Category archive: CMS

CMS Changes Position to Support Arbitration Agreements in Long Term Care Settings

The Centers for Medicare and Medicaid Services (CMS) advised in June that it was going to back off its prior position on prohibiting nursing homes from including arbitration provisions in admission contracts. CMS has reversed its prior position and is currently drafting a new rule, which would allow pre-occurrence arbitration agreements to stand. The Fair…

CMS Update – Sharp Rise in Denials for SNF Claims

CMS issued an update regarding what appears to be a sharp increase in the denial rate for Skilled Nursing Facilities (SNFs) as reported in the 2015 Comprehensive Error Rate Testing (CERT) Report. The CERT Report showed denials increasing from 6.9% reported in 2014 to 11% in 2015. What did CMS attribute as the cause of…

CMS Final Rule – Completed Comprehensive Analysis by Sandberg Phoenix LTC Team

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…

CMS Final Rule – §483.95 Training Requirements

Implementation Date: Phase 3 – November 28, 2018¹ This is a new section which sets forth training requirements, requiring a facility to develop, implement, and maintain an effective training program for all new and existing staff, persons providing service under contractual arrangements, and volunteers, consistent with the respective roles. Section 483.70(e) sets forth the assessment…

CMS Final Rule – §483.45 Pharmacy Services

Implementation Date: Phase 1 – November 28, 2016¹ Section 483.45 incorporates regulations previously contained in §483.60 and was revised to include additional requirements involving pharmacist review of medical records, changes to existing requirements concerning “anti-psychotic” drugs to include “psychotropic” medications, and provisions related to “irregularities” or “unnecessary” use of psychotropic drugs. Currently, a pharmacist is…

CMS Final Rule – §483.85 Compliance and Ethics Program

Implementation Date:  Phase 3 – November 28, 2019 This is a new section developed in response to a mandate under the Affordable Care Act that requires the operating organizations of skilled nursing facilities to have a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations and in promoting…

CMS Final Rule – §483.80 Infection Control

Implementation Date: Phase 1 – November 28, 2016 The new §483.80 adds additional requirements for infection prevention and control. The provisions under existing §483.65 have been re-designated as §483.80. Each facility must implement an “Infection prevention and control program” (IPCP) that must follow accepted national standards, be based upon the facility assessment conducted according to…

CMS Final Rule – §483.75 Quality Assurance and Performance Improvement (QAPI)

Implementation Date: Phase 3 – November 28, 2019 – with the following exceptions Phase 2 – November 28, 2017 – §483.75(a)(2) Initial QAPI Plan must be provided to State Agency Surveyor at annual survey Phase 1 – November 28, 2016 -  §483.75(h) and (i) – Disclosure of information and Sanctions Phase 1 – November 28,…

CMS Final Rule – Freedom from abuse, neglect, and exploitation (§483.12)

Implementation Date: Phase 1 – November 28, 2016 except for (b)(4) Coordination with QAPI plan – implemented in Phase 3 (November 28, 2019) and (b)(5) reporting crimes/1105B – Implemented in Phase 2 (November 28, 2017) Section 483.12 has been changed to “Freedom from Abuse, Neglect and Exploitation” from “Resident Behavior and Facility Practices” in order…

CMS Final Rule – Physician Services (§483.30)

Implementation Date: Phase 1 – November 28, 2016 §483.30 was modified to specify that, in addition to a physician’s recommendation that the individual be admitted to a facility, a physician, a physician assistant, a nurse practitioner, or a clinical nurse specialist must provide orders for the resident’s immediate care and needs. This provision will help…

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