Posted August 19, 2002 Applicable to all long term care facilities By Jerri Lynn Ward, J.D., Garlo Ward, P.C. and Beth Alford, Vice President of Risk Management for Tutera Health Care Services, L.L.C. As we all know, long term care facilities often have difficulty obtaining reasonably priced liability insurance. One of the reasons for this is facility survey history. Here we discuss a possible solution. To give some useful tips on how to be more successful in obtaining insurance, … [Read more...] about Reasonable Insurance Premiums

Applies to all long term care facilities Posted August 29, 2002 By Jerri Lynn Ward, J.D., Garlo Ward, P.C. with an interview with Woody Leverett, J.D. If during the course of a survey, a surveyor witnesses or has reason to believe that residents are suffering abuse or neglect, a facility and/or its employees can be referred to the County District Attorney for criminal investigation. If this situation should occur, it is important to understand your rights when dealing with police … [Read more...] about Know Your Rights When There is a Criminal Investigation at Your Facility

Applies to ICF/MRs Posted September 10, 2002 Please contact Jerri Lynn Ward for more information. Recently, we have seen more requests for increases in level of need (LON) rejected by the Texas Department of Mental Health and Mental Retardation (TDMHMR). As a provider, you need to know that there are a few simple strategies you can utilize to help ensure that your LON request will be granted. This article discusses two methods for increasing the chances of getting TDMHMR to approve an … [Read more...] about Level of Need Appeals: What Every Provider Needs to Know

By Jerri Lynn Ward, J.D., Garlo Ward, P.C. Applies to all nursing facilities Posted September 25, 2002 Meeting state standards for resident-to-staff ratio is no longer enough to ensure compliance with Medicare regulations requiring facilities to provide sufficient nursing services "to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident." A new decision by the Departmental Appeals Board (DAB) in Westgate Healthcare Center vs. CMS … [Read more...] about Ensure Adequate Staffing at your Facility

Applies to all Medicaid and/or Medicare-certified nursing facilities Posted September 27, 2002 For more information contact Jerri Lynn Ward. What you should do when the facility is at its maximum capacity of Medicaid beds, and an additional resident, who was previously in a Medicare bed, is now eligible for a Medicaid bed? Under certain circumstances, the facility can obtain a waiver that allows the resident to remain in the facility and be covered by Medicaid. This situation is … [Read more...] about Obtaining “spend-down” Medicaid Beds for Residents when a Facility is at its Maximum Capacity

Applies to all health care providers Posted October 4, 2002 For more information contact Jerri Lynn Ward. On August 14, 2002 , the Department of Health and Human Services provided changes to the Privacy Rule intended to clarify any uncertainties in the original rule and remove any potentially burdensome requirements. The main changes relate to the consent requirements, business associate requirements, limited data sets, and marketing requirements. Changes to Consent Requirements … [Read more...] about Important Changes to HIPAA Privacy Rule

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 … [Read more...] about Inclusion of Private Pay Residents in Survey Samples

Medicare Reimbursement for Power Operated Vehicles For more information contact Jerri Lynn Ward. Posted October 31, 2002 Are Power Operated Vehicles Covered Under Medicare? Yes, but make sure a specialist orders the POV and thorough documentation exists to prove it is medically necessary. Under what Conditions Does Medicare Reimburse for the Cost of a Power Operated Vehicle? If medically necessary, Power Operated Vehicles (POVs), such as "Scooters," are covered under … [Read more...] about Granny Get Your Scooter!

For more information contact Jerri Lynn Ward. Posted November 13, 2002 Applicable to All Covered Entities The Privacy Rule under HIPAA requires that all covered entities be compliant by April 14, 2003. As of November 14, 2002 you have less than 6 months to make your facility, business, office or practice HIPAA compliant. HIPAA contains over 400 pages of legalese that the average healthcare provider has little time to read and analyze. The following is a short summary of those 400 … [Read more...] about HIPAA: What You Really Need to Know

For more information contact Jerri Lynn Ward. Applicable to ICF-MR's Posted March 25, 2003 The recent Texas Supreme Court Case, Texas Home Management, Inc. vs. Peavy has, again, proven the axiom, bad facts make bad law. In October 2002 the Texas Supreme Court held that an ICFMR might be liable for a murder committed by a resident, while he was on an unsupervised home visit. A facility owned and managed by Texas Home Management, Inc. ("THM") allowed a consumer with violent tendencies, … [Read more...] about ICF-MR’s and the Aftermath of Texas Home Management, Inc. vs. Peavy