On February 18 Centers for Medicare & Medicaid Services (CMS) published in the Federal Register (Volume 76, Number 34, pages 9503-9512) its interim rule on Medicare and Medicaid Programs Requirements for Long-Term Care (LTC) Facilities Notice of Facility Closure. The interim final rule amends the requirements that a long-term care (LTC) facility must meet in order to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or a nursing facility (NF) in the Medicaid program. These requirements implement section 6113 of the Affordable Care Act to ensure that, among other things, in the case of a LTC facility closure, individuals serving as administrators of a SNF or NF provide written notification of the impending closure and a plan for the relocation of residents at least sixty (60) days prior to the impending closure or, if the Secretary terminates the facility’s participation in Medicare or Medicaid, not later than the date the Secretary determines appropriate. The effective date of the rule is March 23, 2011. To be assured consideration, comments must be received no later than 5 p.m. on April 19, 2011. FMI: See www.regulations.gov. See http://www.regulations.gov/#!documentDetail;D=CMS-2011-0018-0001.
The Centers for Medicare and Medicaid (CMS) has revised its brochure The Medicare Appeals Process: Five Levels to Protect Providers, Physicians, and Other Suppliers (Revised January 2011). The brochure is now available in downloadable format from the Medicare Learning Network® at http://www.CMS.gov/MLNProducts/downloads/MedicareAppealsProcess.pdf. The brochure is designed to provide an overview of the Medicare Part-A and Part-B administrative appeals process available to providers, physicians, and other suppliers who provide services and supplies to Medicare beneficiaries, as well as details on where to obtain more information about this appeals process
On February 18 the Centers for Medicare and Medicaid Services (CMS) updated its coverage pages posting a new tracking sheet for Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse. CMS said that after reviewing various preventive services given a grade A or grade B recommendation by the USPSTF, CMS has decided to initiate a new national coverage analysis (NCA) on Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse, which is recommended with a grade B by the USPSTF. CMS says that it would be interested in receiving any recommendations on the appropriate frequency of this service and those qualified to provide it based on documentation from the medical literature, current clinical practice guidelines, or the USPSTF recommendations. Effective January 1, 2009, CMS is allowed to add coverage of “additional preventive services” if certain statutory requirements are met, as provided under section 101(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275). FMI: See http://www.cms.gov/center/coverage.asp to access the Medicare Coverage Center. See also http://www.cms.gov/medicare-coverage-database/reports/national-coverage-whats-new-report.aspx?TimeFrame=7&DocType=All&bc=AgAAQAAAAAAA&#ResultsAnchor. See www.cms.gov.
On February 18, the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) posted to its website the Department of Health and Human Services (HHS) Top FY 2011 Management Challenges, a summary of the most significant management and performance challenges facing HHS and the Department’s progress in addressing those challenges. The document is divided into four parts: (1) health care reform; integrity of the Medicare, Medicaid and the Children’s Health Insurance Program (CHIP); (3) integrity of the Department’s public health and human services programs; and (4) cross-cutting issues that span the Department. For a copy of the document see http://oig.hhs.gov/publications/challenges/files/TM_Challenges10.pdf. In addition to the complete document, a two page executive summary is also made available. http://oig.hhs.gov/publications/challenges/files/TM_Summary10.pdf. The assessment is also included as an appendix to the HHS annual Agency Financial Report, which is publicly available online at http://www.hhs.gov/afr/
On February 11 the plaintiffs in the case of Naylor v DPW filed a motion with the PA Commonwealth Court for summary relief and payment of the state supplement at pre-2010 levels. Naylor v DPW – the class action lawsuit against the Pennsylvania Department of Public Welfare (DPW) – challenges the state’s action to reduce the State Supplementary Payment (SSP) to the severely, blind and elderly indigent. The request for summary relief is posted on the PA Community Legal Services (CLS) blog at http://clsphila.wordpress.com/. The PA Department of Public Welfare (DPW) is provided thirty (30) days to file a response to the motion. Attorneys for the plaintiffs say that it will likely be at least several months before the PA Commonwealth Court issues a ruling. On November 30, 2010 PA Community Legal Services (CLS) along with Dechert LLP, a Philadelphia-based law firm working pro bono, filed the class action lawsuit in Commonwealth Court on behalf of the more than 359,000 Pennsylvanians whose SSP was reduced in February 2010. The lawsuit argues that the reduction in SSP was unlawful because DPW failed to comply with certain rulemaking procedures as was required when they cut the SSP. The rulemaking procedures would have included seeking public and legislative comment and allowing the Independent Regulatory Review Commission (IRRC) to vote on whether the reduction was appropriate. The plaintiffs claim that instead of following such procedure DPW announced the SSP cut simply by publishing a notice in the Pennsylvania Bulletin. The plaintiffs are asking DPW to reinstate the SSP at its January 2010 rate and reimburse the $5.30 monthly amount that is owed to all SSI recipients. FMI: Contact Mike Froelich at mfroehlich@clsphila.org. See www.clsphila.org. See also http://www.clsphila.org/NewsItem.aspx?id=234 and http://www.clsphila.org/files/Naylor%20Petition.pdf.
The PA DPW Office of Developmental Programs (ODP) has notified PARF that the Department of Public Welfare (DPW) has not yet established who will be responsible for completing the Individual Service Plans (ISPs) for individuals who are residing in an Intermediate Care Facility for Persons with Mental Retardation (ICF/MR) and who are also attending either an adult training program licensed under PA Chapter 2380 or a vocational facility licensed under PA Chapter 2390. ODP says that it expects to assign that responsibility for ISPs soon. PARF will notify its members of the final decision. FMI: Contact PARF at parfmail@parf.org.
