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.

  • 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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  • New Q4FY18 SNF PEPPER Access Instructions and Registration Info for May 2 Web Presentation (4/19)

    By PEPPER - April 05, 2019

    On April 5, the new Q4FY18 Skilled Nursing Facility (SNF) PEPPER was released. Find information here: https://pepper.cbrpepper.org/About-PEPPER/Distribution-Schedule-Get-Your-PEPPER

    The CMS contractor will also hold a web session to review the release.

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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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  • CMS Press Release on April 2019 Nursing Home Compare / Five-Star Changes (3/19)

    By CMS - March 05, 2019

    The April 2019 changes include revisions to the inspection process, enhancement of new staffing information, and implementation of new quality measures.

    This includes a lifting of the ‘freeze’ on the health inspection ratings instituted in February 2018. CMS ‘froze’ the health inspection star ratings category after implementing a new survey process for Long-Term Care facilities. Because facilities receive surveys at different times, some facilities would have been surveyed under the old process and others under the new process. Without placing a ‘freeze’ on health inspection star ratings, the facilities would have been scored using two different evaluation processes making the outcomes misaligned and the data inaccurate. CMS ‘froze’ the health inspection star rating score until all nursing homes were surveyed at least once under the new survey process for Long Term Care facilities. Ending the freeze is critical for consumers. In April, they will be able to see the most up to date status of a facility’s compliance, which is a very strong reflection of a facility’s ability to improve and protect each resident’s health and safety.

    Additionally, CMS is setting higher thresholds and evidence-based standards for nursing homes’ staffing levels. Nurse staffing has the greatest impact on the quality of care nursing homes deliver, which is why CMS analyzed the relationship between staffing levels and outcomes. CMS found that as staffing levels increase, quality increases and is therefore assigning an automatic one-star rating when a Nursing Home facility reports “no registered nurse is onsite.” Currently, facilities that report seven or more days in a quarter with no registered nurse onsite are automatically assigned a one-star staffing rating. In April 2019, the threshold for the number of days without an RN onsite in a quarter that triggers an automatic downgrade to one-star will be reduced from seven days to four days. CMS is also making changes to the quality component on Nursing Home Compare that would improve identifying differences in quality among nursing homes, raise expectations for quality, and incentivize continuous quality improvement.

    To provide further value and remain consistent with CMS’s Meaningful Measures initiative the April 2019 Nursing Home Compare Update includes adding measures of long-stay hospitalizations and emergency room transfers, and removing duplicative and less meaningful measures. CMS is also establishing separate quality ratings for short-stay and long-stay residents and revising the rating thresholds to better identify the differences in quality among nursing homes making it easier for consumers to find the right information needed to make decisions.

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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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  • 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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  • 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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