Certificate of Need (CON) is a public policy tool which seeks to slow healthcare cost growth, avoid duplication of programs and services and ensure that new development meets the needs of the community. Nationally, only 12 states have no CON requirements. In Florida, the CON program was enacted in 1973 and applied to the building of new health centers or expansion of certain, complex medical services – including hospitals, nursing facilities, hospices and intermediate care facilities for the developmentally disabled. Read Full Post

On July 31, 2018, the IRF Final Rule was issued by the Centers for Medicare and Medicaid Services, which will take effect FY 2020. In addition to the updates to IRF payment rates and other measures designed to streamline care and reduce inefficiencies, one of the most important takeaways from the Final Rule relates to the removal of the Functional Independence Measure (FIM™) Instrument and Associated Function Modifiers from the IRF-Patient Assessment Instrument (PAI) and Refinements to the Case Mix Classification System. Read Full Post

A corrective statement to clarify Medicare coverage of therapy delivered in a skilled nursing facility or in the home setting was approved recently by a federal court. The statement, to be used as part of the settlement in the Jimmo v. Sebelius case, is designed to clearly explain that therapy to maintain a person's condition or slow down his or her decline is covered under Medicare. Read Full Post

A recent ruling attempts to change the perception that beneficiaries are only eligible for therapy coverage if their health is improving. The ruling is related to a 2013 settlement that established that improvement is not one of the criteria for coverage.

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As part of the Affordable Care Act, in recent years Medicare and Medicaid have worked with federal government agencies, states, patient organizations and others to identify and prevent health conditions that have caused long-term care residents to be unnecessarily hospitalized. As a result, we have seen a significant decline in avoidable hospitalizations over the last several years, according to analysis released by CMS.

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The Centers for Medicare and Medicaid Services finalized a major new rule approximately one month ago to make significant changes to improve patient care and safety. The new rule’s compliance obligations, which will be implemented in three phases that begin this year and extend through 2019, represent the largest update the industry has seen since 1991. The “megarule" as some in the industry are calling it sets high standards for care and targets infections, hospital readmissions, staffing practices and resident safety among other areas.

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CMS releases QRP provider questions and feedback on MDS 3.0.

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The updated language in Section GG requires some new reporting on quality measures beginning October 1, 2016, and getting ready for the change can be overwhelming. Follow these tips so your facility can be as prepared as possible.

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Participants of this year's Florida Health Care Association Annual Conference will be able to hear Elizabeth Barlow, Senior Director of Quality, and Matt Sivret, Division Vice President of Clinical Services discuss how therapy can affect facilities' five star ratings with CMS.

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Over the last several years, CMS has issued Survey and Certification letters regarding specialized surveys with a focus on these areas: 1) MDS and Staffing 2) Dementia 3) Medication Related Events 4) Infection Control (in pilot phase).

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