leadingage michigan snf regulatory day september 17, … · detroit lansing mt. clemens marquette...

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Kitch Drutchas Wagner Valitutti & Sherbrook2379 Woodlake Drive, Suite 400

Okemos, Michigan 48864517.381.7192

www.kitch.com

Detroit Lansing Mt. Clemens Marquette Toledo Chicago

LEADINGAGE MICHIGAN

SNF REGULATORY DAY

September 17, 2014



www.kitch.com

CMS UPDATES

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S&C: 14-18 NH

March 28, 2014o Chapter 7 of the State Operations Manual (SOM) has been revised

to incorporate the following provisions of Section 6111 of the Patient

Protection and Affordable Care Act (the Affordable Care Act):

• Independent IDR: An independent informal dispute resolution process

will be available when a civil money penalty (CMP) is imposed.

• Escrow: After an independent IDR, CMP funds will be collected and

placed in escrow pending completion of any formal appeal.

• 50 Percent Reduction: A CMP may be reduced by 50 percent in certain

cases of prompt correction for self-reported non-compliance.

• Use of CMP Funds: A portion of the CMP attributable to Medicare may

be used for programs for the protection or benefit of nursing home

residents.

S&C: 14-18 NH

March 28, 2014o Reminder of Survey Process Timeframes: Reiterates the

requirements for enforcement action timelines when immediate

jeopardy exists and when immediate jeopardy does not exist.

(Chapter 7 of the SOM at sections 7300 thru 7320).

• The plan of correction for the deficiencies should be deferred until a

revisit to verify that the removal of the immediate jeopardy has been

completed.

• The notice of the Immediate Jeopardy to the provider must be

delivered no later than two days of the end of the survey. If official

notification of all deficiencies, i.e., Form CMS-2567, was not given

on the second day, a completed Form CMS-2567 must be sent to

the entity on the tenth working day.

S&C: 14-19 NH

April 11, 2014

An interim report that discusses the

history of the National Partnership to

Improve Dementia Care, summarizes

activities to date, provides reasons for

early progress and outlines next steps for

future Partnership efforts.

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S&C: 14-30 NH

May 16, 2014

oAs part of the 2010 Affordable Care Act, CMS is

soliciting proposals for a grant opportunity in which

Federal CMP Funds will be utilized to support and

further expand the National Partnership to Improve

Dementia Care in Nursing Homes.

o A total of $500,000 for FY2014-2015 will be

available for a three year period of performance.

Funding will be awarded in 12 month budget

periods.

S&C: 14-20 NH

April 18, 2014o CMS adjusted the number of designated slots and candidates so

States can resume selecting and replacing nursing homes for

SFF designation.

• Now re-building the program by a gradual increase in the number of SFF

slots from its reduced base.

• Later, will also introduce additional methods to address persistently poor

quality in nursing homes.

• Phase in period: States may have the option to start selecting SFFs

immediately or phase in the total to meet the required number by July 2014.

• Continuation of Program Changes: CMS and States will continue with the

Programmatic and Operational Adjustment by conducting the 18 month “last

chance” onsite survey and reviewing the progress of all facilities that have

been on the SFF list for more than 12 months.

S&C: 14-21 LSC

April 18, 2014

Proposed rule that would amend the current fire safety

standards for Medicare- and Medicaid-participating

providers and suppliers. This proposed rule would adopt

the 2012 edition of the Life Safety Code (LSC), National

Fire Protection Association, (NFPA) 101.

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S&C: 14-33 NH

May 20, 2014o CMS published final rule CMS-3267-F in which CMS

implemented reforms in Medicare regulations that are

identified as unnecessary, obsolete, or excessively

burdensome on health care providers and beneficiaries

o Nursing home and LTC (Automatic Sprinkler Systems):

The rule permits a temporary extension of the automatic

sprinkler system installation due date under limited

circumstances

S&C: 14-29 LSC

May 16, 2014

Provides the procedures to apply for approval of a

request for an extension of time by a qualifying long

term care facility that has not met the August 13, 2013

deadline for the installation of a complete automatic

sprinkler system throughout the facility.

S&C: 14-22 NH

April 18, 2014o Currently developing two distinct focused survey processes to

assess dementia care and Minimum Data Set, Version 3.0 (MDS

3.0) coding practices in nursing homes.

o CMS is planning to pilot these survey types beginning in 2014.

The intent of the dementia care focused survey is to document

dementia care practices in nursing homes. The intent of the

MDS focused survey is to document MDS 3.0 coding practices

and associated care planning in facilities.

o This training will be mandatory for those State Survey Agency

(SA) staff conducting reviews as well as one manager or trainer

within the SA.

• Surveyor Implications: Deficient practices noted during the survey will

result in relevant citations.

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S&C: 14-24 ALL

May 2, 2014o Section 2008D is being revised to conform more clearly to the

governing regulation at 42 CFR 489.13.

o Survey Process after Denial of Initial Application: Section 2005

has been revised to reflect the following: an applicant who is

denied certification (CMS), based on a finding of substantial

noncompliance from the initial survey, may reapply for

certification.

• However, the applicant may submit no more than two reapplications

for certification in connection with one enrollment application, and

no more than six months may elapse between the date of the CMS

Regional Office’s (RO’s) first denial and the RO’s receipt of the

second reapplication. Applicants who reapply for certification must

undergo a subsequent survey.

S&C: 14-24 ALL

May 2, 2014o Applicants subject to the Life Safety Code – if the applicant

was in substantial compliance with the LSC on the initial

survey, at SA or AO discretion compliance with the LSC does

not have to be reassessed.

o Various SOM sections, including Sections 2053, 2777, 2779,

3005 and 3008 have been revised to update provisions

concerning Medicaid.

o Assigning Medicaid-only CMS Certification numbers (CCNs)

within the classification system, including in the Automated

Survey Process Environment (ASPEN).

o Multiple provisions of the SOM related to accreditation have

been clarified.

S&C: 14-25 NH

May 16, 2014

oThe guidance under Tag F441, Infection

Control, Preventing Spread of

Infection/Indirect Transmission has been

revised.

oSingle-Use Device Guidance: Nursing

homes may purchase reprocessed single-

use devices when these devices are

reprocessed by an entity or a third party

reprocessor that is registered with the FDA.

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S&C: 14-28 NH

May 9, 2014

A notice of proposed rule-making (NPRM)

regarding Nursing Home Civil Monetary

Penalties was published on May 6, 2014,

which provides clarification of statutory

requirements under Section 6111 of the

Affordable Care Act regarding the approval

and use of Civil Money Penalties (CMPs)

imposed CMS against nursing facilities.

S&C: 14-34 NH

May 20, 2014• Guidance for SNFs and NFs: Use pasteurized shell eggs or liquid

pasteurized eggs to eliminate the risk of residents contracting Salmonella

Enteritidis (SE).

• In accordance with (CDC) and (FDA) standards, SNFs and NFs should not

prepare nor serve soft-cooked, undercooked or sunny-side up eggs from

unpasteurized eggs.

• Surveyors implications: Will look for signed health release agreements

between the resident (or the resident’s representative) and the facility that

acknowledges the resident’s acceptance of the risk of eating undercooked

unpasteurized eggs are not permitted.

– Surveyors can cite this as deficiencies at F371 if fail to comply. Determination of

the appropriate scope and severity shall be based upon the actual or potential

negative resident outcomes in accordance with guidance given at F371.

S&C: 14-35 ALL

May 20, 2014o A “Non-IJ High” category for prioritizing

complaint allegations has been added to Section

5075 of the State Operations Manual (SOM) for

non-long term care (non-LTC).

o It applies to all substantial allegations of

noncompliance (except for immediate jeopardy

(IJ) allegations), and requires a SA complaint

investigation.

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S&C: 14-36 ALL

May 30, 2014o If State Survey Agencies (SAs) or Accrediting Organizations (AOs) identify

any of the breaches of generally accepted infection control standards listed

below, they should refer them to appropriate State authorities for public

health assessment and management:

– Using the same needle for more than one individual;

– Using the same (pre-filled/manufactured/insulin or any other) syringe, pen or

injection device for more than one individual;

– Re-using a needle or syringe which has already been used to administer

medication to an individual to subsequently enter a medication container (e.g.,

vial, bag), and then using contents from that medication container for another

individual;

– Using the same lancing/fingerstick device for more than one individual, even if

the lancet is changed.

S&C: 14-37 NH

May 30, 2014

– F161 - Assurance of Financial Security

– F202 - Documentation for Transfer and Discharge

– F208 - Admission Policy

– F221 - Physical Restraints

– F278 - Accuracy of

Assessment/Coordination/Certification/Penalty

for Falsification

– F281 - Services Provided Meet Professional

Standards of Quality

– F286 - Maintaining 15 Months of Resident Assessments (Use)

– F332 - Medication Errors/Free of Medication Errors of 5% or Greater

– F333 - Medication Errors/Residents are Free of

Significant Medication Errors

– F371 – Sanitary Conditions

– F387 - Frequency of Physician Visits/Timeliness

of Visits

– F388 - Personal Visits by the Physician

– F390 - Physician Delegation of Tasks in SNFs/Performance of Physician Tasks in NFs

– F425 - Pharmacy Services

– F428 - Drug Regimen Review

– F431 - Service Consultation/Labeling of Drugs

and Biologicals/Storage of Drugs and

Biologicals

– F441 - Infection Control

– F492 - Compliance with Federal, State and

local laws and Professional Standards

– F514 - Clinical Records

– F516 - Resident Identifiable

Information/Safeguard against loss, destruction, or unauthorized use

o Revision of the Interpretive Guidelines and, where appropriate,

Investigative Protocols for the following F Tags to incorporate S&C

policy memos issued from October 2003 through May 2014:

S&C: 14-37 NH

May 30, 2014

o Revisions to SOM Chapter 4: Section 4132.1E

Waiver of Program Prohibition has been revised to

incorporate information consistent with CFR

483.151(c)(1).

o Section 4542.2 State Agency (SA) Expenses for

Training of SA Personnel has been revised to include

Association of Health Facility Survey Agencies

(AHFSA) to the list of annual meetings.

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S&C: 14-42 NH

August 25, 2014

o Announcement of the release of a free

learning tool on Building Respect for LGBT

Older Adults.

o The learning tool addresses the needs and

rights of older LGBT adults in long term care

(LTC) and is presented in six online training

modules.

S&C: 14-43 NH

August 25, 2014

o Completion of MDS 3.0 Discharge Assessments for

Transfer from Medicare- and/or Medicaid-Certified

Beds to Non-Certified Beds

o Reinforcing the requirement for MDS 3.0 Discharge

assessments to be completed when a resident

transfers from a Medicare- and/or Medicaid-certified

bed to a non-certified bed.

CY2015 PROPOSED

PHYSICIAN FEE SCHEDULE

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CY2015 Proposed Physician

Fee Schedule• https://www.federalregister.gov/articles/20

14/07/11/2014-15948/medicare-program-

revisions-to-payment-policies-under-the-

physician-fee-schedule-clinical-laboratory


Fee Schedule• Last year, CMS finalized a separate

payment for a chronic care management

(CCM) code, outside of a face-to-face visit,

for managing the care of Medicare

patients with two or more chronic

conditions beginning in 2015.

• Now CMS is proposing details relating to

the implementation of this new code,

including payment rates.


Fee Schedule• CMS is proposing a new process for

establishing PFS payment rates that will

be more transparent and allow for greater

public input prior to payment rates being

set.

• Under the proposed process, payment

changes will go through notice and

comment rulemaking before being

adopted beginning for 2016.

https://www.federalregister.gov/articles/2014/07/11/2014-15948/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-clinical-laboratory

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Fee Schedule• The proposed rule sets forth changes for

quality reporting programs including, the

Physician Quality Reporting System

(PQRS), Medicare Shared Savings

Program, and Medicare Electronic Health

Record (EHR) Incentive Program, as well

as changes to the Physician Compare tool

on the Medicare.gov website.


Fee Schedule• CMS proposes a drop in the current

conversion factor (CF) of $35.8228 down to

$35.7977.

• The Protecting Access to Medicare Act of 2014

(PAMA) replaced the 24 percent reduction in

the PFS with a 0.5 percent update through the

end of this year; however, the law provides a 0

percent update for services furnished on or

after January 1, 2015 through March 31, 2015.

CodeTotal 2015

RVUs

2015

Payment

Rate

(CF=35.79

97)

Total 2014

RVUs

2014

Payment

Rate

(CF=35.82

28)

Percentage

Change

2014-2015

99304 2.57 $92.01 2.61 $93.5 -0.01%

99305 3.67 $131.38 3.72 $133.26 -0.0141%

99306 4.69 $167.9 4.71 $168.73 -0.0049%

99307 1.24 $44.39 1.25 $44.78 -0.0086%

99308 1.94 $69.45 1.93 $69.14 0.0045%

99309 2.56 $91.65 2.54 $90.99 0.01%

99310 3.8 $136.04 3.78 $135.41 0.0046%

99315 2.05 $73.39 2.05 $73.44 -0.0006%

99316 2.96 $105.97 2.94 $105.32 0.0062%

99318 2.7 $96.66 2.69 $96.36 0.0031%

% = (new-old)/old

Estimates for Skilled Nursing Facility Services*

*AMDA

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Watching Paint Dry

More exciting than this presentation?

CMS FINALIZES FISCAL YEAR 2015

PAYMENT AND POLICY CHANGES

FOR MEDICARE SKILLED NURSING

FACILITIES

CMS-1605-F

CMS-1605-F

• Projects a 2% increase, or $750 million, in

Medicare payments to skilled nursing

facilities (SNFs) in fiscal year (FY) 2015.

• The estimated increase reflects a 2.5%

market basket update, reduced by a 0.5

percentage point multifactor productivity

adjustment required by law.

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CMS-1605-F

• CMS will use the new OMB delineations to

identify a provider’s urban or rural status

for rate purposes, the fact sheet said. “In

an effort to mitigate the potential negative

wage index impacts for some providers of

the revised OMB delineations," CMS is

implementing a one-year transition by

using a 50-50 blend of the current and

new OMB delineations in FY 2015.

MEDICAID: FINANCIAL CHARACTERISTICS

OF APPROVED APPLICANTS AND

METHODS USED TO REDUCE ASSETS TO

QUALIFY FOR NURSING HOME COVERAGE

GAO-14-473

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GAO-14-473

• Fourteen percent of Medicaid nursing

home applicants had over $100,000 in

total resources.

• 41% of applicants had total resources—

both countable and not countable as part

of financial eligibility determination—of

$2,500 or less.

• 44% had between $2,501 and $100,000 in

total resources.

GAO-14-473

• median total resources for all approved

applicants was $7,660, which was less

than the median net worth of elderly

households in the United States.

GAO-14-473

• “Although Congress has acted multiple

times to address financial eligibility

requirements for Medicaid coverage of

nursing home care, methods exist through

which individuals, sometimes with the help

of attorneys, can reduce their assets and

qualify for Medicaid…”

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NURSING FACILITIES' COMPLIANCE WITH

FEDERAL REGULATIONS FOR REPORTING

ALLEGATIONS OF ABUSE OR NEGLECT

OEI-07-13-00010

OEI-07-13-00010

• 85 percent of nursing facilities reported at

least one allegation of abuse or neglect to

OIG in 2012.

• 76 percent of nursing facilities maintained

policies that address Federal regulations

for reporting both allegations of abuse or

neglect and investigation results.

OEI-07-13-00010

• 61 percent of nursing facilities had

documentation supporting the facilities'

compliance with both Federal regulations

under Section 1150B of the Social

Security Act.

• 53 percent of allegations of abuse or

neglect and the subsequent investigation

results were reported, as Federally

required.

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OEI-07-13-00010

• “We recommend that CMS ensure that

nursing facilities: (1) maintain policies

related to reporting allegations of abuse or

neglect;

• (2) notify covered individuals of their

obligation to report reasonable suspicions

of crimes; and

OEI-07-13-00010

• (3) report allegations of abuse or neglect

and investigation results in a timely

manner and to the appropriate individuals,

as required.

• CMS concurred with all three.

HEALTH CARE FRAUD AND ABUSE

CONTROL PROGRAM

ANNUAL REPORT FOR FISCAL YEAR 2013

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HCFAC Annual Report for

Fiscal Year 2013• During Fiscal Year (FY) 2013, the Federal

government won or negotiated over $2.6

billion in health care fraud judgments and

settlements.

• It attained additional administrative

impositions in health care fraud cases and

proceedings.


Fiscal Year 2013• FY 2013, approximately $4.3 billion was

deposited with the Department of the

Treasury and the Centers for Medicare &

Medicaid Services (CMS), transferred to

other Federal agencies administering

health care programs, or paid to private

persons during the fiscal year.


Fiscal Year 2013• Of this $4.3 billion, the Medicare Trust Funds

received transfers of approximately $2.85

billion during this period.

• $576 million in Federal Medicaid money was

similarly transferred separately to the

Treasury.

• The HCFAC account has returned over $25.9

billion to the Medicare Trust Funds since the

inception of the Program in 1997.

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Fiscal Year 2013• In FY 2013, the Department of Justice

(DOJ) opened 1,013 new criminal health

care fraud investigations involving 1,910

potential defendants.

• Federal prosecutors had 2,041 health care

fraud criminal investigations pending,

involving 3,535 potential defendants, and

filed criminal charges in 480 cases

involving 843 defendants.


Fiscal Year 2013• 718 defendants were convicted of health

care fraud-related crimes during the year.

• FY 2013, DOJ opened 1,083 new civil

health care fraud investigations and had

1,079 civil health care fraud matters

pending at the end of the fiscal year.


Fiscal Year 2013• In FY 2013, Federal Bureau of

Investigation (FBI) health care fraud

investigations resulted in the operational

disruption of 425 criminal fraud

organizations and the dismantlement of

the criminal hierarchy of more than 115

criminal enterprises engaged in health

care fraud.

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Fiscal Year 2013• In FY 2013, HHS’ Office of Inspector General

(HHS-OIG) investigations resulted in 849

criminal actions against individuals or entities

that engaged in crimes related to Medicare and

Medicaid; and 458 civil actions, which include

false claims and unjust-enrichment lawsuits filed

in Federal district court, civil monetary penalties

(CMP) settlements, and administrative

recoveries related to provider self-disclosure

matters.


Fiscal Year 2013• HHS-OIG also excluded 3,214 individuals

and entities.

NINETY DEFENDANTS CHARGED IN

NATIONWIDE MEDICARE FRAUD

STRIKE FORCE OPERATIONS

DOJ Press Release: May 13, 2014

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DOJ Press Release: May 13,

2014• A multi-state Medicare Fraud Strike Force

takedown has resulted in charges against

90 individuals for their alleged participation

in Medicare fraud schemes involving

approximately $260 million in false billings.

DOJ Press Release: May 13,

2014• The defendants, including 27 doctors, nurses,

and other medical professionals, are charged

with various health care fraud-related crimes,

including conspiracy to commit health care

fraud, anti-kickback violations, and money

laundering.

• A total of 50 defendants were charged in Miami,

FL; 11 were charged in Houston, TX; eight in

Los Angeles, CA; seven in Detroit, MI; seven in

Tampa, FL; and seven were charged in

Brooklyn, NY.

DOJ Release: May 13, 2014

• Defendants allegedly participated in schemes to

submit claims to Medicare for treatments that

were medically unnecessary and often never

provided. Specifically, court documents allege

patient recruiters, Medicare beneficiaries, and

other co-conspirators were paid cash kickbacks

in return for supplying beneficiary information to

providers, so the providers could then submit

fraudulent bills to Medicare.

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MEDICARE CONTRACTORS NEED

MORE OVERSIGHT, GUIDANCE TO

CURB DUPLICATIVE AUDITS

(GAO-14-474)

(GAO-14-474)

• In a report issued August 13, the

Government Accountability Office (GAO)

states that the Centers for Medicare &

Medicaid Services (CMS) needs to

improve its oversight of and guidance to

Medicare contractors to avoid duplicative

postpayment claims reviews that are

administratively burdensome to providers.

(GAO-14-474)

• CMS also should standardize the requirements

for corresponding with providers during the

postpayment claims review process across the

four contractor types—Medicare Administrative

Contractors (MACs), Zone Program Integrity

Contractors (ZPIC), Recovery Audit Contractors

(RACs), and the Comprehensive Error Rate

Testing (CERT) contractors—and then regularly

assess compliance with those requirements,

GAO said.

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ENFORCEMENT ACTIONS

• 08-22-2014

• After it self-disclosed conduct to OIG, Rolling

Hills H.C., Inc. and Fountain Lake Health and

Rehab, Inc. (Rolling Hills and Fountain Lake),

Arkansas, agreed to pay $117,748.32 for

allegedly violating the Civil Monetary Penalties

Law. OIG alleged that Rolling Hills and Fountain

Lake employed two individuals that it knew or

should have known were excluded from

participation in Federal health care programs.

• 08-24-2014

• After it self-disclosed conduct to OIG, the

City of Baytown, Texas, agreed to pay

$29,431.43 for allegedly violating the Civil

Monetary Penalties Law. OIG alleged that

the City of Baytown employed an

individual that it knew or should have

known was excluded from participation in

Federal health care programs.

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• 08-24-2014

• Rock Rapids Health Centre (RRHC), a skilled nursing

facility located in Iowa, entered into a settlement

agreement with the Office of Inspector General (OIG) for

the Department of Health and Human Services, effective

August 24, 2014. The settlement resolves allegations

that RRHC employed an individual who was excluded

from participating in any Federal health care programs.

The excluded individual provided items and services to

RRHC patients that were billed to Federal health care

programs.

2015 Winter Forecast

Better than this presentation?

CASE LAW

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Foundation Health Services,

Inc.• Foundation Health Services, Inc. (FHS), its

affiliated nursing facilities, and its president

and chief executive officer Richard Daspit,

Sr., have agreed to pay $750,000 to the

United States and the State of Maryland to

resolve allegations that they submitted false

claims for payment to Medicaid and Medicare

for materially substandard and/or worthless

skilled nursing facility services.


Inc.• The settlement resolves allegations that

between 2006 and 2010, some of the skilled

nursing services provided at several nursing

facilities managed by FHS were materially

substandard and/or worthless.

• As a result of these failures of care, some

residents allegedly suffered from falls, fractures,

head injuries; malnutrition; dehydration;

pressure sores and infections.


Inc.• FHS failed to (a) follow appropriate fall protocols; (b)

follow appropriate pressure ulcer and infection control

protocols; (c) properly administer medications to avoid

medication errors; (d) appropriately provide for activities

of daily living including bathing, monitoring, feeding and

supervising for some residents; (e) provide appropriate

mental health treatment; (f) answer call lights promptly;

(g) employ a sufficient number and skill-level of nursing

staff to adequately care for the residents; and (h) provide

a habitable living environment, adequate equipment and

needed capital expenditures.

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United States ex rel. Absher v.

Momence Meadows Nursing Ctr, Inc.

• On August 20, 2014, the Seventh Circuit

overturned a $9 million jury verdict and

cast doubt on the efforts to pursue similar

cases in which a business allegedly

provides services of diminished, but still

some, value.



• In 2004, former nurses of the facility, filed

a qui tam (or whistleblower) complaint

alleging that the facility defrauded the

government by providing substandard

services to the patients while seeking

reimbursement for patient care of higher

value. While still under seal, the complaint

was amended multiple times through

2009.



• The government declined to intervene and

the district court unsealed the complaint.

• The relators went forward with the case.

• The relators presented evidence of a host

of shortcomings and noncompliance at

Momence relating to infection control,

cleanliness, food and water temperature,

administration, patient care, and others

issues.

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• The jury ruled in favor of the relators,

finding over 1,700 false claims and

awarding compensatory damages over $3

million and fines of over $19 million.

• With treble damages—resulted in an

award of over $9 million. The court

separately vacated the fines imposed by

the jury based on the Eighth Amendment’s

Excessive Fines clause.



• The worthless services theory—adopted

by the Second, Eighth, and Ninth

Circuits—allows a qui tam relator to bring

claims for violations of the FCA premised

on the theory that the defendant received

reimbursement for products or services

that were worthless.



• In Absher, the district court had instructed

the jury that “[s]ervices can be worthless,

and the claims for those services can, for

that reason be false, even if the nursing

facility in fact provided some services to

the patient.

• To find the services worthless, you do not

need to find that the patient received no

services at all.”

26



• Seventh Circuit rejected the district court’s

instruction.

• For the worthless services theory to apply, the

“performance of the service [must be] so

deficient that for all practical purposes it is the

equivalent of no performance at all.”

• “[i]t is not enough to offer evidence that the

defendant provided services that are worth

some amount less than the services paid for.

That is, a ‘diminished value’ of services theory

does not satisfy this standard.”



• “services that are ‘worth less’ are not

‘worthless.’”

PROPOSED NURSING HOME

ADMINISTRATOR RULES

27

Proposed Nursing Home

Administrator Rules• National Association of Long Term Care

Administrator Boards (NAB), has member

organizations in 50 states and the District

of Columbia.

• NAB is encouraging its member

0rganizations to move toward requiring a

minimum of a bachelor’s degree as a

condition for licensure as a nursing home

administrator.


Administrator Rules• The NAB has taken this position because practice as a

nursing home administrator has become more

complex and requires, at a minimum, the education

and training consistent with a bachelor’s degree.

• 28 states that require a bachelor’s degree for licensure

as a nursing home administrator.

• 45 states that require applicants pass the NAB

national licensing examination.

• 28 states that require applicants pass a state licensing

examination.


Administrator Rules• MCL 333.17309 would require a statutory

amendment to allow the Department to

require a Bachelor’s degree.

• The proposed rules will clarify the

continuing education requirements for

nursing home administrators in Michigan,

which are comparable to the requirements

established by the other states in the

Great Lakes region.

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Administrator Rules• Have been employed as a chief executive or

administrative officer at a Michigan-licensed

hospital for not less than 5 of the 7 years

immediately preceding the date of applying for a

nursing home administrator license, as provided

in MCL 333.17309(3) of the code.

• Pass the national nursing home administrators

licensing examination and the Michigan nursing

home administrators licensing examination.

BENEFICIARY AND FAMILY-

CENTERED CARE (BFCC) QIO

CONTACTOR FOR MICHIGAN

KEPRO

KEPRO

• The new QIN-QIO contract is part of an effort by

CMS to re-structure its QIO program that

historically combined Medicare beneficiary quality

of care case reviews, discharge/discontinuation of

service appeals and quality improvement services

at a single organization in each state or territory.

Under the new structure, beneficiary quality of

care case reviews and appeals have been

separated from quality improvement services and

cannot be administered by the same organization.

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KEPRO

• Beginning Aug. 1, 2014, KEPRO, based in

Ohio, will handle Medicare quality of care

case reviews, discharge/discontinuation of

service and other related review services

for Michigan, Minnesota and Wisconsin.

KEPRO

• Hospital Discharge QIO Request for

Review

– If you believe you are not medically ready to

go home from the hospital

– If you have a legitimate medical reason to

continue receiving a medical service

– If you have not received clear discharge

instructions

KEPRO

• Other Medicare QIO Requests for

Review

– You may request a QIO review if you disagree

with the decision of skilled nursing facility,

comprehensive outpatient rehabilitation

facility, home health agency, or hospice to

discharge you.

https://www.ohiokepro.com/

30

KEPRO

• Quality of Care Complaints

• If you believe you are not receiving the care you

need, you have the right to file a quality of care

complaint. Some common complaints include:

– Wrong medication

– Unnecessary surgery or diagnostic testing

– Inadequate care or misdiagnosis by any

Medicare hospital or doctor

– Early discharge from a health care facility

KEPRO

• To complete a Medicare Consumer QIO

Request for Review or file a complaint:

Contact KEPRO toll-free at 1-855-408-

8557. TTY 1-855-843-4776.

• www.keproqio.com.

LEADINGAGE MICHIGAN

SNF REGULATORY DAY

September 17, 2014



www.kitch.com

http://www.keproqio.com/

leadingage michigan snf regulatory day september 17, … · detroit lansing mt. clemens marquette...

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