Long-Term Care Survey Alert

Published on Sat Jan 17, 2004 PDF

Congress recognizes need for faster appeals in certain cases.

You have to dig a bit to find them, but the mammoth Medicare reform law includes some provisions that should help in the survey arena.
 
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 directs the Secretary of Health & Human Services to develop "expedited appeals" for nursing facilities hit with program termination or denial of payments for new admissions.   The provision applies to appeals filed on or after Oct. 1, 2004. 
 
While the law doesn't define "expedited," there's lots of room for picking up the pace of appeals for providers about to lose their payment stream. "What happens now is that a successful appeal of termination becomes meaningless due to the passage of time," says Howard Sollins, attorney with Ober/Kaler in Baltimore, MD.. "Facilities that do prevail upon appeal win the battle but lose the war because they're out of business."
 
In addition, the law authorizes the Centers for Medicare & Medicaid Services to waive a facility's loss a of nurse aide training in cases that did not involve quality-of-care deficiencies, notes Barbara Gay, director of information for the American Association of Homes & Services for the Aging. "The facility would still have to pay the civil monetary penalty, however," she adds.
 
AAHSA is checking into what non-quality of care related deficiencies might warrant serious enough sanctions to lose nurse aide training privileges. The trade group believes it's counterproductive for a facility struggling with quality of care to lose nurse aide training privileges at a time when the facility really needs more staffing and training.

Capitalize on New Payment Resources
 
The Medicare reform law also offers some payment relief, which can translate into improved resident and survey outcomes, as follows: