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On March 7, 2025, the Centers for Medicare & Medicaid Services (CMS) posted a memo dated March 10, 2025, that gives nursinghomes and surveyors more time to prepare for implementation of new rules and updates to allow surveyors to add extra attention and increase oversight in nursinghomes.
A three-judge federal appeals court panel in Connecticut has likely ended an 11-year fight against a frustrating and confusing rule that left hundreds of thousands of Medicare beneficiaries without coverage for nursinghome care, and no way to challenge a denial. But it can have serious repercussions.
The Reducing Unnecessary Senior Hospitalizations (RUSH) Act of 2020, bipartisan legislation introduced in both the House and Senate, aims to enable more widespread use of telehealth in skilled nursing facilities. WHY IT MATTERS. The RUSH Act – introduced in companion bills from Sens. THE LARGER TREND.
Medicaid managed care plans and the Children’s Health Insurance Program (CHIP) will be subject to new wait time standards and quality ratings requirements, the Centers for Medicare & Medicaid S | CMS defended implementing stronger rules over nursinghome staffing as well as explained its thoughts behind Medicaid access and managed care rules.
Its compliance program guidance (CPG) has improved the efficiency and effectiveness of Medicare and many other federal programs. Last November, the OIG published industry-specific compliance guidance for 2024 for several healthcare subsectors, including nursinghomes and facilities.
Joel Landau, founder and chairman of The Allure Group Nursinghomes have embraced technology, especially during the COVID-19 pandemic, to help seniors, staff, and clinicians better communicate with one another and for residents to stay in touch with loved ones. Nursinghomes are evolving. percent of U.S.
introduced new legislation this week that would provide for permanent Medicare payments for telehealth services at federally qualified health centers and rural health clinics. Butterfield, D-North Carolina, and Glenn Thompson, R-Pa., " WHY IT MATTERS.
Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (“CMS”) issued a much anticipated and contested proposed rule that seeks to establish minimum staffing level requirements for nursinghomes. hours of nursing staff per resident per day, or 3.0 HPRD from nurse aids (NAs). [2]
The Centers for Medicare and Medicaid Services published a proposed rule that aims to promote transparency in the often opaque realm of nursinghome ownership.
The Office of Inspector General (OIG) released an updated Nursing Facility Industry Compliance Program Guidance (ICPG) in November 2024 to assist nursing facilities in navigating the complex regulatory landscape and mitigating compliance risks. The ICP covers the areas listed below.
Skilled nursing faciltiies will receive a higher Medicare pay bump in fiscal 2024 than proposed by the Centers for Medicare and Medicaid Services in April.
In 2023, nursinghomes have seen increased citations by surveyors for noncompliance tied to their pre-dispute, binding agreements for binding arbitration with their residents. The Arbitration Regulations revised the requirements for arbitration agreements when they are used by nursinghomes to resolve disputes with their residents.
"The FCC COVID-19 Telehealth Program will enable Parker to reduce patient face-to-face encounters in the nursinghome and the possible impact of COVID-19, reduce PPE, and minimize staff burden." THE PROBLEM. " Lorraine Breuer, Parker Jewish Institute for Health Care and Rehabilitation. ” MARKETPLACE.
More > Tags: Centers for Medicare & Medicaid Services , Civil Penalties , CMS , Healthcare Providers , Long-Term Care , Long-Term Care Facilities , Medicare. For reference, the 2017 Guidance can be found here. The accompanying CMP Analytic Tool can be found here.)
According to a statement released on the Center for Medicare and Medicaid Services (CMS) website, effective February 14, 2025, implementation of the Hospice Special Focus Program for calendar year 2025 has ceased so that CMS may further evaluate the program. The Final Rule added 42 CFR 488.1135 and created the SFP for hospice providers.
Medicare spends nearly $60 billion on post-acute care annually. There is no way to succeed in value-based care without effectively coordinating with the tens of thousands of nursinghomes, home health agencies and other post-acute providers. In the home, all those different services need to be coordinated a la carte.
Department of Health and Human Services (HHS) issued new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (Nursing Facility ICPG) for nursinghome members of the health care compliance community. Medical Directors in NursingHomes 42 CFR 483.70(g)
The skilled nursing sector has undergone a major transition over the past ten years. Because of shifting demographics and the challenges they place on hospitals, skilled nursing facilities are receiving patients who are struggling with more significant health concerns than in the past. THE PROBLEM. "It’s a win-win.
On Tuesday, Centers for Medicare and Medicaid Services expanded its Medicare telehealth coverage during the COVID-19 pandemic to enable more patients to get virtual care services from their providers. ON THE RECORD.
The Centers for Medicare & Medicaid Services (CMS) has finalized a rule that will require more transparency into nursinghome ownership. | The Centers for Medicare & Medicaid Services has finalized a rule that will require more transparency into nursinghome ownership.
Seniors want to avoid costly nursinghomes and will need help living independently. The most advanced health systems have recognized these converging trends and are moving rapidly to differentiate themselves with more care-at-home options. We also can't ignore the simple fact that the U.S. million in annual cost savings.
Nursinghomes, rehab providers and psychiatric hospitals urged the Centers for Medicare and Medicaid Services to account for economic conditions in fiscal 2024 rates
Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursinghome mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] Indest III, J.D.,
Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursinghome mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] Indest III, J.D.,
In a March 11, 2022, release by the Northern District of Georgia’s Office of the Department of Justice, it was reported that an investigation determined a Georgia nursinghome knowingly submitted claims for unreasonable, unnecessary, and unskilled services for Medicare patients. Attorney Kurt R.
The Office of Inspector General (OIG) conducted an audit and found that selected nursinghomes may not have complied with federal requirements for infection prevention and control and emergency preparedness. Specifically, 28 of 39 nursinghomes they audited had possible deficiencies.
On September 23, 2022, the Centers for Medicare & Medicaid Services (CMS) issued revised COVID-19 nursinghome visitation guidance. If the nursinghome’s county COVID-19 community transmission is high, everyone in a healthcare setting should wear face coverings or masks. cannot wear source control).
A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.
They identified that 6,622 nursinghomes had been cited for infection prevention and control program deficiencies as of February 26, 2020, and Medicare.gov indicated that 24 nursinghomes were part of a nursinghome chain. The OIG’s audit found that 23 of the 24 nursinghomes had possible deficiencies.
On November 3, 2022, the OIG released the results of a recent inspection of a nursinghome by the Texas Health and Human Services (HHS) Office of Inspector General Audit and Inspections Division (OIG Inspections). OIG inspectors recommended the facility develop a process to collect this data and post the information as required.
Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursinghome mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] Indest III, J.D.,
The Centers for Medicare & Medicaid Services launched its enhanced NursingHome Five-Star Quality Rating System which integrates data nursinghomes report on their weekend staffing rates for nurses and information on annual turnover among nurses and administrators. Ratings are updated quarterly.
As of March 2024, over 67 million in the United States are Medicare beneficiaries. Medicare is the single largest payer for healthcare services in the United States. In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Here’s what you need to know.
A Pennsylvania nursinghome will pay $819,640 to settle claims that it provided medically unnecessary rehabilitation therapy to residents to maximize revenue, and without prioritizing clinical needs. overbilled federal healthcare programs such as Medicare for therapy services provided; (b)?billed
On January 7, 2022, the Centers for Medicare & Medicaid Services (CMS) published a memorandum stating that nursinghome staff turnover and weekend staffing will be posted on the Medicare.gov Care Compare public website. The QSO memorandum can be accessed at: QSO-22-08-NH (cms.gov).
To make it easier for families and caregivers to evaluate the quality of nursinghomes, the Center for Medicare & Medicaid Services (CMS) regularly publishes data on its “ Care Compare ” website. Last month, CMS added additional metrics to how it scores the quality of nursinghomes. Staff Turnover.
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has excluded a Louisiana man from participation in federal healthcare programs due to his ownership interest in seven Louisiana nursinghomes that OIG previously excluded. As a result, OIG has excluded the nursinghomes and their owner.
An Indiana provider of skilled nursing and long-term care services has agreed to pay $5,591,044.66 to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program. The complaint alleged that the provider had engaged in conduct to defraud the Medicare program. to the United States.
A Maine nursinghome with a history of federal fines was listed as a special focus facility (SFF) after two residents wandered off in separate incidents last year. They were one mile from the nursinghome, so police took her to the facility. In the second case, the resident was hit and killed by a motor vehicle.
Board Certified by The Florida Bar in Health Law On June 15, 2022, the US Department of Justice (DOJ) announced it has sued three nursinghomes in Ohio and Pennsylvania, citing their “grossly substandard skilled nursing services.” Indest III, J.D.,
On October 21, 2022, the Centers for Medicare and Medicaid Services (CMS) announced changes to its Special Focus Facility (SFF) program, including new steps to address nursinghome facilities that fail to graduate from the SFF program in a timely manner, or “yo-yo” back into non-compliance after graduating from the SFF program.
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