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The Long Term Care Community Coalition is hosting a webinar on Medicare’s new payment system for skilled nursing facilities, Patient-Driven Payment Model (PDPM) on Tuesday, October 15, 2019, at 1:00 p.m.  The Center for Medicare Advocacy’s Senior Policy Attorney Toby S. Edelman will discuss how the new system works and what it means for residents. … Read more

The Centers for Medicare & Medicaid Services (CMS) implemented a new Medicare Part A reimbursement system for skilled nursing facilities (SNFs), called Patient-Driven Payment Model (PDPM), on October 1, 2019.[1] Therapists immediately began reporting that nursing homes and therapy companies were laying them off and demanding that they change their therapy practices, shifting residents from … Read more

Joint alert from the Center for Medicare Advocacy and the Long Term Care Community Coalition. New Icon On October 7, 2019, the Centers for Medicare & Medicaid Services (CMS) announced changes to Nursing Home Compare that make it easier for residents and families to identify facilities with a history of resident abuse, neglect, or exploitation. … Read more

The Patient Driven Payment Model is Here What Does It Mean For Residents? On October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) began implementing a new payment system for Medicare-covered nursing home care. The payment system is called the “Patient Driven Payment Model” (PDPM). PDPM creates a new set of financial incentives … Read more

In his September 16, 2019 comments on the Administration’s proposed revisions to the nursing facility Requirements of Participation, California State Attorney General Xavier Becerra writes that the proposed rule violates the 1987 federal Nursing Home Reform Law, the Social Security Act, the Affordable Care Act, and the Administrative Procedures Act. Beccera describes the proposed changes … Read more

On September 20, 2019, the U.S. House of Representatives passed the Forced Arbitration Injustice Repeal (FAIR) Act. The FAIR Act prohibits pre-dispute arbitration agreements in consumer, employment, antitrust, and civil rights cases. The Act also prohibits any agreements or practices that interfere with an individual’s right to participate in joint, class, or collective action. Representative … Read more

On September 15, 2019, the Center for Medicare Advocacy (the Center) and the Long Term Care Community Coalition (LTCCC) submitted comments opposing the Trump Administration’s proposed rule to revise the nursing home Requirements of Participation. The proposed rule is the latest example of the Administration’s efforts to deregulate the nursing home industry. Among the changes, … Read more

As of September 16, 2019, nursing homes nationwide can begin asking residents (or their representatives) to sign a pre-dispute arbitration agreement. The Trump Administration reversed a previous prohibition on such agreements in a July 2019 final rule. Although there is ongoing legal action to overturn the Administration’s rule, implementation has not been delayed for the … Read more

September 15, 2019 Administrator Seema Verma Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-3347-P P.O. Box 8010 Baltimore, MD 21244-1850 Re: CMS-3374-P; Federal Register, Vol. 84, No. 138 (July 18, 2019) Submitted electronically: www.regulations.gov Dear Administrator Verma: The Center for Medicare Advocacy and the Long Term Care Community Coalition … Read more

September 2019 Background Under the Trump Administration, the Centers for Medicare & Medicaid Services (CMS) has been advancing efforts to deregulate the nursing home industry by rolling back the rights and protections of nursing home residents. These efforts include reducing accountability for substandard care, such as by shifting the default financial penalty for the most … Read more

Background. Nursing homes administer antipsychotic drugs to approximately 20 percent of residents nationwide. Sadly, and too often, nursing homes use these drugs as a way of chemically restraining residents exhibiting the behavioral symptoms of dementia, despite the Food and Drug Administration’s (FDA) “black box” warning against using antipsychotic drugs on elderly patients with dementia. The … Read more

                      Joint statement from the Center for Medicare Advocacy and the Long Term Care Community Coalition. On July 23, 2019, the U.S. Government Accountability Office (GAO) published a report on nursing home resident abuse, Improved Oversight Needed to Better Protect Residents from Abuse. The GAO … Read more

Although the revised Requirements of Participation published in October 2016[1] have not yet been fully implemented, the Centers for Medicare & Medicaid Services (CMS) published proposed rules on July 18, 2019 to revise them and also to make changes in survey and enforcement rules.[2]  CMS contends that its proposals are intended to “promote efficiency and … Read more

On July 23, 2019, the Senate Finance Committee held its second nursing home hearing this year, “Promoting Elder Justice: A Call for Reform,”[1] following its March 6 hearing “Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes.”[2]  The Center for Medicare Advocacy is pleased that the July 23 hearing included a national advocate … Read more

PROMOTING ELDER JUSTICE: A CALL FOR REFORM HEARING BEFORE THE U.S. SENATE COMMITTEE ON FINANCE July 23, 2019 Statement of Toby S. Edelman Senior Policy Attorney Center for Medicare Advocacy 1025 Connecticut Avenue, N.W., Suite 709 Washington, DC  20036 I am a Senior Policy Attorney in the Washington, D.C. office of the Center for Medicare … Read more

                      Background. Every month, the Centers for Medicare & Medicaid Services (CMS) identifies nursing homes with an extremely poor record of resident care for inclusion in the Special Focus Facility (SFF) program for enhanced oversight. Due to limited resources, CMS currently caps the SFF program … Read more

                      In 2016, the Obama Administration promulgated regulations prohibiting pre-dispute arbitration agreements between nursing homes residents (or their representative) and facilities. On July 18, 2019, the Trump Administration published a Final Rule rolling back certain features of the 2016 resident protection. Most notably, the Final … Read more

The federal website for information about nursing homes, Nursing Home Compare,[1] reports information for each Medicare-certified and Medicaid-certified nursing facility in three categories – health inspections, staffing, and quality measures – as well as an overall score that combines the three domains. The health inspections domain reflects the findings of standard (annual) and complaint surveys … Read more

Elder Justice: What “No Harm” Really Means for Residents is a newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a “no harm” deficiency is and what it means for nursing home … Read more

The Centers for Medicare & Medicaid Services (CMS) identifies about 88 nursing facilities – generally one to two facilities per state – that are among the most poorly performing facilities in the country.[1] These nursing facilities, which CMS calls Special Focus Facilities (SFFs), have “more problems” than other facilities, “more serious problems” than other facilities, … Read more

On April 25, 2019, the Centers for Medicare & Medicaid Services (CMS) published a notice of proposed rulemaking that would revise the definition of group physical, speech and occupational therapy to allow six residents, rather than four, to participate in a group therapy session. If finalized, the rule would place even more nursing home residents … Read more

June 18, 2019 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1718-P P.O. Box 8016 Baltimore, MD 21244-8016 Re: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2020 Submitted electronically to: http://www.regulations.gov. … Read more

Nursing home financial arrangements are important issues of public policy. Failures by state and federal governments to ensure nursing home financial accountability and integrity have an increasingly devastating impact on nursing home residents and their families across the country. According to a recent report by The New York Times, the U.S. Department of Housing and … Read more

Every month, the Centers for Medicare & Medicaid Services (CMS) identifies nursing homes with an extremely poor record of resident care for inclusion in the Special Focus Facility (SFF) program. This program is a federally mandated initiative to address persistent problems through enhanced oversight. Over an 18 to 24-month period, CMS expects SFFs to significantly … Read more

At present, only 88 nursing facilities nationwide (0.6% of the nation’s total number of facilities) are identified as Special Focus Facilities (SFFs). The Centers for Medicare & Medicaid Services (CMS) describes SFFs as having “more problems” than other facilities, “more serious problems” than other facilities, and “[a] pattern of serious problems that has persisted over … Read more

    Background. Medicare beneficiaries are entitled to a maximum of 100 days of skilled nursing facility (SNF) care in a benefit period when they meet specific coverage criteria. However, Medicare Part A only covers the full cost of a beneficiary’s skilled care during the first 20 days of a nursing home stay. Starting on … Read more

As part of its investigative series on nursing home care in Florida, Naples Daily News (part of the USA Today Network) reports that the new Medicaid reimbursement system for Florida’s nursing homes, scheduled for full implementation in 2023, will increase reimbursement for some of the state’s most poorly performing facilities by millions of dollars while … Read more

Public information about enforcement actions imposed and upheld against nursing facilities is inaccurate and limited, or missing. The Center for Medicare Advocacy (the Center) analyzed whether the federal website Nursing Home Compare to determine if it accurately reports civil money penalties (CMPs) that were imposed against nursing facilities and upheld by Administrative Law Judges (ALJs).  … Read more

On May 21, 2019, the Long Term Care Community Coalition (LTCCC) hosted a webinar on nursing home profits and losses. Dara Valanejad, a Policy Attorney with both the Center for Medicare Advocacy and LTCCC, participated in the webinar. Mr. Valanejad presented findings from the Medicare Payment Advisory Commission’s March 2019 report to Congress, discussed how … Read more

Last year, New Jersey-based Skyline Healthcare abandoned more than 100 nursing facilities nationwide, forcing multiple states to seek receiverships in court in order to protect residents and make sure they received food, medications, and care.[1] States had allowed Skyline to take over the facilities, many from the nursing home chain Golden Living, even as Skyline’s … Read more

With more and more patients quickly discharged from acute care hospitals to skilled nursing facilities (SNFs), SNF residents are more clinically complex than ever. Despite the fact that residents have greater health care needs, federal standards for professional staffing at SNFs have not changed in more than 30 years. The consequences are dire. The Inspector … Read more

On April 25, 2019, the Centers for Medicare & Medicaid Services (CMS) published a notice of proposed rulemaking that would revise the definition of group physical, speech and occupational therapy to allow six residents, rather than four, to participate in a group therapy session. If finalized, the rule would place even more nursing home residents … Read more

On April 25, 2019, the Centers for Medicare & Medicaid Services (CMS) published a notice of proposed rulemaking (NPRM) on fiscal year 2020 payment and policy changes for Medicare-certified skilled nursing facilities. Most notably, the proposed rule projects an $887 million increase in aggregate payments to SNFs and revises the definition of group therapy to … Read more

Reducing the re-hospitalization of nursing home residents is a constant and important public policy goal. At present, the goal is largely met by imposing financial sanctions against hospitals[1] and skilled nursing facilities (SNFs)[2] when residents are re-hospitalized. A better way of reducing re-hospitalizations of nursing home residents would be ensuring that residents get the care … Read more

                      GAO Findings. Federal law requires state survey agencies to investigate allegations of resident abuse and neglect stemming from complaints and facility-reported incidents. About three-quarters of all abuse violations nationwide stem from these investigations. Unfortunately, a recently published management report by the U.S. Government Accountability … Read more

Elder Justice: What “No Harm” Really Means for Residents is a newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a “no harm” deficiency is and what it means for nursing home … Read more

The Trump Administration solicited ideas for cutting nursing home standards of care[1] and has announced plans to publish new Requirements of Participation in order to reduce the burden on nursing facilities.[2] In October 2016, the Obama Administration revised these Requirements, which establish the standards of care for nursing facilities that receive public reimbursement from the … Read more

The facts are in: The ever-increasing use of observation status deprives many Medicare beneficiaries of care and coverage in skilled nursing facilities (SNFs).  In 2018, research by Avalere Health confirmed that the use of SNFs by beneficiaries in the traditional Medicare program declined each year between 2009 and 2016. Avalere identified the cause as “fewer … Read more

Many nursing homes have closed in recent months throughout the country.  The nursing home industry instinctively claims that the cause is Medicaid rates that are low,[1] too low even to cover nursing home costs (See our joint letter, below). The New York Times’ recent article about the closure of a rural South Dakota nursing facility … Read more

On November 28, 2019 – three years after the revised federal nursing home rules were issued – “Phase 3” requirements will go into effect. These include a number of new requirements that nursing homes must implement, and in some cases, new systems that must be put in place. This presentation will examine the Compliance and … Read more

The U.S. Senate Committee on Finance held a hearing on nursing home resident abuse and neglect on March 6, 2019. The Senate Finance Committee did not invite a single consumer advocate to testify before the Committee, although a nursing home industry representative did participate in the hearing. As a result, the Center for Medicare Advocacy … Read more

The Long Term Care Community Coalition (LTCCC), a non-profit consumer advocacy organization headquartered in New York, has published a report examining the federal requirements and key practices for addressing nursing home resident abuse, neglect, and crime. The report, Addressing Abuse, Neglect, and Suspicion of a Crime Against Nursing Home Residents, is free and available on … Read more

Nursing homes can be penalized through the imposition of a civil money penalty (CMP) for either the number of days that the facility has not been in compliance with a federal requirement (per-day) or for each instance of noncompliance (per-instance). Responding to requests from the nursing home industry, the Trump Administration rolled back previous guidelines … Read more

NOT FORGOTTEN: PROTECTING AMERICANS FROM ABUSE AND NEGLECT IN NURSING HOMES Hearing held March 6, 2019 Statement for the record submitted by:  Tony Chicotel, Staff Attorney; Michael Connors, Long Term Care Advocate; Janet Wells, Public Policy Consultant California Advocates for Nursing Home Reform 650 Harrison Street, #2 San Francisco, CA  94107 www.canhr.org Toby Edelman, Senior … Read more

Medicare requires a three-day inpatient hospital stay in order to qualify for care at a skilled nursing facility. Sadly, and all too often however, beneficiaries are classified as hospital outpatients on observation status. While outpatients on observation status and inpatients may receive the same care and services, for the same number of days or weeks, … Read more

On March 6, 2019, the U.S. Senate Committee on Finance held a hearing entitled “Not Forgotten: Protecting Americans From Abuse and Neglect in Nursing Homes.” The hearing consisted of two panels of witnesses. The first panel included Patricia Blank (daughter of a nursing home neglect victim), Maya Fischer (daughter of a nursing home rape victim), … Read more

United States Senate Committee on Finance “Not Forgotten: Protecting Americans From Abuse and Neglect in Nursing Homes” March 6, 2019 Statement submitted by: Long Term Care Community Coalition, Center for Medicare Advocacy, National Consumer Voice for Quality Long-Term Care, Justice in Aging, California Advocates for Nursing Home Reform, and National Academy of Elder Law Attorneys … Read more

In cooperation with states, the Centers for Medicare & Medicaid Services (CMS) regularly identifies a subset of nursing facilities, generally one to two facilities per state, that are among the most poorly performing facilities in the country. These nursing facilities, which CMS calls Special Focus Facilities (SFFs), have “more problems” than other facilities, “more serious … Read more

In cooperation with states, the Centers for Medicare & Medicaid Services (CMS) identifies a subset of nursing facilities, generally one to two facilities per state, that are among the most poorly performing facilities in the country.  These nursing facilities, which CMS calls Special Focus Facilities (SFFs), have “more problems” than other facilities, “more serious problems” … Read more

States Whose Nursing Facilities Employ Few Registered Nurses Are More Likely To Be Penalized for Readmissions of Their Residents to Hospitals In 2014, as part of the Protecting Access to Medicare Act, Congress created the Skilled Nursing Facility Value-Based Purchasing Program, whose financial incentives are intended to reduce rehospitaliations of nursing home residents.  In December … Read more