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Compliance and Ethics Program Implementation

Effective November 28, 2019, the Phase III requirements of the Long Term Care Requirements of Participation require all nursing facilities to implement a Compliance and Ethics program consistent with the dictates of 42 CFR § 483.85 (F895). The Rule obligates facilities to have a written compliance and ethics program in place that is likely to be effective in preventing and detecting criminal, civil, and administrative violations under the Social Security Act and in promoting quality of care. The Regulation lists multiple requirements for the program, which relate to historical compliance guidance issued by other federal agencies, including the Office of the Inspector General.

Latsha Davis & Marshall P.C. at PACAH Spring Conference

On Thursday, April 26, 2018, Tanya Daniels Harris, Esq. will give a lecture entitled, "DOH Sanctions: A New Era" from 10:30 to 11:30am at PACAH's 2018 Spring Conference, held at The Penn Stater Hotel & Conference Center. Later that day, David Marshall and Steve Montresor will host Latsha Davis & Marshall's Booth at the Spring Vendor Show. We hope to see you at Tanya's session and at the Vendor Show, and wish all attendees a successful Conference.

Home Health Conditions of Participation

The Centers for Medicare & Medicaid Services (CMS) have finalized new Conditions of Participation ("CoPs") for home health agencies ("HHAs") that will become effective on January 13, 2018. These CoPs represent the first major update to the rules governing HHAs in roughly 20 years.

LDM Attorneys to Present at PHCA 2017 Annual Convention

PHCA's 2017 Annual Convention is scheduled for September 26-28 at the Seven Springs Mountain Resort. On Tuesday, September 26, 2017, from 9:45am-10:45am, Kimber Latsha and Tanya Harris will be presenting the following session: "What You Need to Know About Preparing for Surveys and Responding to an Adverse Survey/Licensure Action".

Contracting With MCOs Under Community Health Choices

In order to implement Pennsylvania's Community Health Choices ("CHC") initiative, the Commonwealth has selected three managed care organizations ("MCOs") to maintain CHC provider networks and distribute MA funds accordingly. The MCOs selected by Pennsylvania are AmeriHealth Caritas, Pennsylvania Health and Wellness (Centene), and UPMC for You.

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.

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Latsha Davis & Marshall P.C.
1700 Bent Creek Boulevard, Suite 140
Mechanicsburg, PA 17050

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