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Posts tagged "Medicaid"

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.

Third Circuit Greenlights Short-Term Medicaid Annuities

The use of Medicaid annuities as planning device has been a hotbed of litigation since the passage of the Deficit Reduction Act of 2005 (DRA). The Pennsylvania Department of Human Services (DHS) has routinely found itself on the losing end of this ongoing battle. In the case of Zahner v. Secretary Pennsylvania Department of Human Services, the United States Court Of Appeals for the Third Circuit addressed the use of short-term annuities as a Medicaid planning device, issuing another decision favoring Medical Assistance (MA) beneficiaries. The Zahner decision has significant implications for the provider community.

Medicaid Enrollment Revalidation Deadline Looming

The Affordable Care Act requires Medicare and Medicaid providers to revalidate their enrollment information, initially by March 24, 2016 and at least every five (5) years thereafter. This process is already underway in Pennsylvania for Medical Assistance providers, and is coordinated through the Office of Long Term Living (OLTL). You can access OLTL's revalidation information here.

Court Holds Responsible Party Provisions are Consistent with Nursing Home Reform Act

In the recent case of Eades v. Kennedy, PC Law Offices, the United States Court of Appeals for the Second Circuit found that provisions of an admission agreement that imposed certain financial obligations on the husband of a nursing home resident did not violate the Nursing Home Reform Act (NHRA), and that the NHRA does not preempt Pennsylvania's indigent support statute. In that case, the daughter and husband of a deceased nursing home resident filed suit against the law firm hired by the nursing home to collect resident's unpaid bill. As part of their claim, the plaintiffs claimed that the responsible party provisions of the admission agreement were unlawful under the NHRA. They further argued that the NHRA preempted Pennsylvania's indigent support statute.

Provider Right to Sue for Adequate Rates in Federal Court Severely Restricted

In Armstrong v. Exceptional Child Center, Inc., the United States Supreme Court found that providers do not have a private right of action under §30(A) of the Medicaid Act to require a state to increase Medicaid payment rates, significantly impacting the ability of providers to sue states in federal court to challenge Medicaid rates. Section 30(A) of the Medicaid Act, often referred to as the "Equal Access Provision," requires states to:

Refunds of Resident Trust Accounts

On June 26, 2013, the General Assembly of the Commonwealth of Pennsylvania amended the Probate, Estates, and Fiduciaries Code to allow nursing facilities to disperse up to $10,000 from a resident trust account after the resident's death in certain circumstances. If the deceased resident was a recipient of Medical Assistance benefits, the facility may disperse up to $10,000 from the resident trust account to a licensed funeral director to contribute to burial expenses, regardless of whether a personal representative has been appointed. If the decedent's burial expenses total less than $10,000, then the facility may pay the remaining funds to the decedent's family members, not to exceed $10,000. Preference is given to family members in the following order: spouse, child, parent, then sibling. Previously, facilities could only disperse up to $3,500 from a patient's care account to a licensed funeral director and could not exceed a total of $4,000 after paying the remainder to family members. If a facility makes such a payment, it will be released to the same extent as if the payment had been made to the decedent's personal representative.

MA Audit Issues Must Be Appealed at the Time of Audit

On July 10, 2013, the Commonwealth Court of Pennsylvania ruled that providers wishing to challenge adjustments made to their Medical Assistance ("MA") cost report must file a timely appeal from their audit report in order to preserve any audit issues for purposes of setting case-mix rates.

OIG Clarification on Medicare Exclusion Process

On May 8, 2013, the Office of Inspector General ("OIG") issued an Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs. Previously, the only official guidance from OIG on the scope and effect of its exclusion from participation was published in its 1999 Special Advisory Bulletin, which the Updated Bulletin replaces and supersedes. An OIG exclusion is a legal prohibition on payment by Federal health care programs, such as Medicare and Medicaid, for items or services furnished by (1) an excluded person or (2) at the medical direction or on the prescription of an excluded person. This prohibition extends beyond direct patient care and reaches administrative and management services payable by Federal health care programs.

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