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 California Department of Public Health (CDPH) has issued an All Facilities Letter (AFL) to remind skilled-nursing facilities that its MDS newsletters, California MDS Nuggets, are posted on the CDPH website. The AFL also notes that the December issue includes significant changes to sections G, K and O of the Resident Assessment Instrument Manual released by the Centers for Medicare & Medicaid Services in October and November 2013. For more information, see the attached AFL and related newsletter.
The California Department of Public Health (CDPH) has issued the attached All Facilities Letter encouraging general acute care hospitals (GACHs) to assist in transferring patients to skilled-nursing facilities (SNFs) by ensuring their transfer documents include informed consent, specifically as it relates to psychotherapeutic drugs. In order for a SNF to accept a patient, the SNF must be able to verify that informed consent was obtained for any continuing psychotherapeutic drug prescriptions. The informed consent requirement for SNF admission is more broad than for GACHs and applies to all psychotherapeutic medications (e.g., antidepressants, mood stabilizers, anxiolytics, hypnotics, etc.). To facilitate timely and effective transfer of a patient between a GACH and a SNF, hospitals may choose to encourage appropriate staff (case managers, discharge planners, transferring physicians and providers) to include consent information for all psychotherapeutic drugs obtained from the patient or their designee as part of the patient’s transfer summary.
The California Department of Public Health (CDPH) has issued an All Facilities Letter (AFL) concerning the informed consent process for skilled-nursing facilities (SNFs). The AFL reaffirms that when SNFs admit a patient with “unchanged, preexisting orders for psychotherapeutic drugs, physical restraints, or the prolonged use of a device that may lead to the inability to regain use of a normal bodily function,” they must verify that the patient health records contain documentation that the patient gave informed consent for the order treatment. The AFL and updated FAQs are attached.
The Centers for Medicare & Medicaid Services (CMS) has approved State Plan Amendment (SPA) #13-034, exempting distinct-part skilled-nursing facilities (DP/SNFs) from the Medi-Cal payment reduction and rate freeze required by AB 97, passed in 2011. The restoration of the rates going forward is the result of provisions included in CHA-sponsored SB 239, passed by the state Legislature in 2013.
Approval of the SPA paves the way for implementation of full and unreduced 2013-14 rates, retroactive to Sept. 1, 2013, for DP/SNFs in designated rural or frontier areas, and retroactive to Oct. 1, 2013, for remaining DP/SNFs. CHA will provide additional information about the timelines for rate implementation as soon as it is available.
To clarify coverage policies following a recent settlement agreement, the Centers for Medicare & Medicaid Services (CMS) has revised portions of its Medicare Benefit Policy Manual on services provided by skilled-nursing facilities, inpatient rehabilitation facilities, home health agencies and outpatient therapy. Based on the settlement agreement, Jimmo v. Sebelius, CMS Transmittal 176 specifies that standards requiring potential for improvement may not be applied as a rule of thumb to determine Medicare coverage for services that require skilled-nursing care or skilled therapy services. It also provides guidance on appropriate documentation. CMS notes that the transmittal, attached, does not represent an expansion of benefits or a change in Medicare’s longstanding policy on the need for skilled-nursing care and skilled-therapy services.
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.