CMS: Hearings Related To State Survey Actions Must Be Filed Electronically

CMS has issued a survey and certification letter stating that effective October 1, 2014, providers that disagree with actions imposed on their agencies/facilities and want to request a hearing with an Administrative Law Judge in the Civil Remedies Division must submit their request electronically to the Departmental Appeals Board using the DAB E-File. Click here to see it. Petitioners must first become registered users to utilize the electronic filing system. The letter includes an attachment that provides instructions on how to register and use the DAB’s Electronic Filing System.

Please note, written requests for hearings delivered by postal delivery are no longer accepted unless the petitioner does not have access to the internet or a computer. In those instances, the petitioner may call the Civil Remedies Division and provide an explanation as to why they cannot file electronically.

Click here to read the letter.

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GAO: Small Percentage Of Medicaid Enrollees Cost The Most

According to newly released findings from the Government Accountability Office (GAO), only 5% of Medicaid-only eligible enrollees accounted for nearly 50% of the billions of government dollars paid in Medicaid-only eligible claims between 2009 and 2011. Unlike the high-cost 5% group, the least expensive 50% of Medicaid-only enrollees accounted for less than 8% of the expenditures for those enrollees. For fiscal year 2013, Medicaid expenditures totaled about $460 billion, covering 72 million enrollees -some of whom were eligible for Medicare, too. The GAO suggests CMS improve efforts to manage expenditures and facilitate improvements to care by identifying additional information about Medicaid-only eligible enrollees responsible for a high proportion of expenditures.

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Final Regulation Regarding SNF Hospice Contracts Released

HMS Healthcare Management Solutions has learned the final regulation requiring nursing facilities and skilled nursing facilities to have contracts with hospices (mirroring the requirement in the 2008 Hospice Conditions of Participation) has been released.  It is set for publication in the Federal Register tomorrow and will be effective 60 days from publication.

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AMA To Challenge SNF Care Prerequisite

Earlier this week, delegates of the the American Medical Association (AMA) approved plans to change the 72-hour hospitalization requirement for Medicare Part A coverage of skilled nursing facility (SNF) care. The resolution asserts Medicare should immediately cover a SNF stay if a physician determines its the best setting for care.

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Long Term Care Open Door Forum

The Centers for Medicare & Medicaid Services (CMS) will be holding an Open Door Forum (ODF) for Skilled Nursing Facilities (SNF) / Long Term Care (LTC) on Thursday, May 2, 2013 at 2:00p.m. Eastern Time (ET).

To participate by phone, dial (800) 837-1935 and reference conference ID #78862506.

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SNFs Could Soon Share Responsibility For Hospital Readmissions

According to the Medicare Payment Advisory Commission (MedPAC), approximately 14% of Medicare patients discharged from hospitals to skilled nursing facilities (SNFs) are rehospitalized for conditions that potentially could have been avoided.  As a result, SNFs could soon share responsibility with hospitals for avoidable readmissions.

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OIG: SNFs Fail To Meet Requirements For Care, Discharge Planning

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released Skilled Nursing Facilities Often Fail to Meet Care Planning & Discharge Planning Requirements the latest in a series of studies examining Skilled Nursing Facility (SNF) payments and quality of care. The report found for 37% of stays, SNFs did not develop care plans that met requirements or did not provide services in accordance with care plans.

Click here to read more.