Applies to all Medicaid and/or Medicare certified nursing facilities
Posted October 18, 2002
For more information contact Jerri Lynn Ward.
A recent Survey and Certification Clarification memorandum (S&CC #02-07) published by the Texas Department of Human Services answers the question “Can private pay residents be included in samples done by surveyors during certification surveys?” The answer is yes.
Section 2714.1 of the State Operations Manual, entitled “Application of Medicare/Medicaid Requirements to Private Pay Patients,” states that “The CoPs/Requirements apply to the entire certified provider/supplier and to all patients/residents being served by the certified entity, regardless of payment source.”
This means that during a survey, surveyors may review the care provided to private pay patients/residents in the same way they review the care provided to Medicare or Medicaid patients/residents. Private pay patients/residents who reside in a certified area of a facility must be counted in the total certified census for determination of sample size, and all observations and findings related to private pay patients/residents are included on the CMS-2567. This means that private pay patients/residents whose beds are located among Medicare or Medicaid certified beds can be included in the survey sample.
There is one exception to this rule, however—patients/residents residing in a separate and distinct, non-certified portion of a facility cannot be used in the sample taken by surveyors. Also, this procedure for determining a survey sample does not apply to patients/residents in hospital-based skilled nursing facilities.
For more information on this subject, contact Jerri Lynn Ward with your specific question(s).
All information in this article is informational only and is not legal advice. Should you have any questions or a situation requiring advice, please contact an attorney.
Copyright 2004 by Garlo Ward, P.C., all rights reserved
Austin, Texas 78752-3714 USA