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Nursing Home Medical Assistance Per Diem Payments To Be Denied If Resident's Attending Physician Not An MA Certified Provider

In a Medical Assistance (MA) Bulletin issued April 1, 2016, the Department of Human Services (DHS) stated that effective September 25, 2016, physicians and practitioners who order, refer or prescribe items or services for MA beneficiaries must themselves be enrolled in the MA Program. The Bulletin states that to "track" this requirement, DHS will look to the claim field for the "ordering or referring physician" and the NPI number associated with that physician. If that physician is not on file as an MA provider, then the claim will be denied.

LDM Attorneys To Present At PACAH 2017 Spring Conference

PACAH's 2017 Spring Conference is scheduled for April 25th through 28th in State College, PA. Our attorneys will be available during the conference and will be presenting the following sessions:

OIG Issues Resource Guide For Measuring Effectiveness of Corporate Compliance Programs

On March 27, 2017, the Office of the Inspector General ("OIG") posted a Resource Guide for Measuring Compliance Program Effectiveness. You can access the OIG's Guide here. The Guide is organized under the following "elements" that should be addressed under an organization's Compliance Program:

Revisions to Nursing Facility Admission Agreement Due to Changes Under LTC Final Rule

The Long-Term Care Final Rule which revises the requirements of participation in the Medicare and Medicaid programs will become effective on November 28, 2016. As a result of the changes under the Final Rule, providers will need to review their nursing facility admission agreements to ensure that the provisions of the agreement are consistent with the regulatory requirements. In addition to reviewing and updating the admission agreement, providers will also need to review and update existing policies and procedures and/or develop new policies to reflect the changes under the Final Rule. READ MORE - Revisions to Nursing Facility Admission Agreement Due to Changes Under LTC Final Rule.docx

U.S. District Court Grants Injunction Staying CMS Ban on Pre-Dispute Binding Arbitration Agreements

On November 7, 2016, the U.S. District Court for the Northern District of Mississippi granted the motion for preliminary injunction filed by the American Health Care Association (AHCA) and other plaintiffs, staying the November 28, 2016 effective date of the ban on pre-dispute binding arbitration agreements imposed by the Centers for Medicare & Medicaid Services (CMS). CMS has the right to appeal the District Court's decision to the Fifth Circuit Court of Appeals. At this point in time, we have not had confirmation as to whether CMS will invoke its right to an appellate court review of the District Court's ruling.

Notice of Nondiscrimination and Taglines Posting Requirements Now in Effect

The Final Rule implementing Section 1557 of the Affordable Care Act went in to effect on October 16, 2016. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities.

CMS Imposes Ban on Pre-Dispute Binding Arbitration Agreements in Nursing Facilities

On September 28, 2016, the Centers for Medicare & Medicaid Services ("CMS") issued the final Requirements of Participation ("Final Rule") for nursing facilities. The Final Rule becomes effective on November 28, 2016. A key provision under the Final Rule is the ban on pre-dispute binding arbitration agreements. Nursing facilities that participate in the Medicare or Medicaid programs are prohibited from: (a) entering into a pre-dispute arbitration agreement with a resident or a resident's representative; and (b) requiring a resident to sign an arbitration agreement as a condition of admission. In light of the Final Rule, facilities that currently utilize a pre-dispute binding arbitration clause or agreement have a couple of potential options. One option is to wait and see if any litigation is filed by any providers supported by their representative trade association to challenge the regulation. In such event, an injunction most likely would be requested, and if granted, would stay the implementation date of the ban until a decision could be made on the merits of CMS' rulemaking. Another option is to develop a plan to amend your current arbitration clause or agreement to conform to the new rule. Facilities that utilize a separate stand-alone agreement would need to discontinue its use by the effective date. Facilities that have an arbitration clause within their admission agreement could either strike it out or remove it from the admission agreement.

CMS Instructs Nursing Facilities To Protect Residents From Unauthorized Photographs and Video Recordings

On August 5, 2016, CMS released Survey-and-Cert-Letter-16-33.pdf. In that letter, CMS noted that unauthorized photographs or video recordings of residents could result in violations of resident privacy, and could, in certain circumstances, be construed as abuse. In addition to these compliance issues under the Requirements of Participation for Long Term Care Facilities, the unauthorized use and disclosure of such photographs and videos also can result in violations under the HIPAA Privacy Rule. CMS has instructed state survey agencies, such as the Pennsylvania Department of Health, to conduct a review of facility policies designed to prevent these unauthorized actions. Surveyors are expected to review policies during the next standard survey of each facility, and during subsequent surveys as warranted.

Kimber Latsha named Best Lawyers® 2016 Health Care Law "Lawyer of the Year" in Harrisburg

Latsha Davis & McKenna, P.C. proudly congratulates Kimber L. Latsha on being named the Best Lawyers® 2016 Health Care Law "Lawyer of the Year" in Harrisburg.

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