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WHAT'S
NEW
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WEEK
OF JUNE 25, 2007
CDC
Releases The Guideline for Isolation Precautions: Preventing Transmission
of Infectious Agents in Healthcare Settings, 2007
On June 25, 2007 CDC released a set of guidelines that updates
and expands the isolation precautions for hospitals and other
health care settings. This new guideline has 219 pages and applies
to ambulatory care, long term care, hospitals, home care and infusion
services as well as other specialized environments in health care.
The new guidelines:
This
document is intended for use by infection control staff, healthcare
epidemiologists, healthcare administrators, nurses, other healthcare
providers, and persons responsible for developing, implementing,
and evaluating infection control programs for healthcare settings
across the continuum of care. http://www.cdc.gov/ncidod/dhqp/gl_isolation.html
2008
Patient Safety Goals
The Joint Commission this week announced the 2008 National Patient
Safety Goals and related requirements for each of its accreditation
programs. Changes to the long-term care program include: the timeliness
of reporting and receipt of critical test results and values;
reduce the likelihood of patient harm associated with the use
of anticoagulation therapy; and comply with either the current
World Health Organization (WHO) or the CDC hand hygiene guidelines.
The assisted living program has only changed the hand hygiene
guideline option, to use either those from the WHO or the CDC.
The full test of the 2008 Goals and Requirements is posted on
the Joint Commission Website. |
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WEEK
OF JUNE 18, 2007
Revised
NPI Application/Update Form
The NPI Application/Update Form (CMS-10114, 05-07) has been revised
and is now available for download on the CMS website.
Annual
Update of the International Classification of Diseases, Ninth
Revision, clinical Modification (ICD-9-CM)
The ICD-9-CM codes are updated annually as stated in the Medicare
Claims Processing Manual, Chapter 23. The annual update codes
will be effective for dates of service on and after October 1,
2007. The new, revised, and discontinued ICD-9-CM diagnosis codes
can be accessed on the CMS website.
http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07
_summarytables.asp#TopOfPage
or
at the National Center for Health Statistics (NCHS) website at:
http://www.cdc.gov/nchs/icd9.htm
It
is generally recommended by CMS that all providers purchase a
new set of ICD-9-CM code bookes each year unless they have a subscription
service which automatically sends the updated pages for their
coding books.
MDS
Required for Payment for Missed Assessments
CMS verified last week that facilities will not be paid at the
default rate when a corresponding MDS has not been accepted into
the state database. Until now, facilities have interpreted the
regulation to say that the default rate would be paid if billed
by the facility when the facility completely missed submitting
a PPS assessment. During a Long-Term Care Open Forum, CMS verified
language which first appeared in writing in a transmittal several
weeks ago, instructing fiscal intermediaries not to make payment
on any claim submitted when the corresponding MDS assessments
are not in the state database. In order to be paid for the days
in the payment block of the missed assessment, providers should
submit the missed assessment using the current date as the ARD
(not setting the ARD back in time) as soon as the oversight is
identified, regardless of how late the assessment is. Once the
assessment is in the database, the default rate can be billed
for the entire payment block.
CMS
Issues Clarification of Physical Restraints
CMS Survey and Certification Letter S&C 07-22 was issued June
22, 2007 and addresses several terms used to define physical restraints
in the requirements for long-term care facilities. It clarifies
the phrases "remove easily" and "freedom of movement"
as related to the physical restraints definition, and further
defines the meaning of "medical symptom." In S+C 07-22,
CMS expresses commitment to reducing unnecessary physical restraint
use in nursing facilities and notes that proper interpretation
of the definition is necessary in order to understand whether
or not facilities are accurately assessing devices and meeting
the federal requirement for their use. Although the requirements
describe the narrow instances when physical restraints may be
used, growing evidence indicates that physical restraints have
a limited role in medical care. The effective date is no later
than 30 days after issuance of the memorandum, which will also
be incorporated into the State Operations Manual, Appendix PP. |
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WEEK
OF MARCH 12, 2007
Licensure
Rules Updated for Ohio Residential Care Facilities
The licensure rules for assisted living facilities in the State
of Ohio were finalized for the five year review and are now posted.
The effective date will be April 1, 2007. |
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WEEK
OF DECEMBER 18, 2006
CMS
Releases Revised State Operations Manual: Appendix P
New revisions were added to the State Operations Manual for the
survey process in long term care facilities. Transmittal 22 was
published on December 15, 2006, effective December 18, 2006. The
areas of revision were as follows: Index; Task 5, Information
gathering; Sub Task 5A, General Observations of the Facility;
Sub Task 5C, Resident Review; Sub Task 5E, Medication Pass and
Pharmacy Services.
CMS
Releases Revised State Operations Manual: Appendix PP
The revised version of Appendix PP, Guidance to Surveyors in Long
Term Care Facilities, Transmittal 22 was published on December
15, 2006, effective December 18, 2006. The regulatory text at
tags F329, F330, F331 has been combined into F329. The regulatory
test at tags F425, F426 and part of F427 has been combined into
Tag 425 and the regulatory text at Tags F431, F432 and part of
text at F427 has been combined into Tag 431. In addition the entire
interpretive guidelines for all of the combined into Tag 431.
In addition the entire interpretive guidelines for all of the
combined tags have been revised. |
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WEEK
OF SEPTEMBER 18, 2006
Dementia
Care Practice Recommendations
The Alzheimer's Association has released its Phase 2 care practice
recommendations for assisted living and nursing homes. These recommendations
cover six care areas: food and fluid consumption, pain management,
social engagement, wandering, falls and physical restraint free
care.
Surveyor
Guidance for Unnecessary Drugs, Pharmacy Services, Drug Regimen
Review and Labeling and Storage of Drugs and Biologicals
Revised guidance for long term care surveyors for surveying Unnecessary
Drugs, Pharmacy Services, Drug Regimen Review and Labeling of
Drugs and Biologicals were published on September 20, 2006. These
guidelines will become effective on December 18, 2006 at which
time these changes will be incorporated into appendix PP of the
State Operations Manual. An investigative protocol was added which
covers medication and medication review regimen issues and severity
guidance for F329. Ftags 425 through 431 were collapsed into three
tags, F425 Pharmacy Service, F428 Drug Regimen Review and F431
Labeling and Storage of Drugs and Biologicals. Severity guidance
is provided for each of the tags and changes were made to the
survey process to support the new guidance.
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WEEK
OF August 7, 2006
JCAHO
Issues Safety Goals, Requirements
The Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) has announced its 2007 National Patient Safety Goals and
related requirements for each of its accreditation programs, including
long-term care, and its disease-specific care certification program.
NCAL
Releases 2006 State Regulatory Review
NCAL has released its 2006 edition of the Assisted Living State
Regulatory Review. The 171-page report summarizes assisted living
regulations across 20 categories, in all 50 states and the District
of Columbia. The report is available free of charge and includes
phone numbers, e-mail addresses, and Web site information for
state agencies that oversee assisted living. The 2006 Regulatory
Review covers regulations on licensure term, definition, scope
of care, move-in/move-out criteria, requirements for resident
assessments, Alzheimer's unit requirements, Medicaid waiver policy,
and requirements for medication management, physical plant, staff
training, and disclosure.
ICD-9-CM
Coding Updates
Medicare has issued the annual update of the International Classification
of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
to Medicare contractors. This annual update will apply to claims
with service dates on or after October 1, 2006, as well as discharges
on or after October 1, 2006, for institutional providers.
Prospective
Payment System Changes for 2007
The Centers for Medicare and Medicaid Service (CMS) has issued
a final notice for updates to the skilled nursing facilities (SNFs)
Medicare prospective payment system (PPS) program (71FR43158).
The fiscal year 2007 changes will be effective October 1, 2006.
The CMS notice can be found in the July 31 Federal Register.
Dispensing
Controlled Substances for Pain Treatment
The Drug Enforcement Administration (DEA) has issued a proposed
rule that will allow a physician to prescribe up to a 90-day supply
of Schedule II controlled substances during a single office visit,
where medically appropriate. This will make it easier for patients
with chronic pain or other chronic conditions, to avoid multiple
trips to a physician. The Notice of Proposed Rulemaking is acoompanied
by a policy statement, "Dispensing Controlled Substances
for the Treatment of Pain," which provides information requested
by medical professionals regarding DEA's position on this important
issue. A sixty-day public comment period on the Notice of Propsed
Rulemaking began on September 6, 2006, the date of publication.
New
Medicare Learning Network Products
The new CMS "Website Wheel" is now available. This resource
provides up-to-date web addresses for the most frequently used
Medicare provider web pages, including the new URLs that resulted
from the CMS Website redesign. You can request a copy of the CMS
Website Wheel, free of charge, by going to the MLN order page.
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WEEK
OF JULY 17, 2006
IOM
Report on Medication Errors
A study was conducted by the Institute of Medicine, under contract
with CMS on Preventing Medication Errors. A report is now available
from IOM which should be helpful to providers in understanding
the different causes and ways to prevent errors.
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WEEK
OF JUNE 12, 2006
Revised
Appendix P
On June 16, CMS re-issued SOM Transmittal 20, which contained
the revised version of Appendix P. The original version did not
have the correct effective and implementation dates noted in the
body of the transmittal; the transmittal number and its date (June
9) are the same. Changes include the addition of "Psychosocial
Outcome Guidance" to Part IV Deficiency Categorization; the
addition of "Determining Citations of Past Noncompliance
at the Time of the Current Survey" to Task 5 Information
Gathering and Task 6 Information Analysis for Deficiency Determination;
and Revision of Task 5F Quality Assessment and Assurance Review.
Also included in this revision are corrections of minor errors.
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WEEK
OF MAY 29, 2006
CMS
Issues Updated Survey Guidance SOM
On June 1, 2006, CMS issued Transmittal 19: State Operations Manual
Appendix PP Guidance to Surveyors for Long Term Care Facilities,
which includes updates and corretions to:
- F248
& 249 Activities
- F276
Quarterly Review Assessment
- F332/333
Influenza and Pneumococcal Immunizations
- F356
Nurse Staffing Information posting
- F369
Paid Feeding Assistants
- F520
Quality Assessment and Assurance
The
changes are effective as of the date of issuance.
CMS
Issues Nurse Staff Posting Memo
On May 26, 2006, CMS issued notification of the implementation
of a new regulatory tag (F356) for citation of deficiencies regarding
the posting of nurse staffing information. The change was issued
as part of the general changes that were already planned to Appendix
PP (new link to Appendix PP below). The memo recinds use of deficiency
tag F492 to cite deficiencies in nurse staffing posting for compliance
with federal, state, and local laws. Tag F492 remains for other
issues involving compliance with federal, state, and local laws.
Tag F356 will be added to Aspen for the June 2006 release.
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WEEK
OF MAY 15, 2006
Pandemic
Influenza Checklist
The U.S. Department of Health and Human Services has released
the "Long-Term Care and Other Residential Facilities Pandemic
Influenza Planning Checklist." Long-term care and other residential
facilities can use this tool to self-assess the strengths and
weaknesses of their current planning efforts.
Revised
Appendix P, SOM, Survey Protocol for LTC Facilities
On May 1, 2006, CMS issued a revised Appendix P for the State
Operations Manual which defines the survey protocol for long term
care facilities. The revisions include addition of the Psychosocial
Outcome Severity Guide to Part IV Deficiency Determination, adding
Determining Citations of Past Noncompliance at the Time of the
Current Survey guid to Task 5, Information Gathering to Task 6,
Information Analysis for Deficiency Determination, and the revision
of Tasks 2, 5F, and II.B.3. Also included in the revisions are
corrections. All revisions to Appendix P will appear in red italics.
The effective date for these revisions is June 1, 2006.
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WEEK
OF APRIL 3, 2006
Joint
Commission Issues Sentinel Event Alert on Tubing Misconnections
On April 3, the Joint Commission published a Sentinel Event Alert
on tubing and catheter misconnections. Of particular concern is
the use of luer connectors, which can be used in a variety of
medical components and accessories. Other causes of errors identified
in the report include the use of tubes or catheters for purposes
other than what they were intended and locating functionally dissimilar
tubes near one another. The alert outlines types of misconnection,
root causes, risk reduction strategies, and the Joint Commission's
recommendations.
According
to the Joint Commission, an assessment of the healthcare organization's
actiosn taken in response to sentinel events is a part of full
accreditation surveys and random unannounced surveys.
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WEEK
OF MARCH 27, 2006
CMS
Moves Up Facilitated Part D Enrollment
A month earlier than originally scheduled, CMS is mailing letters
to 1.2 million Medicare beneficiaries in other federal assistance
programs such as Supplemental Security Income (SSI) and Medicare
savings programs, as well as beneficiaries who have applied and
been approved for extra financial help. The letters, which will
be printed on green paper to be more easily identified, will explain
the Medicare Part D benefit and that the letter's recipient will
be enrolled in a Medicare prescription drug plan (PDP) by CMS
if he/she takes no action to enroll or to decline enrollment in
Part D before April 30, 2006. Like the auto-enrollment for dual
eligible beneficiaries last fall, CMS is enrolling this group
of beneficiaries to assure that they receive this benefit immediately,
and without having to pay a penalty for enrolling after May 15,
2006. CMS also is reminding beneficiaries - especially those with
"creditable" or existing drug coverage typically from
employers or unions - to consider whether or not Part D coverage
is as good as, or better than, their existing coverage. In addition,
people who lose their creditable coverage can sign up for Part
D without paying the premium penalty after May 15, 2006 as long
as they enroll in Part D within 63 days of losing creditable coverage.
NCAL
Releases 2006 State Regulatory Review
NCAL has released its 2006 edition of the Assisted Living State
Regulatory Review. The 171-page report summarizes assisted living
regulations across 20 categories, in all 50 states and the District
of Columbia. The report is available free of charge and includes
phone numbers, e-mail addresses, and Web site information for
state agencies that oversee assisted living. The 2006 Regulatory
Review covers regulations on licensure term, definition, scope
of care, move-in/move-out criteria, requirements for resident
assessments, Alzheimer's unit requirements, Medicaid waiver policy,
and requirements for medication management, physical plant, staff
training, and disclosure.
Update
to 2002 RAI Manual (March, 2006)
CMS released a March update to the Long Term Care Facility Resident
Assessment Instrument User's Manual.
Medicare
Part D Exception Request Form
A standardized, one-page Medicare Part D Exceptions Request Form
can be found online at the CMS Provider website at: http://www.cms.hhs.gov/center/provider.asp
CMS
Releases Fact Sheet on Getting Drugs Under Medicare Part D After
the Transition Period
In an effort to make sure that Medicare Part D beneficiaries have
access to the drugs they need CMS has issued a new fact sheet,
"Getting Drugs After Your Transition".
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WEEK
OF MARCH 20, 2006
CMS
Releases Part D Transition Guidance
CMS released the final 2007 Transition Guidance for Part D sponsors
earlier this week. The guidance establishes a minimum set of standards
for Part D plan sponsor transition policies. These minimum standards
specify the components of a transition process beyond simply the
assurance of a temporary supply of non-formulary drugs or a transition
period constituting a particluar length of time. To address the
needs of individuals who are stabilized on certain drug regimens
when they join a plan, Part D plans are required to establish
an appropriate transition process for new enrollees who are transitioning
to a Part D plan from other prescription drug coverage - including
other Part D plans - and whose current drug therapies may not
be included in their new Part D plan's formulary, or situations
in which enrollees are stabilized on formulary drugs that require
prior authorization or step therapy under a plan's utilization
management rules. While Part D plans may implement additional
step therapy or prior authorization edits during transition, they
may do so only if such edits are resolved at the point of sale.
Additionally, transition processes must also address cases in
which a beneficiary changes their setting of care, for example
from a hospital to a home or institutional setting, to provide
uninterrupted access to needed drugs. The guidance also recognizes
the needs of new full-benefit dual eligibles who may be auto-enrolled
in a prescription drug plan who may be unaware of the impact of
the prescription drug plan's formulary or utilization management
practices on their existing drug regimens. A fact sheet describing
the minimum required standards for a Part D sponsor transition
process, the 2007 Transition Guidance, a summary of changes from
the 2006 to 2007 guidance and the new guidance are also available
for review and reference.
CMS
Orders Nursing Homes to Recycle Drugs
A letter issued March 22 by the Centers for Medicare and Medicaid
Services directs state Medicaid programs to require that nursing
homes return unused drugs to pharmacies. In addition, the letter
informs state Medicaid directors to ensure that Medicaid is repaid
for unused drugs after a nursing home resident dies, is discharged
or has his drug prescriptions changed. This policy will be effective
as of April 1, 2006, but the number of individuals affected by
this requirement is expected to be small as it does not apply
to individuals participating in the Medicare drug benefit unless
they receive a few specific drugs covered by Medicaid. This federal
requirement, however, may provide a national push to the drug
recycling movement that has taken hold in several states.
Medicare
Prescription Drug Coverage: How to File a Complaint, Coverage
Determination or Appeal
A fact sheet was issued by CMS which explains process to people
with Medicare and their families on how to file a complaint, request
a coverage determination or request an appeal under the Medicare
Part D Prescription Drug Coverage.
Message
to Nursing Home Administrators on Medicare Prescription Drug Coverage
This document from CMS provides information on the Transition
process along with valuable resources for providers, residents
and families.
The
Physician Part D Resource Fact Sheet
This document issued by CMS provides an overview of what's covered;
informational websites and toll free assistance phone numbers;
glossary of terms; the physician's role; and a flowchart of the
appeal process.
New
Name for Provider Education Articles
The Medicare Learning Network announced a new name for their provider
education articles. To more closely associate these articles with
the Medicare Learning Network, i.e., the official educational
information source for Medicare Fee-ForService (FSS) providers,
the articles previously known as "Medlearn Matters"
articles will now be known as "MLN Matters" articles
(the MLN standing for "Medicare Learning Network". For
MLN General Information - http://www.cms/hhs/gov/MLNGenInfo. If
you know the specific number of an article, such as SE0620, you
can go directly to the URL for an article by using this format:
http://www.cms/hhs/gov/MLNMattersArticles/downloads/
SE0620.pdf
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WEEK
OF MARCH 13, 2006
CMS
Surveyor Guidance for Activities (Tags F248 and F249)
On March 10, 2006, revised surveyor guidance for surveying Activities
requirements in long term care facilities was published. This
guidance becomes effective June 1, 2006. This guidance will be
incorporated into Appendix PP of the State Operations Manual.
CMS
Surveyor Guidance for Psychosocial Outcome Severity Guide
New surveyor guidance for using the Psychosocial Outcome Severity
Guide for surveying long term care facilities was published on
March 10, 2006. This guidance becomes effective June 1, 2006.
This guidance will be incorporated into Appendix P of the State
Operations Manual.
CMS
Surveyor Guidance for Quality Assessment and Assurance (Tags F520
and F521)
On March 10, 2006 revised surveyor guidance for surveying QAA
requirements in long term care facilities was published. This
guidance will become effective on June 1, 2006. This guidance
will be incorporated into Appendix PP of the State of Operations
Manual.
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WEEK
OF JANUARY 16, 2006
OIG
Workplan for 2006
The 2006 workplan was released of the Office of the Inspector
General for Health and Human Services on November 16, 2006. There
are a number of areas where Skilled Nursing Facilities are addressed:
medical necessity of Infusion therapy, laboratory services, and
consecutive inpatient stays, whether SNFs are in appropriately
billing and whether controls are in place to preclude duplicate
billing.
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WEEK
OF DECEMBER 26, 2005
RAI
User Manual Update
The RAI User's Manual for the MDS 2.0 was updated in December,
2005. When accessing the update go to download section of the
webpage and under Update Files subheading, click on December update
2005.
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WEEK
OF NOVEMBER 14, 2005
THERAPY
CAPS EFFECTIVE 1-1-06
Beginning 1-1-06, financial limitation of therapy services (caps)
will be implemented. The dollar amount for the 2006 limitation
on Physical therapy, Speech-Language Pathology services and Occupational
Therapy services will be $1740.00 for the time period 1-1-06 through
12-31-06. These limits were in effect in 1999 but were removed
by law in 2000-2002. The statutory limits went back into effect
9-1-2003. The Medicare Prescription Drug, Improvement, and Modernization
Act re-enacted the moratorium and extended it until December 31,
2005.
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WEEK
OF AUGUST 15, 2005
Omnicare
Releases New Fact Sheet (#3) on MMA
The latest fact sheet from Omnicare provides information from
CMS on service and performance criteria for pharmacies providing
services to long term care residents under Medicare Part D.
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WEEK
OF AUGUST 8, 2005
Medicare
Part A Skilled Nursing Facility Prospective Payment System Pricer
Update for FY 2006
CMS published the SNF payment rates for FY 2005 (October 1, 2004
through September 30, 2005), in the federal register on July 30,
2004. The statute mandates an update to the Federal rates using
the latest SNF full market basket. The SNF Wage Index notice will
be effective on October 1, 2005, and the index will be published
in the federal register before that date. Medicare systems will
apply the FY 2006 SNF PPS payment rates that are effective for
service dates beginning October 1, 2005 through December 31, 2005.
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WEEK
OF AUGUST 1, 2005
Final
Prospective Payment System Rule
On August 4, 2005, the skilled nursing facility final prospective
payment system rule for fiscal year 2006 was published in the
Federal Register.
Medicare
Part A Skilled Nursing Facility (SNF) Prospective Payment System
(PPS) Pricer Update FY 2006
A Medlearn Matters MM3972 titled "Medicare Part A Skilled
Nursing Facility (SNF) Prospective Payment System (PPS) Pricer
Update FY 2006" has been posted to the medlearn website.
The article announces that FY 2006 SNF PPS payment rates will
be effective on October 1, 2005. Medicare systems will apply the
FY 2006 SNF PPS payment rates that are effective for service dates
beginning October 1, 2005 through December 31, 2005.
Toolkit
for Healthcare Professionals: Medicare Prescription Drug Coverage
CMS has released the Toolkit for Healthcare Professionals: Medicare
Prescription Drug Coverage. The kit includes downloadable educational
materials specifically for physicians and other healthcare professionals
and their staff to learn the basics about Medicare Prescription
Drug Coverage. Facilities can add their logo and business information
to these materials and copy as needed according to CMS. |
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WEEK
OF JULY 25, 2005
Omnicare
Releases New Fact Sheet (#2) on MMA
The latest fact sheet from Omnicare is a comprehensive Medicare
Part D Glossary. As long term care facilities navigate through
the implementation of Medicare Part D there are many new acronyms
and glossary terms to be learned. This sheet provides information
to enable providers to learn and understand some of the new vocabulary.
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WEEK
OF JULY 18, 2005
Message
to Nursing Home Administrators on Medicare Prescription Drug Coverage
A new Medlearn article was recently posted by CMS (sixth in the
series) with a special message for nursing home administrators.
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WEEK
OF JULY 4, 2005
New
Expedited Review for Medicare Denials
Effective July 1, 2005, Home Health Agencies, Skilled Nursing
Facilities, Comprehensive Outpatient Rehabilitation Facilities
and Hospices with beneficiaries in original Medicare will be required
to notify beneficiaries of their right to a new expedited review
process when these providers anticipate that Medicare coverage
of their services will end. SNFs must use a new form, "Generic
Notice of Medicare Provider Non-Coverage", no later than
two days before the date the SNF determines coverage will end.
Beneficiaries may request an expedited review by the Quality Improvement
Organization (QIO) in their state if they do not agree with the
facility's decision. CMS has issued a Medlearn Matters article
with more
information and also addresses this procedure on the CMS
website. |
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WEEK
OF JUNE 27, 2005
New
Expedited Review Process for Disputed Terminations of Medicare-Covered
Services in SNFs, HHAs, CORFs and Hospices
Beginning July 1, 2005, beneficiaries in original Medicare will
have access to a new fast-track, expedited review process when
Medicare coverage of SNF, HHA, CORF, or hospice services is about
to end. CMS published the final regulations needed to implement
the new process on November 26, 2004.
More
Web-Based Educational Products Available on Medicare Prescription
Drug Coverage
A new Medlearn article (fifth in the medlearn Matters Series)
is available from CMS with additional information about web-based
educational products that are available on the Medicare Prescription
Drug Coverage. This article describes new fact sheets and other
educational resources that can be accessed on the medicare.gov
website. |
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WEEK
OF JUNE 6, 2005
Surveyor
Guidance for Medical Director, Tag F501
On June 9, 2005, CMS released new surveyor guidance for F501.
This new guidance deals with the requirements for Medical Directors
and includes interpretive guidance and an investigative protocol
along with severity guidance for deficiencies cited at F501. The
effective date for the new guidance will be November, 2005. |
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WEEK
OF APRIL 11, 2005
Surveyor
Guidance for Incontinence and Catheters, Tag F315
On April 11, 2005, CMS released an advance copy of the new guidance
for surveyors for incontinence and catheters. This new guidance
collapses current Tags F315 and F316 into one tag which will be
F315. The new guidance contains Interpretive Guidelines and a
new investigative protocol along with compliance and severity
guidance. The effective date for the new guidance is June 27,
2005. |
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WEEK
OF NOVEMBER 7, 2004
Guidance
to Surveyors for Long Term Care Facilities
On November 12, 2004, the Centers for Medicare and Medicaid Services
(CMS) issued a new guidance document (Transmittal 4) which replaces
the old text surveyors used to cite facilities for deficiencies
under F Tag 314, care and treatment of pressure ulcers. In addition
revisions were made to F 314, to include certain definitions of
non-pressure related ulcers.
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WEEK
OF AUGUST 30, 2004
Skilled
Nursing Facility Consolidated Billing Revised: 8/31/2002
A revised Provider Education Article was recently posted to the
Medlearn Matters website.
MedWatch
- The FDA Safety Information and Adverse Event Reporting Program
FDA and Pfizer notified health care professionals of revision
to the WARNINGS section of labeling for Geodon (ziprasidone),
describing the risk of hyperglycemia and diabetes in patients
taking Beodon. FDA asked all manufacturers of atypical antipsychotic
medications, including Pfizer, to add this Warning statement to
labeling.
CMS
Strengthens Efforts to Reduce Fraud and Abuse
CMS (Centers for Medicare and Medicaid Services) has announced
a new CMS initiative and proposed regulation to protect the nation's
largest federal health programs from fraud and abuse and further
reduce improper payments through the use of enhanced electronic
tools now available. CMS is building on its current program integrity
efforts by implementing new steps to analyze program data to detect
improper payments and potential areas of fraud and abuse in the
Medicare and Medicaid programs more quickly and accurately.
Falls
Tool Kit
The VA National Center for Patient Safety has published a Falls
Tool Kit which is now available to help providers in their efforts
to keep patients safe.
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WEEK
OF AUGUST 23, 2004
HHS
Publishes HIPAA Fact Sheets
HHS has published two new fact sheets, which provide an easy-to-understand
overview of what the privacy rule means to consumers. The first
fact sheet, entitled, "Privacy and Your Health Information"
is a general overview of the rule, explaining the privacy rule
gives individuals rights over their health information, sets rules
and limits on how information can be used and disclosed and requires
covered entities to take steps to protect health information.
The second fact sheet, entitled, "Your Health Information
Privacy Rights", focuses on each of the privacy rights individuals
have under the privacy rule.
CMS
Clarification on Corridor Mounted Computer Touch Screens
On August 12, CMS released a memo to State Survey Agency Directors
that clarifies the CMS policy regarding corridor width requirements
and the installation of computer touch screens in health care
facilities. The memo provides guidance for surveyors to evaluate
compliance with the safety code requirements in facilities that
mount touch screens on corridor walls. CMS instructs surveyors
to verify that the computer screen does not extend out more than
3.5 inches from the wall and is located at least 60 inches above
the floor. No chairs, tables, filing cabinets or cards can be
located in the corridor where these devices have been mounted.
National
Guideline Clearinghouse Releases New Clinical Practice Guidelines
The National Guideline Clearinghouse has released several new
practices guidelines as follows:
Pain
Management in the Long Term Care Setting
Osteoporosis
Falls
and Falls Risk
COPD
Management in the Long Term Care Setting
Acute
Change of Condition in the Long Term Care Setting
Depression
CMS
Quarterly Provider Update
The CMS Quarterly Provider Update was updated on Friday, August
27, 2004 to include several recently published regulations and
instructions.
Article
Concerning Subject of "Incident To" Services
An article was recently published on the Medlearn Matters website
which addresses or clarifies "Incident To" Services
billed by physicians and non-physician practitioners to carriers.
"Incident To" Services are defined as those services
that are furnished incident to physician professional services
in the physician's office or in a patient's home. These services
are billed as Part B services to your carrier as if you personally
provided them, and are paid under the physician fee schedule.
Drug
Enforcement Administration Releases Updated Guidelines on Prescribing
Pain Medications
The U.S. Drug Enforcement Administration, in conjunction with
Last Acts Partnership and the Pain and Policy Studies Group at
the University of Wisconsin, issued updated guidelines for health
care professionals and law enforcement personnel on the clinical
and regulatory issues of prescribing controlled pain medications.
The document is in a question and answer format. The guidance
follows a 2001 consensus statement produced by the same group
entitled "Promoting Pain Relief and Preventing Abuse of Pain
Medications: A Critical Balancing Act".
Study
Shows Mortality Reduction in Elderly Through Use of Influenza
Vaccine
A prospective, cohort study published in the August 14th issue
of the British Medical Journal revealed "robust evidence"
of reduced mortality among elderly patients vaccinated against
influenza during periods of high circulation of the virus. The
subjects included 24,535 patients older than 75 years of age.
The authors found that in unvaccinated members of the cohort,
all cause mortality was strongly associated with influenza circulating
in the population. The association was strongest with respiratory
deaths but was also present in cardiovascular deaths.
HIPAA
Frequently Asked Questions
A new FAQ was issued on the OCR Office of Civil Rights Website
which describes how the HIPAA Privacy Rule relates to state public
records laws (also known as freedom of information or open record
laws).
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WEEK
OF AUGUST 16, 2004
New
Precautions for Lovenox
The FDA and Aventis Pharmaceuticals revised the clinical pharmacology,
precautions, and dosage and administration sections of labeling
for Lovenox, describing the need for a dosage adjustment for patients
with severe renal impairment (creatinine clearance <30mL/min)
who have increased exposure to enoxaparin. No specific dosage
adjustment is required in patients with mild or moderate renal
impairment however low-weight patients should be observed carefully
for signs and symptoms of bleeding.
Annual
Update for Skilled Nursing Facilities
Information regarding the annual update for skilled nursing facilities
is now posted at the AdminaStar Federal Website.
Study
Identifies Inappropriate Medication Prescriptions for Elderly
According to an August issue of the Archives of Internal Medicine,
one in five elderly Americans are prescribed medications that
are inappropriate for older people. The study of 1999 insurance
claims of non-hospitalized patients used the Beers revised list
of drugs identified by physicians and pharmacologists to be avoided
by the elderly. The researchers found that although persons 65
or older make up less than 15% of the population, they make up
nearly one third of the prescription drug users. In addition,
findings how that elderly persons are more likely to take several
drugs concurrently.
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WEEK
OF AUGUST 9, 2004
Medicare
Expands Drugs Available Under Program to Help Beneficiaries With
Severe Illnesses
Under the Medicare Replacement Drug Demonstration, Medicare will
pay for certain drugs and biologicals that can be taken by the
patient at home and that replace drugs which are currently under
Medicare Part B when administered in a doctor's office. Newer,
more effective medications that replace some currently covered
oral anti-cancer drugs also will be covered. The demonstration
program is primarily intended for Medicare beneficiaries with
limited or no drug coverage who prefer to replace the Part B drugs
they currently use with treatments available under the demonstration
program.
Automated
Survey Processing Environment Enforcement Manager for Nursing
Homes
A memo dated August 12, 2004, was sent to all State Survey Agency
Directors concerning the national date for transition to the automated
enforcement manager. Guidance was also provided for entering various
survey and enforcement activities into the new tracking system.
Resident
Assessment Instrument (RAI) Training Program
A new RAI Training Program to assist State Survey Agencies in
training providers was recently announced. A schedule of release
dates for various training materials was also established. CMS
believes that this core set of materials will be useful in reducing
the need to constantly develop new training materials. Questions
or comments about the resources can be directed to Kirsten Jensen
at (410) 786-1095 or Rosemary Dunn at (410) 786-1372.
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WEEK
OF AUGUST 2, 2004
FDA
Safety Information and Adverse Event Reporting Program
FDA and Janssen revised the WARNINGS section of labeling, describing
the increased risk of hyperglycemia and diabetes in patients taking
Risperdal. MedWatch is posting a revised version of the letter
originally distributed to health care professionals November,
2003. FDA asked all manufacturers of atypical. Antipsychotic medications,
including Janssen, to add this Warning statement to labeling.
Consolidated
Billing Update
A number of articles were recently posted as special editions
to the Medlearn Matters area which concern skilled nursing facilities
consolidated billing.
Consolidated
Billing Update - Certain Types of Exceptionally Intensive Outpatient
Hospital Services
Skilled
Nursing Facility Consolidated Billing as it Relates to Ambulance
Services
Skilled
Nursing Facility Consolidated Billing and Erythropoietin (EPO,
Epoetin Alfa) and Darbepoetin Alfa (Arenesp)
Skilled
Nursing Facility Consolidated Billing as it Relates to Dialysis
Coverage
Skilled
Nursing Facility Consolidated Billing and Preventive/Screening
Services
Skilled
Nursing Facility Consolidated Billing as it Relates to Prosthetics
and Orthotics
Medicare
Prescription Drug, Improvement, and Modernization Act - Skilled
Nursing Facility Consolidated Billing and Services of Rural Health
Clinics and Federally Qualified Health Centers
Skilled
Nursing Facility Consolidated Billing as it Relates to Clinical
Social Workers
Skilled
Nursing Facility Consolidated Billing as it Relates to Certain
Diagnostic Tests
CMS
Quarterly Provider Update
The CMS Quarterly Provider Update was updated to include several
new regulations and instructions.
Medlearn
Matters - Articles Related to CRs
CR3235 - Indian Health Service (IHS) or Tribal Critical Access
Hospital (CAH) Payment Methodology for Inpatient and Outpatient
Services
Medlearn
Matters - Articles Related to CRs
CR3323 - Additional Clarification of Bill Types 22x and 23x Submitted
by Skilled Nursing Facilities with Instruction for Involuntarily
Moving a Beneficiary Out of the SNF and Ending a Benefit Period
Medlearn
Matters - Articles Related to CRs
SE0431 - Skilled Nursing Facility Consolidated Billing
SE0432
- Skilled Nursing Facility Consolidated Billing as It Relates
to Certain Types of Exceptionally Intensive Outpatient Hospital
Services
SE0433
- Skilled Nursing Facility Consolidated Billing as It Relates
to Ambulance Services
SE0434
- Skilled Nursing Facility Consolidated Billing and Erythropoietin
(EPO, Epoetin Alfa) and Darbepoetin Alfa (Aransep)
SE0435
- Skilled Nursing Facility Consolidated Billing as It Relates
to Dialysis Coverage
SE0436
- Skilled Nursing Facility Consolidated Billing and Preventive/Screening
Services
SE0437
- Skilled Nursing Facility Consolidated Billing as It Relates
to Prosthetics and Orthotics
SE0438
- MMA-Medicare Prescription Drug, Improvement, and Modernization
Act - Skilled Nursing Facility Consolidated Billing and Services
of Rural Health Clinics and Federally Qualified Health Centers
SE0439
- Skilled Nursing Facility Consolidated Billing as It Relates
to Clinical Social Workers
SE0440
- Skilled Nursing Facility Consolidated Billing as It Relates
to Certain Diagnostic Tests
National
Quality Measures Clearinghouse
The National Quality Measures Clearinghouse website, sponsored
by the agency for health care research and quality, US Department
of Health and Human Services, is updated regularly. The new measures
are listed alphabetically by developer.
Medicare
Preventive Services: Osteoporosis, Diabetes and Prostate Cancer,
A Guide to Billing Bone Density Studies, Diabetes Self-Management
Training Services and Prostate Screening Services. This publication
is designed to help providers better understand the importance
of adult immunizations and identify ways to increase immunization
rates in the healthcare community.
Medicare
Preventive Services: Adult Immunizations, A Guide to Billing Influenza
and Pneumococcal Vaccinations
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WEEK
OF JULY 26, 2004
HIPAA
Update: Interaction of Privacy rule With Other Laws
A newly published document is now available which addresses the
interaction of another federal law concerning the confidentiality
of alcohol and drug abuse patient records under (42 CFR Part 2)
and the HIPAA Privacy Rule. This educational document, "The
Confidentiality of Alcohol and Drug abuse Patient Records Regulation
and HIPAA Privacy Rule: Implications for Alcohol and Substance
Abuse Programs", was produced by the Department's Substance
Abuse and Mental Health Services Administration.
HIPAA
Privacy: Frequently Asked Questions
The Office of Civil Rights also offers a series of frequently
asked questions on the topic of preemption of state law. This
information can be found on the OCR website under "Preemption
of State Law".
OIG
Alert About Charging Extra for Covered Services
A Special Edition article was posted on the "Medlearn Matters
website" concerning physicians, suppliers and providers.
This alert noted that extra contractual charges beyond Medicare's
deductible and co-insurance constitutes a potential assignment
violation. The alert identifies potential liabilities that are
posed by billing Medicare patients or services that are already
covered by Medicare.
Medicare
Announces Pay Increase for Inpatient Rehab Facilities
In a press released issued July 29, 2004, the Centers for Medicare
and Medicaid Services announced a pay increase for inpatient rehab
facilities. According to a representative from CMS, Medicare's
goal is to make sure that beneficiaries receive high quality care
in the most appropriate setting for their needs. With the payment
increases combined with more sophisticated approaches to make
sure that payments are going to the right patients, CMS indicates
they are able to achieve that goal more effectively than ever
for inpatient rehab care. The notice of the payment increase will
be published in the July 30, 2004 Federal Register.
CMS
Announces Increases in Nursing Home Payment Rates
A press release was issued by the Centers for Medicare and Medicaid
Services on July 29, 2004 announcing an update to the Medicare
payment rates for skilled nursing facilities that will result
in an estimated 440 million dollar increase in Medicare payments
in fiscal year 2005. The increase reflects a 2.8% annual update
in payment rates. The update notice also reflects a decision by
CMS to retain the current classification system that establishes
daily payment rates to skilled nursing facilities based on the
needs of Medicare beneficiaries. The payment updates are included
in a notice that will be published in the July 30, 2004 Federal
Register.
Medicare
Proposes Payment Rule to Provide New Preventative Benefits and
Raise Physician Payments for 2005
The Centers for Medicare and Medicaid Services announced on July
27, 2004, proposed new benefits to help Medicare beneficiaries
stay healthier and to get access to preventative medical services
as well as the implementation of an across-the-board 1.5% increase
in payment rates for physicians who care for Medicare beneficiaries.
The proposed rule will be published in the August 5, 2004 Federal
Register. Comments will be accepted until September 24, 2004.
CMS plans to publish the final rule by November 1, 2004 with an
effective date of January 1, 2005.
Screening
for Osteoporosis in Post Menopausal Women
The Quality Tools website sponsored by the Agency for Healthcare
Research and Quality (AHRQ), U.S. Department of Health and Human
Services, recently updated their website and included under the
US Preventative Services Task Force, information concerning the
screening for Osteoporosis in Postmenopausal Women.
Office
of Civil Rights (OCR) Updated FAQ
Recently the Office of Civil Rights published a new answer to
the Frequently Asked Question, "When does the Privacy Rule
allow covered entities to disclose protected health information
to law enforcement officials". The answer can be accessed
from the "What's New" column on the OCR website.
October
2004 Quarterly Update of Healthcare Common Procedure Coding System
(HCPCS)
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WEEK
OF JULY 19, 2004
Health
Information Technology Initiative
The Department of Health and Human Services announced on July
21, 2004, details of a ten year plan to help long term care facilities
and other health care providers adopt and improve the user of
electronic medical records. The plan includes offering incentives
such as grants and awards, low rate loans and using Medicare reimbursement
to reward the use of EMRs.
CMS
Satellite and Webcast Training Programs
The Centers for Medicare and Medicaid Services announced a schedule
of satellite and webcast training programs through October of
2004 that include sessions on Pain Management, July 23; Pressure
Ulcers, August 3; Incontinence, August 12; RAI, August 27 and
October 29. The programs are designed to provide training and
information to CMS Regional Offices, State Agencies and Providers,
and are usually 2 1/2 hours in duration. To register for these
programs or obtain more information, click here: http://cms.internetstreaming.com
JCAHO
Releases New LTC Safety Goals
The Joint Commission on Accreditation of Health Care Organizations
announced recently the new Patient Safety Goals for 2005, which
include several new items for long term care facilities. Under
the existing goal of improving medication safety, JCAHO is calling
on facilities to identify and at least annually, review a list
of look-alike/sound-alike drugs used in the organization and to
take action to prevent errors involving the interchange of these
drugs. JCAHO is also calling on facilities to reconcile medications
across the continuum of care, to take steps to reduce harm from
falls and to reduce the risk of pneumonia and influenza through
vaccination programs.
HHS
Fact Sheet on Health Information Technology
On July 21, 2004, the Department of Health and Human Services
issued a fact sheet with details of a ten year health information
technology plan to build a national electronic health information
infrastructure in the United States. This plan responds to the
call by President Bush to achieve electronic health records for
most Americans within a decade. The report identifies goals and
action areas, as well as a broad sequence needed to achieve the
goals.
Drugs
from Bogus Canadian Website Found to be Fake, Substandard
In a July 19, 2004 FDA News Digest Update, the Federal Drug Administration
reported on an analysis of three commonly prescribed drugs that
were purchased from a website advertised as Canadian showing the
drugs were fake, substandard and potentially dangerous. The products
in question were so-called generic versions of Viagra, Lipitor
and Ambien. The findings from this analysis reinforce the FDA's
strong concerns about buying prescription drugs from unknown sources.
CMS
Quarterly Provider Update
The CMS Quarterly Provider Update was released on Friday, July
23, 2004 and includes information on a variety of recently published
regulations and instructions.
Guidelines
for Drug Nutrient Interactions
The National Guideline Clearinghouse recently published a guideline
on Drug Nutrient Interactions. A list of major recommendations
were compiled and included with each recommendation was a guideline
statement followed by a code of "A", "B" or
"C" indicating the strength of the evidence supporting
each of the guidelines. Of particular importance to long term
care is Guideline #3 under "Major Recommendations" which
reads, "When medications are administered via an enteral
feeding tube, the tube should be flushed before and after each
medication is administered".
CMS
Addresses Renal Disease Services
The Centers for Medicare and Medicaid Services recently issued
followup Q&As to a March, 2004 Survey and Certification Letter
regarding certification requirements and coordination of care
expectations for long term care facilities who offer end-stage
renal disease services to residents.
CMS
Addresses Physician Signature Stamps
On July 8, 2004, a CMS survey and certification letter clarified
that Hospice and Home Health Agencies may accept a physician's
rubber stamp signature when permitted by federal, state and local
law and when authorized by HHA or Hospice policy. The HHA or Hospice
must obtain a signed statement attesting that the physician is
the only one who has the stamp and uses it.
GAO
Recommends Review of Current Fire Safety Requirements
The General Accounting Office (GAO), has recommended that the
Centers for Medicare and Medicaid Services review current fire
safety requirements in its report, "Nursing Home Fire Safety:
Recent Fires Highlight Weaknesses in Federal Standards and Oversight".
CMS
Issues First DAVE Bulletin and Tip Sheet
The Centers for Medicare and Medicaid Services has issued their
first bulletin and "tip sheet" on the Data Assessment
and Verification Project. The project's goals and activities to
date are included, in addition to findings and guidance for appropriate
coding of the MDS 2.0
CMS
Updates HCPCS Codes for Skilled Nursing Facility and Home Health
PPS
The Center for Medicare and Medicaid Services recently published
a quarterly update of the Healthcare Common Procedure Coding System
Codes subject to the consolidated billing provision of the skilled
nursing facility and home health prospective payment systems.
The updates are effective as of October 1, 2004. Transmittal 224
updates the HCPCS Codes used for skilled nursing facility consolidated
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WEEK
OF JULY 12, 2004
National
Patient Safety Foundation Website
The National Patient Safety Foundation has designed a website
to improve the safety of patients. The goal of the website is
to:
- Identify
a core body of knowledge
- Identify
pathways to apply the knowledge
- Develop
and enhance the culture of receptivity to patient safety
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