As every long-term care facility doing business in Illinois can attest, Medicaid eligibility determinations and benefit awards have been slow, with HFS often falling months, if not years, behind. A group of SNFs and their residents are trying to change that. Several healthcare providers and their patients have filed suit against Felicia Norwood in her official capacity as the Director of the Illinois Department of Healthcare and Family Services (“HFS”) in federal court.
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The past few weeks have been busy ones for the Sandberg Phoenix & von Gontard Long-Term Care and Senior Living team as we have collectively analyzed and blogged about each of the revisions to the federal nursing home regulations. These revisions to 42 CFR 483(B) are the first comprehensive updates since 1991 and address the requirements Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs.
Implementation Date: November 28, 2016¹Section 483.15 replaces section 483.12 and requires the facility to establish an admissions policy. Section (a)(2) states facilities cannot request or require residents or potential residents to waive their rights to Medicare or Medicaid benefits or any rights conferred by applicable state, federal and local licensing or certification laws. Section(a)(2)(iii) prohibits facilities from requesting or requiring residents or potential residents to waive facility liability for personal property losses.
Implementation Date: Phase 1 – November 28, 2016Perhaps the greatest attention of the CMS final rule changes has focused on the arbitration provision (§483.70(n)). Beginning November 28, 2016, all facilities enrolled in the Medicaid and Medicare program are prohibited from entering into pre-dispute arbitration agreements with any resident or resident’s representative. This provision creates a pre-condition to participation in the Medicare or Medicaid programs.
Over the next few weeks, the Sandberg Phoenix Long-Term Care and Senior Housing Team will be rolling out its analysis of the new CMS Final Rule revising the requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs. We will address each revision and how it impacts both the care provided to residents and how that care is to be provided.