New Rule Affords Opportunity to Reduce Fines

Nursing homes that self-report compliance violations and quickly address them will see their fines cut in half, under a new final rule released March 17 by the Centers for Medicare & Medicaid Services.

McKnight’s reports that organizations must report the violation before it is identified by CMS or by state inspectors in order to qualify for reduced civil monetary penalties (CMPs). Operators are required to forego administrative hearings to remain eligible. The reduction does not apply when immediate jeopardy or patient harm is possible. If a nursing home decides to appeal violations, the CMP would be held in an escrow account, and returned to the home with interest if the appeal succeeds.

The rule was created through a section of the Patient Protection and Affordable Care Act, and was originally proposed in July 2010. CMPs currently range from $50 to $10,000 per day of noncompliance, according to CMS. The rule will take effect Jan. 1.


Published in: on March 21, 2011 at 8:49 am  Leave a Comment  
Tags: , , ,

Pressure Sores Rate Decreasing

According to a new report from the U.S. Department of Health and Human Services Agency for Health Care Quality (AHRQ), the percentage of short-stay nursing home residents with pressure sores fell by nearly 17% between 2000 and 2008.

The prevalence of pressure sores among long-stay residents fell almost 16% over the same period. The report noted that short-stay residents have a higher rate of pressure sores, and some patients may  develop the condition during hospitalization before coming into a nursing home.

In addition, researchers analyzed potentially avoidable hospitalizations among nursing home residents and home health recipients. Researchers found a decline in the number of home health patients being hospitalized for potentially avoidable conditions within 30 days of the beginning of care between 2001 and 2008. During the same period, the number of residents hospitalized for potentially avoidable conditions within 30 days of entering a nursing home increased slightly. The full report can be accessed by clicking here.


Published in: on March 1, 2011 at 2:30 pm  Leave a Comment  
Tags: , ,

Medicaid Recovery Program Postponed

The Centers for Medicare and Medicaid Services (CMS) announced a delay in the April 1 implementation date for the Medicaid recovery audit contractor (RAC) program, which was created under the Affordable Care Act. Medicaid RACs are tasked with identifying and recovering Medicaid overpayments and identifying underpayments.

CMS noted that operational issues as well as the necessity of amending state Medicaid plans made the delay necessary. CMS will issue a final rule later this year with the new implementation date.


Published in: on February 28, 2011 at 6:38 pm  Leave a Comment  
Tags: , , ,

CMS Proposes New Nursing Home Closure Rules

The Centers for Medicare & Medicaid Services issued an interim rule regarding new procedures for the closure of long-term care facilities. The rule sharply amends the notification-of-closure period — and increases the stakes significantly for potential penalties for administrators.

The rule, which appeared in the February 18 Federal Register, is slated to go into effect March 23. Required under the Affordable Care Act, it requires long-term care administrators to submit written notification to residents 60 days prior to a facility closure. Notification also must be made to the Department of Health and Human Services and the state’s long term care ombudsman. Currently, administrators must do so just 30 days before a planned closure.

Closure notices have to contain a state-approved relocation plan and “include assurances that the residents will be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs, choice and best interests of each resident,” according to the rule.

Administrators who fail to comply with the rule can face civil monetary penalties of up to $100,000. Additionally, administrators can be denied participation in any federal health care program and could be subject to further penalties. Comments on the rule are due to HHS by April 19.


Published in: on February 22, 2011 at 4:00 pm  Leave a Comment  
Tags: , ,

Flu Activity Remains Widespread in NC

Three more flu-associated deaths during the past week are a reminder that flu activity remains widespread in North Carolina, and the N.C. Division of Public Health is encouraging individuals to continue taking precautions to protect themselves from illness. Since late December, the state has recorded 14 deaths from flu, including six among children.

Look for the most recent flu Facts and Figures at


Published in: on February 21, 2011 at 4:54 pm  Leave a Comment  
Tags: ,

Kaiser Family Foundation Releases 2011 Primer on Medicare Spending and Financing

Medicare is our nation’s single largest health insurance program, covering more than 47 million Americans and now representing 15% of all federal outlays.  The Henry J. Kaiser Family Foundation publishes an annual primer that serves as an excellent resource for both explaining Medicare and forecasting the challenges it faces.  A copy of the newly-released 2011 Primer can be accessed by clicking here.

Published in: on February 19, 2011 at 3:26 pm  Leave a Comment  

Redesigned North Carolina Medical Journal website debuts

The North Carolina Medical Journal – a journal of health policy analysis and debate – is an excellent resource. Their updated website has a wealth of information and links to cutting edge innovation, research, and news.  You can link to their redesigned site by clicking here.


Published in: on February 16, 2011 at 9:59 am  Leave a Comment  

CMS update for SNF PC Pricer now available

The updated FY 2011 SNF PC Pricer is now updated with corrections to the pricing factor error. It can be accessed by clicking here.

Published in: on February 14, 2011 at 3:45 pm  Leave a Comment  
Tags: ,

2011 NC Medical Facilities Plan Now Available Online

The North Carolina State Medical Facilities Plan is an annual document that contains policies and methodologies used in determining the need for new health care facilities and services in North Carolina. It contains a wealth of information, statistics, and data. The plan also contains background information on the North Carolina State Health Coordinating Council (SHCC), on the annual planning cycle, and general policies related to implementing the planning cycle. The 2011 Plan is now posted online and can be accessed by clicking here.

Published in: on February 11, 2011 at 5:04 pm  Leave a Comment  
Tags: , , ,

Assisted Living Rates Increased by 5% in 2010, Says MetLife

Base rates for assisted living communities increased by 5.2 percent nationally in 2010, according to an annual market survey from the MetLife Mature Market Institute. The monthly rate for a one-bedroom apartment or private room with private bath rose from $3,131 in 2009 to $3,293 in 2010, according to the survey. Arkansas reported the lowest average monthly rate ($2,073) while Washington, D.C., had the highest average rate ($5,231). Just over two-thirds (68%) of the assisted living communities surveyed by MetLife provide Alzheimer’s and dementia care for residents. Half (49%) of those communities charge an additional fee for this service. The national average monthly base rate for Alzheimer’s and dementia care is $4,762, up from $4,435 in 2009.

A copy of the press release detailing the survey’s results can be found by clicking here.


Published in: on February 10, 2011 at 4:02 pm  Leave a Comment  
Tags: ,