Corporate Compliance

Is your facility doing everything that it can to be compliant? With all of the updates in one place below, you can stay up to date on OIG guidance and the requirements of the Affordable Care Act standards. Also, learn about the most effective prevention tactics to protect your facility from non-compliance so that you can focus on what’s most important - caring for your residents.

  • COVID-19: Most States Have State-Specific Section 1135 Waivers as of 4/02/20

    By CMS - April 02, 2020

    CMS approved additional state Medicaid waiver requests under Section 1135 of the Social Security Act (Act). The waivers were approved within days of states’ submitting them, and offer states new flexibilities to focus their resources on combating the outbreak and providing the best possible care to Medicaid beneficiaries in their states. The waivers were approved within days of states' submitting them, and offer states new flexibilities to focus their resources on combating the outbreak and providing the best possible care to Medicaid beneficiaries in their states.

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  • CMS Finetunes Targeted Infection Control Inspections; Tells SNFs/NFs to Complete Voluntary Self-Assessment With COVID-19 Focused Survey Tool (3/20)

    By CMS - March 23, 2020

    Memorandum Summary

     

    • On Friday, March 13, 2020, the President declared a national emergency, which triggers the Secretary’s ability to authorize waivers or modifications of certain requirements pursuant to section 1135 of the Social Security Act (the Act). Under section 1135(b)(5) of the Act, CMS is prioritizing surveys by authorizing modification of timetables and deadlines for the performance of certain required activities, delaying revisit surveys, and generally exercising enforcement discretion for three weeks.
    • During this three-week time frame, only the following types of surveys will be prioritized and conducted:
    • Complaint/facility-reported incident surveys: State survey agencies (SSAs) will conduct surveys related to complaints and facility-reported incidents (FRIs) that are triaged at the Immediate Jeopardy (IJ) level. A streamlined Infection Control review tool will also be utilized during these surveys, regardless of the Immediate Jeopardy allegation.
    • Targeted Infection Control Surveys: Federal CMS and State surveyors will conduct targeted Infection Control surveys of providers identified through collaboration with the Centers for Disease Control and Prevention (CDC) and the HHS Assistant Secretary for Preparedness and Response (ASPR). They will use a streamlined review checklist to minimize the impact on provider activities, while ensuring providers are implementing actions to protect the health and safety of individuals to respond to the COVID-19 pandemic.
    • Self-assessments: The Infection Control checklist referenced above will also be shared with all providers and suppliers to allow for voluntary self-assessment of their Infection Control plan and protections
    • During the prioritization period, the following surveys will not be authorized: Standard surveys for long term care facilities (nursing homes), hospitals, home health agencies (HHAs), intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and hospices. This includes the life safety code and Emergency Preparedness elements of those standard surveys; and revisits that are not associated with IJ.
    • Furthermore, for Clinical Laboratory Improvement Amendments (CLIA), we intend to prioritize immediate jeopardy situations over recertification surveys, and generally intend to use enforcement discretion, unless immediate jeopardy situations arise.
    • Finally, initial certification surveys will continue to be authorized in accordance within current guidance and prioritization.

     Additional Instructions for Nursing Homes

    We are disseminating the Infection Control survey developed by CMS and CDC so facilities can educate themselves on the latest practices and expectations. We expect facilities to use this new process, in conjunction with the latest guidance from CDC, to perform a voluntary self-assessment of their ability to prevent the transmission of COVID-19. This document may be requested by surveyors, if an onsite investigation takes place. We also encourage nursing homes to voluntarily share the results of this assessment with their state or local health department Healthcare-Associated Infections (HAI) Program. Contact information for each state’s health departments is identified on the Centers for Disease Control & Prevention’s (CDC’s) website at:https://www.cdc.gov/HAI/state-based/index.html.

    Furthermore, we remind facilities that they are required to have a system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility, and when and to whom possible incidents of communicable disease or infections should be reported (42 CFR 483.80(a)(2)(i) and (ii)). CDC recommends that nursing homes notify their health department about residents with severe respiratory infection, or a cluster of respiratory illness (e.g., > or = 3 residents or HCP with new-onset respiratory symptoms within 72 hours). Local and state reporting guidelines or requirements may vary. Monitor the CDC website for information and resources to help prevent the introduction and spread of COVID-19 in nursing homes (CDC Preparing for COVID-19: Long-term Care Facilities, Nursing Homes:https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html ).

    We urge providers to review the tools and implement actions to protect the health and safety of individuals to respond to the COVID-19 pandemic.

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  • CDC Updated List of People at Higher Risk for Severe COVID-19 Illness (3/20)

    By CMS - March 23, 2020

    Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.


    Based upon available information to date, those at high-risk for severe illness from COVID-19 include:

    • People aged 65 years and older
    • People who live in a nursing home or long-term care facility
    • Other high-risk conditions could include:
      • People with chronic lung disease or moderate to severe asthma
      • People who have serious heart conditions
      • People who are immunocompromised including cancer treatment
      • People of any age with severe obesity (body mass index [BMI] >40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk
    • People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk

    Many conditions can cause a person to be immunocompromised, including cancer treatment, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications.

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  • Department of Justice Launches National Nursing Home Initiative (3/20)

    By DOJ - March 04, 2020

    Knoxville, Tenn. – U.S. Attorney J. Douglas Overbey joined Attorney General William P. Barr in announcing the Department of Justice’s National Nursing Home Initiative, which will coordinate and enhance civil and criminal efforts to pursue nursing homes that provide grossly substandard care to their residents. 

    The National Nursing Home Initiative focuses on some of the worst nursing homes around the country and the Department has already initiated investigations into approximately thirty individual nursing facilities in nine states as part of this effort. 

    “Millions of seniors count on nursing homes to provide them with quality care, and to treat them with dignity and respect when they are most vulnerable,” said Attorney General William P. Barr.  “Yet, all too often, we have found nursing home owners or operators who put profits over patients, leading to instances of gross abuse and neglect.  This national initiative will bring to justice those owners and operators who have profited at the expense of their residents, and help to ensure residents receive the care to which they are entitled.”

    “Protecting seniors is a top priority of the U.S. Attorney’s Office for the Eastern District of Tennessee”, said U.S. Attorney Overbey.  “Many senior citizens experience circumstances that make them particularly vulnerable to fraud and abuse.  Victimization of our elderly citizens, by either abuse or financial exploitation, is inexcusable and will result in the prosecution of anyone who commits these crimes.  The U.S. Attorney’s office will continue to coordinate with our federal, state, and local law enforcement partners to fight elder fraud and abuse throughout our region.”

    The department considers a number of factors in identifying the most problematic nursing homes.  For example, the department looks for nursing homes that consistently fail to provide adequate nursing staff to care for their residents, fail to adhere to basic protocols of hygiene and infection control, fail to provide their residents with enough food to eat so that they become emaciated and weak, withhold pain medication, or use physical or chemical restraints to restrain or otherwise sedate their residents. 

    Care failures victimize residents, causing them to suffer in pain and to be exposed to the great indignities.  Care failures cause residents to develop pressure sores down to the bone, to lie in their own waste for hours, to starve because they cannot reach the food on their trays and to remain unwashed for weeks at a time.  Nursing homes that provide grossly substandard care also force vulnerable elderly residents who cannot leave the facilities to live in filthy and dangerous conditions where there are leaks in the roofs, mold is found growing in facilities, and rodents are found living in residents’ rooms.  These are some of the gross actions and the inactions that the department intends to pursue and prosecute.

    The National Nursing Home Initiative reflects the department’s larger strategy and commitment to protecting our nation’s seniors, coordinated by the department’s Elder Justice Initiative in conjunction with the U.S. Attorneys’ Offices.  The Elder Justice Initiative and the U.S. Attorneys’ Offices are essential to the department’s investigative and enforcement efforts against nursing homes and other long-term care entities that deliver grossly substandard care to Medicare and Medicaid beneficiaries.  The Initiative and the U.S. Attorneys’ Offices also support the efforts of state and local prosecutors, law enforcement, and other elder justice professionals to combat elder abuse, neglect and financial exploitation, with the development of training, resources, and information.  

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  • OIG Will Do Medicaid Nursing Home Life Safety and Emergency Preparedness Reviews (3/20)

    By OIG - December 31, 2019
    Previous OIG audits on Medicaid nursing home life safety and emergency preparedness have identified multiple issues that put vulnerable populations at risk and indicated that nursing homes in various States are not complying with these requirements. In 2016, CMS updated its health care facilities' life safety and emergency preparedness requirements to improve protections for all Medicare and Medicaid beneficiaries, including those residing in long-term-care (LTC) facilities. In addition, in 2019 CMS also issued expanded guidance on emerging infectious disease control to ensure that health care facilities are prepared to respond to threats from infectious diseases. OIG is reviewing this area because residents of LTC facilities are particularly vulnerable to risks such as fires, natural disasters, or disease outbreak. Our objective is to determine whether LTC facilities that received Medicare or Medicaid funds complied with new Federal requirements for life safety and emergency and infectious disease control preparedness.
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  • LTCSP Procedure Guide - Updated (11/19)

    By CMS - November 25, 2019

    The LTCSP Procedure Guide provides instruction on the procedural and software steps necessary for completing the Long-term Care Survey Process. Surveyors use the Procedure Guide for all standard surveys of SNFs and NFs, whether freestanding, distinct parts, or dually participating. The LTCSP steps are organized into seven parts: 1) offsite preparation; 2) facility entrance; 3) initial pool process; 4) sample selection; 5) investigation; 6) ongoing and other survey activities; and 7) potential citations. Below is a broad overview of the key onsite parts of the LTCSP (parts 3 – 7).

     
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  • CMS Podcast Targets Nursing Homes in Multi-Part Series (8/19)

    By CMS - August 01, 2019

    Nursing Home Strategy Part 1 – Strengthening Oversight

    The Centers for Medicare and Medicaid Services (CMS) posted the 5th episode of the CMS: Beyond the Policy podcast which focuses on the first of the CMS’s 5-pronged strategy on strengthening oversight in nursing homes. This podcast features CMS Administrator Seema Verma, Dr. Kate Goodrich, CMS Chief Medical Officer and Director of our Center for Clinical Standards and Quality and Matt Hittle, Senior Adviser for Administrator Seema Verma discussing CMS’s efforts regarding nursing home oversight.

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  • Abuse and Neglect of Medicare Beneficiaries: OIG Targets SNFs (6/19)

    By OIG - June 12, 2019

    The Department of Health and Human Services Office of Inspector General issued two new reports that address the identification, reporting and investigation of incidents of potential abuse and neglect of our nation's most vulnerable populations, including seniors and individuals with developmental disabilities. OIG issued an early alert in 2017 based on the preliminary findings of this work. Our resulting work, released in June 2019, identify thousands of Medicare claims that indicate abuse and neglect of beneficiaries, including beneficiaries in skilled nursing facilities. If you suspect someone is the victim of abuse or neglect, contact law enforcement immediately.

    Reports:

    CMS Could Use Medicare Data To Identify Instances of Potential Abuse or Neglect 

    Incidents of Potential Abuse and Neglect at Skilled Nursing Facilities Were Not Always Reported and Investigated

     

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  • LTCSP Survey Resources Including Entrance Conference Worksheet and Beneficiary Protection Notification Review Worksheet UPDATED (3/19)

    By CMS - March 19, 2019
    This Long-term Care Survey Process ZIP file contains a multitude of reference materials that are provided to the surveyors going into facilities, including, for example, a document detailing their principles of documentation, a document showing how they edit and finalize statements of deficient practices, and a tool breaking out resident interview questions in the initial pool process by care areas, such as choices, activities, abuse, etc. In addition, this file is now the only resource containing the Entrance Conference Worksheet and the Beneficiary Protection Notification Review Worksheet.

    NOTE: CMS updated this file In March 2019.

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  • OIG: CMS Improperly Paid for SNF Services When Required Qualifying 3-day Stay Wasn't Met (2/19)

    By CMS - February 21, 2019

    CMS Improperly Paid Millions of Dollars for Skilled Nursing Facility Services When the Medicare 3-Day Inpatient Hospital Stay Requirement Was Not Met (A-05-16-00043)

    According to Federal law, to be eligible for coverage of posthospital extended care services, a Medicare beneficiary must be an inpatient in a hospital for not less than 3 consecutive calendar days (3-day rule) before being discharged from the hospital. CMS improperly paid 65 of the 99 skilled nursing facility (SNF) claims we sampled when the 3-day rule was not met. Improper payments associated with these 65 claims totaled $481,034. On the basis of our sample results, we estimated that CMS improperly paid $84 million for SNF services that did not meet the 3-day rule during 2013 through 2015.

    We attribute the improper payments to the absence of a coordinated notification mechanism among the hospitals, beneficiaries, and SNFs to ensure compliance with the 3-day rule. We noted that hospitals did not always provide correct inpatient stay information to SNFs, and SNFs knowingly or unknowingly reported erroneous hospital stay information on their Medicare claims to meet the 3-day rule. We determined that the SNFs used a combination of inpatient and non-inpatient hospital days to determine whether the 3-day rule was met. In addition, because CMS allowed SNF claims to bypass the Common Working File (CWF) qualifying stay edit during our audit period, these SNF claims were not matched with the associated hospital claims that reported inpatient stays of less than 3 days.

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  • OIG State Survey Agencies not Adequately Verifying Correction of Deficiencies (2/19)

    By OIG - February 08, 2019

    CMS Guidance to State Survey Agencies on Verifying Correction of Deficiencies Needs To Be Improved To Help Ensure the Health and Safety of Nursing Home Residents (A-09-18-02000)

    State survey agencies (State agencies) must verify that nursing homes corrected identified deficiencies, such as the failure to provide necessary care and services, before certifying whether the nursing homes are in substantial compliance with Federal participation requirements for Medicare and Medicaid.

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  • LTCSP Initial Pool Care Areas UPDATED (12/18)

    By CMS - December 18, 2018
    This includes four documents, one each for: record review, resident interview, resident observations, and resident representative interview. They walk through what the surveyors investigate/ask related to each care area during the initial pool to help determine which residents they will choose for in-depth investigations in the final sample. In other words, these screening tools trigger surveyors to either investigate further or not investigate further.
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  • CMS Alerts States re: SNFs/NFs With Potential Staffing Issues, Etc. (12/18)

    By CMS - December 02, 2018

    Payroll Based Journal (PBJ) Policy Manual Updates, Notification to States and New Minimum Data Set (MDS) Census Reports

    • Notification to States –

    The Centers for Medicare & Medicaid Services (CMS) will provide CMS Regional Offices (ROs) and State Survey Agencies with a list of facilities with potential staffing issues to support survey activities for evaluating sufficient staffing and improving resident health and safety.

    • Updates in the PBJ Policy Manual and Frequently Asked Questions (FAQs) – We are expanding the guidance on the meal breaks policy to ensure consistency. In addition, we are adding guidance regarding reporting hours for “Universal Care Workers.”

    • Additional Technical Support for Facilities – New MDS-based census reports in the Certification and Survey Provider Enhanced Reporting (CASPER) system.

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  • OIG to look at PBJ: CMS Oversight of Nursing Facility Staffing Levels (8/18)

    By OIG - August 22, 2018
    Staffing levels in nursing facilities can impact residents' quality of care. Nursing facilities that receive Medicaid and Medicare payments must provide sufficient licensed nursing services 24 hours a day, including a registered nurse for at least 8 consecutive hours every day. CMS uses auditable daily staffing data, called the Payroll-Based Journal, to analyze staffing patterns and populate the staffing component of the Nursing Home Compare website - a site that enables the public to compare the results of health and safety inspections, the quality of care provided at nursing facilities, and staffing at nursing facilities. We will examine nursing staffing levels reported by facilities to the Payroll-Based Journal and CMS's efforts to ensure data accuracy and improve resident quality of care by both enforcing minimum requirements and incentivizing high quality staffing above minimum requirements.
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  • RAC Approved and Proposed Topic Lists (6/18)

    By CMS - June 11, 2018
    CMS now maintains pages listing approved and proposed RAC topics for the Recovery Audit program.
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