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These audits help reduce waste, abuse, and mismanagement and promote economy and efficiency throughout HHS. We help leaders and future leaders in the health care industry work smarter and faster by providing provocative insights, actionable strategies, and practical tools to support execution. In addition, the Times gained access to ratings information typically not made public from academics who, via research agreements with CMS, had access to such data. Verma pledges to improve transparency, quality and compliance without undue paperwork burdens on nursing homes. CMS is developing quality measures that score providers based on patient outcomes, not adherence to processes, Verma said. "I have directed my team at CMS to undertake a comprehensive review of our regulations, guidelines, internal structure, and processes related to safety and quality in nursing homes," she said.
Medicare Advantage insurers and other managed care organizations have incentives to favor lower-cost home health care versus skilled nursing facility care, as they seek to deliver services in settings that consumers prefer and at lower costs. This trend has been enabled by the creation of SNF-at-home models and other programs for delivering more advanced care in the home. However, SNF-at-home has been a slow-growing offering and is still in its early stages. The Centers for Medicare & Medicaid Services is taking steps to ensure that patients are not inappropriately denied coverage for post-acute care in particular settings — including skilled nursing facilities — by Medicare Advantage organizations .
“We're strengthening our enforcement policies to hold nursing homes accountable for the care they provide.”
MA organizations will not be restricted in prior authorization and post-claim review, as ways to ensure services meet Medicare coverage rules. CMS raised the issue as part of a proposed rule issued on Dec. 15, stating that MAOs generally cannot apply coverage criteria that is more restrictive than traditional Medicare coverage, as determined by national coverage determination , local coverage determinations and Medicare laws. This also applies to certain “substantive coverage criteria and benefit conditions” that are not governed by an NCD or LCD, including transfers to post-acute settings. The Office of Audit Services conducts independent audits of HHS programs and/or HHS grantees and contractors. These audits examine the performance of HHS programs and/or grantees in carrying out their responsibilities and provide independent assessments of HHS programs and operations.
In some states, you can shelter these funds for your mother’s benefit in a “pooled disability” or “” trust managed by a nonprofit. This is unlikely to save the money for you because the funds still will be subject to Medicaid estate recovery, but they could be used for whatever might enhance your mother’s life during her remaining years. As fall comes to a close and winter ushers in, the federal government is reminding nursing home operators that they must provide residents access to the latest Covid vaccines and treatment. The report alleges the 588-bed facility used 13 companies and three fraudulent schemes to create the appearance of paying for services for the nursing home when in fact the money was diverted for personal profit, according to the Dec. 16 press release.
The Quotes That Defined Skilled Nursing in 2022 — and Hint at What’s Ahead
And at least in some cases, the Times reports, this results from corruption; an inspector in Florida in 2017 and the head of Oklahoma's health department in 2002 separately pled guilty to charges of accepting bribes in exchange for letting homes know when they would be inspected. Specifically, CMS as of 2018 requires facilities to submit payroll records detailing the daily hours logged by staff. However, CMS permits facilities to include in the total reported number of staff hours on Care Compare both the hours of staff who work directly with patients and the hours of administrative staff, who do not see patients—without any breakdown between the two. When administrative burden increases with little or no benefit, patients suffer because mountains of unnecessary paperwork keep providers from patients. Additionally, high administrative costs can make it difficult for facilities to operate, Verma said.
You can sell the house “as is,” or try to get a better price by fixing it up, or at least cleaning it out. If you advance your own money for these expenses, make sure you document it with a formal promissory note between your mother and yourself — even if you’re signing it as your mother’s agent under her durable power of attorney. Otherwise, the Medicaid agency may deem any repayment of the loan as a gift from your mother to you causing a period of ineligibility for benefits. To solve these issues, the authors advocated for a “responsive regulatory” incentive structure, in which regulatory interventions are aligned with both the risks incurred by the homes and their emergency preparedness status. Looking into emergency preparedness deficiencies at these homes, the researchers found that the exposed facilities had a greater percentage of at least one such issue — 83.9 percent versus 76.9 percent.
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OIG investigates potential violations to hold accountable those who victimize residents of nursing homes. Patient neglect and inadequate care by nursing facilities is a recurring challenge that OIG works with the Department of Justice to address in False Claims Act cases. According to the Times, despite the weight CMS allots in-person inspections in its overall star rating, "the exams do little to penalize homes with serious problems"—particularly among nursing homes with five stars for care quality, which are nearly as likely to fail these inspections as they are to ace them.
CMS should reevaluate the Inpatient Rehabilitation Facility payment system, which could include seeking legislative authority to make any changes necessary to more closely align IRF payment rates and costs. In response to the allegations, Brookdale said it was disappointed by the lawsuit and "categorically den that Brookdale engaged in intentional or fraudulent conduct." As a precaution, board members and former regulators called for more auditing of self-reported data—but audits remained rare, according to the Times. The Medicaid and CHIP Access to Prescription Digital Therapeutics Act, introduced this week in Congress, would create standardized coverage in Medicaid and CHIP plans for approved digital health...
California nursing homes were most likely to be deficient in their use of emergency and standby power systems, the researchers observed. Among the 1,182 facilities identified, the authors then determined that 495 sites were considered “exposed” and 687 were “unexposed.” They defined exposed as those homes with “moderate” to “very high” wildfire risk, using designations from the California Office of the State Fire Marshal. A study conducted by the Commonwealth Fund last month found that if vaccination continued at its current pace, the country faced a potential winter surge of Covid infections that could result in 16,000 hospitalizations and 1,200 deaths per day by March 2023. Another patient who was there for five months after a stroke said she only received three showers in that time. A man who was badly injured in a car crash lost 30 pounds as a result of the care at the rehab center, according to the attorney general, and his condition worsened during his time there. He would later be admitted to the hospital for severe malnutrition, dehydration, a worsening pressure injury and a bone infection in his right foot.
HHS is requesting an additional $45 million in the FY 2020 budget to strengthen nursing home enforcement. "We're also committed to working with Congress to strengthen nursing home enforcement. The FY 2020 Budget also requests $442 million for Survey and Certification, a $45 million increase from the previous year," she said.
Arizona, for example, has only 15.2% of staff and 22% of residents considered up to date on their vaccinations. North Dakota, on the other hand, has 60.9% of residents but only 18.5% of staff that are up to date, according to the analysis. Skilled Nursing News is the leading source for news and information covering the skilled nursing industry. The Office of Evaluation and Inspections conducts national evaluations of HHS programs from a broad, issue-based perspective. The evaluations incorporate practical recommendations and focus on preventing fraud, waste or abuse and encourage efficiency and effectiveness in HHS programs. According to the Times, the odds of such circumstances happening by chance are "virtually zero," indicating that some nursing homes can anticipate when their inspections will occur.
“Emergency preparedness in nursing homes should be commensurate with local environmental risks to ensure residents’ safety,”a statementfrom the journal said. CMS should take actions to ensure that incidents of potential abuse or neglect of Medicare and Medicaid beneficiaries are identified and reported. HHS' Centers for Medicare and Medicaid Services has an essential, ongoing responsibility to oversee nursing homes and shares with State agencies the responsibility for ensuring that nursing homes meet Federal requirements for quality and safety. CMS oversees the State process for certifying nursing homes and provides guidance to States regarding the survey process. Proper nursing home care requires a partnership involving Federal, State, and local entities, the provider community, residents, and their families.
The Texas health system is using a diabetes care management program that tracks engagement and pushes targeted resources and interactions to address care gaps and costs. Nursing homes in California located in higher-risk wildfire exposure zones tend to be less prepared for emergencies than facilities without such risk, a new study has found. “We look forward to working with the administration, and we will continue our tireless efforts to protect the health of our residents,” they added. AHCA/NCAL President and CEO Mark Parkinson and LeadingAge President and CEO Katie Smith Sloan issued a joint statement following CMS’s memo, pointing to the fact that resident vaccination rates are nearly four times higher than the “dismal” 11% rate among the general public.
That staffing problem has continued through 2022, according to the attorney general's office. During the first few months of the pandemic, from March to June of 2020 when nursing home staffing across the country was stretched beyond thin, 166 Cold Spring Hills residents died, 98 of which were from COVID. The facility failed to report 51 of those deaths to the state's DOH, the lawsuit stated, a fraudulent underreporting by more than 50 percent. A Long Island nursing home is under fire from the New York attorney general's office after troubling, jaw-dropping allegations surfaced regarding abysmal patient care and a $22 million fraud by the owners of the facility.
The person looking after him was not told when the man died, or even was informed of his condition after going back to the facility. Top Management ChallengeOIG annually identifies top management and performance challenges HHS faces as it strives to fulfill its mission. In addition to fraud, the Brooklyn-based agency was also cited for cheating aides out of their wages. Engaged in a $2 million fraudulent promissory note scheme when purchasing the facility. New York Attorney General Letitia James sued Cold Spring Hills Center for Nursing Rehabilitation in Woodbury for allegedly diverting over $22.6 million in Medicaid and Medicare funds to the owners' pockets.
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