment and for facilitating care management in nursing homes and non-critical access hospital swing-beds. The MDS 3.0 has been designed to improve the tool’s reliability, accuracy and usefulness, and to expand resident input during the assessment process. Visit the CDPH website to access other California MDS 3.0 information at www.cdph.ca.gov/programs/LnC/Pages/MDS.aspx. For more information on the MDS newsletters, see the attached All Facilities Letter.
Under a final rule recently issued by the Centers for Medicare & Medicaid Services (CMS), skilled-nursing and other long-term care facilities that provide hospice care through a Medicare-certified hospice provider must have a written agreement with the hospice specifying the roles and responsibilities of each entity. The goal of the rule is to improve the quality and consistency of hospice care for long-term care residents, and to reduce duplication by increasing care coordination and communication between the two types of providers. A copy of the rule is attached.
The Centers for Medicare & Medicaid Services (CMS) has issued a reminder to state survey agencies about access and visitation rights for residents for long-term care facilities (LTCs), including skilled-nursing facilities. The CMS memorandum reviews current interpretive guidelines that require that all individuals seeking to visit a resident be given full and equal visitation privileges, based on resident preference and within reasonable restrictions for resident safety. Residents must be notified of their rights to have visitors on a 24-hour basis, including but not limited to spouses (including same-sex spouses), domestic partners (including same-sex domestic partners), other family members and friends.
CHA has created a toolkit to help members gain allies in the fight against pending Medi-Cal cuts and impact the legislative and budget negotiations taking place in Sacramento. The toolkit is part of a comprehensive grassroots advocacy effort to defeat these cuts.