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  1. Nursing Home Enforcement: Center Submits Comments on CMS’s Draft Guidance Regarding the Immediate Imposition of Remedies
  2. Comments Submitted on Center for Medicare and Medicaid Innovation (CMMI)
  3. Center Submits Comments on HHS Notice of Benefit and Payment Parameters for 2019

Nursing Home Enforcement: Center Submits Comments on CMS’s Draft Guidance Regarding the Immediate Imposition of Remedies

2018 Medicare Rates

Part A Monthly Premium:

0-29 qualifying quarters of employment: $422.00;
30-39 quarters: $232.00; 

Inpatient Hospital

Deductible
Per Spell of Illness: $1,340.00

Co-pays
Days 1–60: $0;
Days 61–90: $335.00/day;
Lifetime Reserve Days: $670.00/day

Skilled Nursing Facility

Co-pay, Days 1–20: $0;
Co-pay, Days 21–100: $167.50

Standard Monthly Part B Premium

$134.00 (but note that these premiums vary by income level)

Part B Deductible

$183.00 for all Part B beneficiaries.

The Centers for Medicare & Medicaid Services (CMS) issued a Survey and Certification Letter on October 27, 2017 (S&C: 18-01-NH), outlining proposed changes to Chapter 7 of the State Operations Manual (SOM). The proposed guidance that CMS is seeking to implement will have a profound effect on CMS’s own ability to meaningfully enforce the nursing home requirements against deficient nursing homes. Most notably, the changes will:

  • Create a distinction between different types of immediate jeopardy that does not exist in the federal regulations;
  • Allow CMS Regional Offices (ROs) to lower per day Civil Money Penalties (CMPs);
  • Allow ROs to select remedies for deficiencies in a manner that seemingly violates federal regulations; and
  • Allow ROs to have discretion in determining whether to apply the immediate imposition of remedies to past noncompliance at all.  

The Center for Medicare Advocacy strongly opposes CMS’s draft revisions, which will put nursing home residents at an even greater risk of harm, injury, or death. In guidance issued just last year (S&C: 16-31-NH), CMS expanded the bases for the immediate imposition of remedies, including CMPs, at facilities cited for certain deficiencies and which represent some of the poorest performing facilities in the country. The Center is dismayed to see CMS attempting to reverse its own guidance in favor of the nursing home industry’s demands, as evidenced by the American Health Care Association’s (AHCA) March 9, 2017 letter to former Secretary Price objecting to the “out-of-control” use of CMPs. 

CMS is seeking comments on the draft guidance until December 1, 2017. The Center submitted comments on November 22nd and encourages all those affected by CMS’s latest attempt to deregulate nursing homes to submit comments before the deadline. 


Comments Submitted on Center for Medicare and Medicaid Innovation (CMMI)

Last week, in collaboration with other advocacy organizations, the Center submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the Center for Medicare and Medicaid Innovation (CMMI) Request for Information on Innovation Center New Direction.  In response to an outline of a more market-based and weaker regulatory approach to designing and implementing Medicare demonstration programs, the Center urged CMS to keep consumer protections, and the interests of Medicare beneficiaries, primary.  Among other issues, the Center expressed opposition to both allowing physicians to balance bill beneficiaries and moving Medicare towards a premium support (voucher) model. The Center also pushed for integration of oral health services into Medicare. 


Center Submits Comments on HHS Notice of Benefit and Payment Parameters for 2019

The Center for Medicare Advocacy, working with other advocacy organizations, also submitted comments and signed on to a letter expressing concerns about the HHS Notice of Benefit and Payment Parameters for 2019 proposed rule. The proposed rule, among other things, could weaken ACA requirements for essential health benefits in 2019. The ACA requires insurers to cover essential health benefits such as ambulatory services, emergency services, hospitalization, maternity care, mental health and substance abuse, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services, and pediatric services. Any attempt to weaken these essential benefits through regulation and deny people care is unacceptable and must be rejected.

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