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.

  • SNF ABN and Other Financial Liability Protection Guidance Updated (1/19)

    By cms - January 15, 2019

    CMS has issued two transmittals updating Chapter 30, "Financial Liability Protections," of the Medicare Claims Processing Manual.

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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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  • LTCSP Survey Resources Including Entrance Conference Worksheet and Beneficiary Protection Notification Review Worksheet UPDATED (12/18)

    By CMS - December 18, 2018
    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 December  2018.

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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 Involuntary Transfer and Discharge in Nursing Homes (11/18)

    By OIG - November 09, 2018

    The involuntary transfer or discharge of a resident of a nursing home can be unsafe and a traumatic experience for the resident and his or her family. To address these concerns, Congress passed the Nursing Home Reform Act of 1987 to protect residents against involuntary transfer and discharge. However, data from the National Ombudsman Reporting System show that from 2011 through 2016, the Long-Term Care Ombudsman Program, established to advocate for older Americans by the Older Americans Act of 1965, cited complaints related to "discharge/eviction" more frequently than any other concern. In addition, the media has recently highlighted the rise in nursing home evictions. CMS estimates that as many as one-third of all residents in long-term care facilities are involuntarily discharged. We will determine the extent to which State long-term care ombudsmen address involuntary transfers and discharges from nursing homes and the extent to which State survey agencies investigated and took enforcement actions against nursing homes for inappropriate involuntary transfers and discharges. We will also examine the extent to which nursing homes meet CMS requirements for involuntary transfers and discharges.

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  • Consider Hand in Hand for Fed Dementia/Abuse Training Requirements

    By Caralyn Davis - October 16, 2018

    The Centers for Medicare & Medicaid Services (CMS) recently released an updated Hand in Hand Series for Nursing Homes, a training series focused on caring for residents with dementia and on preventing abuse. While CMS isn’t currently offering continuing education units (CEUs) for Hand in Hand, the agency recommends—but does not mandate—that providers use Hand in Hand to fulfill federal requirements for training all nursing home staff about dementia management and resident abuse prevention, said CMS officials at the Oct. 11 Skilled Nursing Facility/Long-term Care Open Door Forum (ODF).

     

    “Federal law requires that nurse aides complete in-service training on dementia management and resident abuse prevention,” they explained. “Additionally, facilities must now provide dementia management and resident abuse prevention training to all facility staff, contractors, and volunteers.”

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  • GAO Calls for CMS to Audit SNF/NF Quality Data (9/18)

    By GAO - September 28, 2018

    About 15,600 nursing homes participate in Medicare and Medicaid. To help ensure that residents receive quality care, the Centers for Medicare & Medicaid Services (CMS) collect data (such as nurse staffing levels) on these nursing homes.

    We testified that CMS's data showed mixed results—they showed an increase in consumer complaints along with improvements in the quality of care. We found that data issues (e.g., different states using different data collection methods) complicated CMS’s ability to assess whether the results reflected actual changes.

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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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  • LTCSP Procedure Guide and Training - Updated (7/18)

    By CMS - July 26, 2018

    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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  • Nursing Home Compare & PBJ Updates: Long-stay Resident Hospitalization Rate to Be Added to NHC / Five Star; Non-Nursing Staff for PBJ to Be Posted; Health Inspection Freeze to End (6/18)

    By CMS - June 22, 2018
    • In October 2018, the long-stay hospitalization measure will be posted on the Nursing Home Compare website as a long-stay quality measure. In the spring of 2019, this quality measure will be included in the Five Star Quality Rating System.  Additionally, in July 2018 we will update the other claims-based quality measures reported on the Nursing Home Compare website.
    • To increase transparency, CMS will begin posting the number of hours worked by other staff (i.e., non-nursing) in July 2018. Facilities are required to submit hours for all other staff as listed in Table 1 of the PBJ Policy Manual. We will also distinguish between hours submitted for direct employees and contract staff. 
    • In October 2019, CMS will resume posting the average number of citations per inspection for each state and nationally. CMS is monitoring outcomes of the new inspection process and plans to resume health inspection rating calculations (i.e., end the freeze) in the spring of 2019. CMS will communicate more details about this prior to its implementation.



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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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  • CMS Basic Life Safety Online Training Course Available (4.18)

    By CMS - April 24, 2018

    New CMS eLearning course: The BLSC Training Online Course is intended to cultivate and refine surveyor skills, foster understanding of the survey process, and enhance surveyors’ overall ability to conduct LSC surveys for Medicare and Medicaid certification on behalf of CMS.

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  • PBJ Public Use Files: 3Q 17 Data Available (4/18)

    By CMS - April 23, 2018
    CMS releases quarterly Payroll-Based Journal (PBJ) public-use files that currently include nursing hours and resident census data for every nursing home in the United States. 
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  • PBJ Data Used in 5 Star Effective April 2018; CMS-671 Collection Ends June 1 (4/18)

    By CMS - April 09, 2018

    • Transition to Payroll-Based Journal (PBJ) Data – Starting in April, 2018, CMS will use PBJ data to determine each facility’s staffing measure on the Nursing Home Compare tool on Medicare.gov website, and calculate the staffing rating used in the Nursing Home Five Star Quality Rating System.

    • Staffing data audits - We are providing lessons-learned from audits conducted, and guidance to facilities for improving their accuracy. Nursing homes whose audit identifies significant inaccuracies between the hours reported and the hours verified, or facilities who fail to submit any data by the required deadline will be presumed to have low levels of staff. This will result in a one-star rating in the staffing domain, which will drop their overall (composite) star rating by one star for a quarter.

    • Requirement for registered nurse (RN) staffing – We are reminding nursing homes of the importance of RN staffing and the requirement to have an RN onsite 8 hours a day, 7 days a week. Nursing homes reporting 7 or more days in a quarter with no RN hours will receive a one-star rating in the staffing domain, which will drop their overall (composite) star rating by one star for a quarter. This action will be implemented in July 2018, after the May 15, 2018 submission deadline for data for 2018 Calendar Quarter 1, 2018 (January – March, 2018) data.

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  • CMS Updates Revised SNF ABN Medicare Claims Processing Manual Guidance, Moves up Mandatory Implementation (3/18)

    By CMS - March 30, 2018
    The purpose of this change request (CR) is to revise the SNF ABN, Form CMS-10055. With this revision, CMS is discontinuing the 5 SNF Denial Letters and the Notice of Exclusion from Medicare Benefits (NEMB-SNF), Form CMS-20014.
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