Despite a huge shortfall between reimbursement and the cost of care, two bills designed to partially alleviate that failed: The failed legislation, Senate Bill 1050 and House Bill 3342, would have set up a long-term care quality provider participation program (QPPP) that provided additional compensation to SNFs that met certain quality metrics. … [Read more...] about Medicaid Rate Increase Fails in Texas Legislature
Proposed Congressional Bill Would Affect Ancillary Services
Proposed HR 2143, would prevent physicians from self-referring Medicare patients to in-office "ancillary services." According to the Congressmen who introduced the bill: “Multiple GAO studies have outlined the rampant abuse and waste of more than $3 billion of taxpayer money through Medicare reimbursement for unnecessary services that are driven purely by greed for personal profit,” Speier said in a statement. “Now is the time to improve the quality and … [Read more...] about Proposed Congressional Bill Would Affect Ancillary Services
Comprehensive Review of Nursing Home Regulations Planned?
Administrator Seema Verma has directed CMS to undergo a comprehensive reive of nursing home regulations, guidance and processes: Administrator Seema Verma said that the goal is to bolster safety and quality in SNFs across the country. “This is not business as usual — we are pushing beyond the status quo,” she wrote in a blog post Monday. “CMS’ approach to oversight of nursing homes is constantly evolving,” she added. “Just as we’re unleashing innovative strategies and technologies in other … [Read more...] about Comprehensive Review of Nursing Home Regulations Planned?
Provider Concerns about Patient-Driven Payment Mode
The PDPM takes effect on October 1, 2019. You can read about the concerns being raised on behalf of nursing homes under the model here. … [Read more...] about Provider Concerns about Patient-Driven Payment Mode
CMS Increases Rates For Medicare Advantage Payments
CMS announced the increase on April 1, 2019: Today, the Centers for Medicare & Medicaid Services (CMS) finalized updates that will take significant steps in continuing the Trump administration’s efforts to increase competition among Medicare Advantage and Part D plans so patients get higher quality care at lower costs. These changes will increase plan choices and benefits, and include important actions to address the opioid crisis. “Today’s changes give plans the ability to be innovative … [Read more...] about CMS Increases Rates For Medicare Advantage Payments
The Revised Appendix Q
On March 5, 2019, CMS sent a memo to the State Survey Agencies regarding revisions in Appendix Q, Guidance on Immediate Jeopardy. Here is a summary of the key changes: Likelihood instead of potential: This changes the previous version in that it clarifies that rather than a "potential for serious harm," in order to cite IJ in situations where residents or patients have not suffered serious injury, harm, impairment or death, the surveyor is to determine whether the noncompliance creates a … [Read more...] about The Revised Appendix Q
DEA Registrants Beware!
The Texas Medical Board is reporting that scammers posing as DEA agents are targeting physicians, pharmacies, and individuals for the purpose of extortion. The United States Drug Enforcement Administration (DEA) is aware that registrants are receiving telephone calls and emails by criminals identifying themselves as DEA employees or other law enforcement personnel. The criminals mask their telephone number on caller ID by showing the DEA Registration Support 800 number. Please be aware … [Read more...] about DEA Registrants Beware!
DOL Proposes New Rule Regarding Calculation of Overtime Pay Rates
The Proposed Rule was published on Friday, March 29, 20 and is available here. The proposed rule is designed to help employers who provide more perks to employees instead of raises in amounts of salaries. The existing "regular rate" rules, which have not been updated in 50 years discourage the practice: “Under current rules, employers are discouraged from offering more perks to their employees, as those perks may be vaguely defined in calculating an employees’ regular rate of … [Read more...] about DOL Proposes New Rule Regarding Calculation of Overtime Pay Rates
Law Enforcement & the Intellectually Disabled
In Louisiana, law enforcement locked up a 16-year-old because all options for services had been exhausted: What we do know is prosecutors knew the 16-year-old Cadarius was not competent to stand trial, but they still charged him as an adult. The move, according to Judge Jenifer Clason, who handles both juvenile and adult cases in Claiborne Parish, was because “we were able to make sure he was safe and properly cared for.” A very sad story. … [Read more...] about Law Enforcement & the Intellectually Disabled
Guilty Plea in HIPAA Criminal Case
A former patient information coordinator of a health care system pleaded guilty to a count of unlawfully disclosing patient information: "Specifically, on Aug 11, 2017, Kalina unlawfully disclosed personal gynecological health information related to two such patients, with the intent to cause those individuals embarrassment and mental distress," the Justice Department statement says. Apparently, her motive was retaliation against employees who worked at her previous employment from … [Read more...] about Guilty Plea in HIPAA Criminal Case