On May 28th, the Illinois Department of Public Health (“IDPH”) issued emergency rules requiring state nursing homes develop plans to test both employees and residents as recommended by CMS.
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Charges are expected to be filed against the Administrator of a nursing home and three of its nurses following the deaths of 12 residents of the Rehabilitation Center at Hollywood Hills in Hollywood, Florida in the aftermath of 2017’s Hurricane Irma. The charges are anticipated to include manslaughter charges.
Recent Findings by Office of Inspector General Regarding Reporting of Potential Abuse and Neglect at Skilled Nursing Facilities
The Office of Inspector General (OIG) recently released the findings of an audit performed to determine the prevalence of incidents of potential abuse or neglect of Medicare beneficiaries residing in skilled nursing facilities (SNFs). Specifically, OIG looked at beneficiaries who resided in a SNF during 2016 and who also had a hospital emergency room (ER) Medicare claim containing a high-risk diagnosis code.
On September 28, 2016, CMS created the “Arbitration Rule”, banning arbitration agreements in nursing home admission agreements. By creating this Rule, CMS took the position that, due to the inequality of bargaining power between potential nursing home residents and long term care facilities, those facilities could no longer require, or even offer, binding arbitration as part of the admission process or at any point prior to a dispute arising.
CMS issued an update regarding what appears to be a sharp increase in the denial rate for Skilled Nursing Facilities (SNFs) as reported in the 2015 Comprehensive Error Rate Testing (CERT) Report. The CERT Report showed denials increasing from 6.9% reported in 2014 to 11% in 2015. What did CMS attribute as the cause of this significant increase? DOCUMENTATION Here are some documentation requirements that CMS reported for the increase in denials resulting from missing or incomplete certification/recertification including: