Compliagent's COO, Paige Pennington, Addresses New Regulatory Developments in LTC Discharge and Transfer Requirements at the National ACO, Bundled Payment & Readmission Summit  

On October 26, 2017, Compliagent's COO, Paige Pennington, delivered a talk regarding new regulatory developments in LTC discharge and transfer requirements at the National ACO, Bundled Payment & Readmission Summit (Part of the 2017 NRPC C-Suite Invitational Series) at the California Endowment Conference Center in Los Angeles, California.  

Call or email us for more information about how these changes may impact your facility -- 310-996-8950; info@compliagent.com.

Posted on November 2, 2017 .

Some States Fell Short in Timely Investigation of the Most Serious Nursing Home Complaints between 2011-2015

 

On September 29, 2017, the Office of Inspector General (OIG) released a report finding that some states fell short in timely investigation of the most serious nursing home complaints between 2011-2015. Under federal and state regulations, CMS relies on individual states’ respective state survey agencies to address various types of concerns raised by residents, family members, and nursing home staff. Such concerns include residents admitted to the hospital because of preventable infections, residents left sitting in their urine and feces for hours, and inappropriate social media posts by employees.

State agencies must conduct onsite investigations within a certain period of time for the most serious level of complaints. Previous reports by the OIG found that state agencies often did not conduct onsite investigations within the required time frame, which requires that immediate jeopardy cases be investigated within two working days and that non-immediate jeopardy-high priority cases be investigated within 10 working days.

OIG Results

The OIG found that during 2011-2015, while the number of nursing home residents decreased overall, the number of nursing home complaints state agencies received increased 33 percent (47,279 to 62,790). The report also found that, in 2015, both Tennessee and Georgia received a total of 912 immediate jeopardy complaints, which accounts for 17% of all immediate jeopardy complaints. Out of 912 complaints, 654 (71%) were investigated late. Additionally, across all five years, Arizona, Maryland, New York, and Tennessee accounted for almost half of the high priority complaints not investigated onsite within 10 workings days. Furthermore, almost one-quarter of states did not meet CMS’s annual performance threshold for timely investigations of high priority complaints in all four years and all states substantiated almost on third of the most serious nursing home complaints.

Overall, the OIG data report offers Centers for Medicare and Medicaid Services some insights into the states that have room for improvement in prioritizing and responding within the required time frame to nursing home complaints. The OIG will continue to monitor the oversight of nursing homes and will initiate additional reviews as necessary.

National Partnership to Improve Dementia Care Achieves Goals to Reduce Unnecessary Antipsychotic Medications in Nursing Homes

On October 2, the National Partnership to Improve Dementia Care announced that it met its goal of reducing the national prevalence of antipsychotic use in long-stay nursing home residents by 30 percent by the end of 2016. It also announced a new goal of a 15 percent reduction by the end of 2019 for long-stay residents in those homes with currently limited reduction rates. Nursing homes with low rates of antipsychotic medication use are encouraged to continue their efforts and maintain their success.

For More Information:

·         Fact Sheet

·         National Partnership to Improve Dementia Care in Nursing Homes webpage

According to New Study, Preferred SNF Provider Networks Reduce Readmissions

Hospitals using a preferred network were able to reduce their readmission rates from skilled nursing facilities by 6.1 percentage points between 2009 and 2013, the study found. That's compared to a 1.6 percentage point drop in such readmissions to hospitals that did not have a network.

Read more here: 

http://content.healthaffairs.org/content/36/9/1591.abstract

Posted on September 20, 2017 .

The Office of Inspector General Focuses on Nursing Home Abuse

The Office of Inspector General (OIG) released a special “Eye on Oversight” webinar series, which features top areas of interest for the OIG. Recently, the series presented by Regional Inspector General, General Brian Whitley, focused on nursing home abuse. The OIG reported that in 2016, there were more than 1,000 open nursing home abuse cases and that 85% of nursing homes reported at least one instance of abuse or neglect in 2016 alone. The OIG utilizes various tools to combat abuse and neglect in nursing homes including:

1.       Conducting Investigations;

2.       Exclusions;

3.       Corporate Integrity Agreements; and

4.       Recommendations to the Centers for Medicare and Medicaid Services (CMS) regarding nursing home abuse and neglect.

In past years, the OIG has made recommendations to CMS regarding the reduction of antipsychotics, which have been implemented through various education, guidance, and regulation revisions. The OIG reports a 30% reduction in abuse and neglect related to antipsychotics due to the recommendations made by the OIG.

Throughout the OIG's recent audits and reports including information gathered through partnerships with state Medicaid enforcement partners, the OIG found three common factors that contributed to the incidences of abuse in nursing homes:

1.       Lack of staffing including adequate and trained staff as well as sufficient supplies;

2.       Over medication of residents leading to negative quality of care outcomes including falls; and

3.       Individual bad actors, such as nursing assistants, who had previous criminal histories.

The OIG maintains that focusing on these areas may help nursing homes reduce deficiencies related to nursing home abuse and neglect. The Regional Inspector General also stated that the OIG will continue its efforts to root out fraud, hold wrongdoers accountable, and recommend solutions to better protect nursing home residents.

 

Posted on August 2, 2017 .

Justice Department Charges Hundreds in False Billing Schemes

More than 400 people, including doctors, pharmacists and nurses, have been charged in connection with a massive health care fraud scheme that cost the federal government of more than $1.3 billion, federal officials announced Thursday.

Read more at: http://www.ocregister.com/2017/07/13/hundreds-ensnared-in-justice-department-health-care-fraud-crackdown-on-1-3-billion-in-false-billings/amp/.

 

 

Posted on July 14, 2017 .

CMS Proposes Rule That Would Remove The Ban On Pre-Dispute Arbitration Agreements in Long Term Care

n June 8, 2017, the Centers for Medicare & Medicaid Services ("CMS") published a proposed rule that would remove the ban on pre-dispute arbitration agreements established in 2016. Under the new proposed rule, long term care facilities may enter into pre-dispute arbitration agreements as long as certain transparency requirements are met. CMS also proposes to remove the provision banning long term care facilities from requiring residents to sign arbitration agreements as a condition of admission.

Read more at: http://www.jdsupra.com/legalnews/cms-proposes-rule-to-reverse-pre-17362/

Posted on June 16, 2017 .

No Business Associate Agreement? A $31,000 Mistake.

On April 20, 2017, the Office for Civil Rights (OCR) announced that the Center for Children’s Digestive Health (CCDH) paid $31,000 to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy rule. The settlement was initiated as a part of a compliance review following an investigation of a business associate, FileFax, Inc. FileFax stored records containing protected health information (PHI) for CCDH.

The investigation by the OCR revealed that the parties began sharing PHI since 2003 but neither party could produce a signed Business Associate Agreement (BAA) prior to October 2015.

The OCR has been reinforcing BAA requirements and has issued settlements with providers totaling $23 million in 2016. The Catholic Health Care Services of the Archdiocese of Philadelphia (CHCS) paid $650,000 as a settlement in 2016 as a result of lacking necessary BAAs. CHCS provided services to six skilled nursing facilities and the OCR received notification from each facility that a mobile device was stolen, potentially compromising 412 individuals' information. CHCS was found to have lacked the necessary BAA and did not conduct an accurate and thorough risk assessment of the potential risks and vulnerabilities of electronic protected health information (ePHI).

A BAA is not optional under HIPAA rules and regulations.  If you have a vendor who performs certain functions involving PHI/ePHI you must have a signed BAA in place to comply with the requirements under OCR.

Posted on May 10, 2017 .