Category archive: Long-Term Care

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…

Delays in Illinois Medicaid Approval Under Fire

As every long-term care facility doing business in Illinois can attest, Medicaid eligibility determinations and benefit awards have been slow, with HFS often falling months, if not years, behind. A group of SNFs and their residents are trying to change that. Several healthcare providers and their patients have filed suit against Felicia Norwood in her…

CMS: Change in Direction on Arbitration Ban

On September 28, 2016, CMS created the “Arbitration Rule”, banning arbitration agreements in nursing home admission agreements. By creating this Rule, CMS took the position that, due to the inequality of bargaining power between potential nursing home residents and long term care facilities, those facilities could no longer require, or even offer, binding arbitration as…

Proposed “Arbitration Fairness Act of 2017” Continues Trend to End the Enforcement of Pre-Dispute Arbitration Agreement

Sen. Al Franken of Minnesota and Rep. Hank Johnson of Georgia have introduced the Arbitration Fairness Act of 2017. This bill, if enacted, would amend the Federal Arbitration Act (FAA) by adding a new chapter invalidating agreements that require arbitration of employment, consumer, antitrust or civil rights disputes entered into before a dispute arises. Sen….

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…

National Pressure Ulcer Advisory Panel (NPUAP) Biennial Meeting

Recently, the National Pressure Ulcer Advisory Panel met at its Biennial meeting in New Orleans on March 10th and March 11th. A panel of experts met to discuss the terminology and evidence related to end-of-life wounds and skin failure issues. You may have heard of the terms that are sometimes used to describe end-of-life wounds,…

HIPAA Update – Newest Settlement of $475,000 Results From Untimely Breach Report

Don’t let your clients get caught paying a “big” settlement for failing to report a HIPAA breach! For the first time, the Office of Civil Rights (OCR) has announced a HIPAA settlement with a provider who failed to provide a timely breach report. Presence Health, a health network serving Illinois with approximately 150 locations, including…

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