Health Law Alert

2012: Issue 17 - Focus on Long Term Care

CMS Issues Multiple Skilled Nursing Facility/Nursing Facility Guidance Documents

By: Howard L. Sollins

On September 27, 2012, the Centers for Medicare and Medicaid Services (CMS) issued advance copies of four significant survey guidance documents amending the State Operations Manual (SOM) governing the Medicare skilled nursing facility (SNF) and Medicaid nursing facility (NF) survey and certification process. They are being implemented as of November 30, 2012.

The SOM amendments were issued in multiple Survey and Certification (S&C) guidance documents, each of which was accompanied by CMS slides and training materials:

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2013 OIG Work Plan: Key Issues for Skilled Nursing Facilities/Nursing Facilities

By: Howard L. Sollins

The Office of Inspector General, U.S. Department of Health and Human Services (OIG) Work Plan is one of the core source documents for the establishment and updating of any health care provider corporate compliance plan. In addition to the Work Plan’s general guidance about the authority and priority of this law enforcement agency, each provider community is well-advised to focus on both continuing and newly identified areas of interest, investigation and prosecution. The following discussion highlights the Work Plan areas most relevant for Medicare-certified skilled nursing facilities (SNFs) and Medicaid-certified nursing facilities (NFs) (collectively “Facilities”).

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Aid and Attendance Benefit: A Useful Benefit to Veterans in Nursing Homes

By: Christopher P. Dean

Veterans, their spouses and their parents who are admitted to long term care facilities may be eligible for a long-standing program called the Aid and Attendance Pension benefit (the “Aid and Attendance Benefit”). The Aid and Attendance Benefit can pay for beneficiaries’ daily personal care if they can demonstrate a need for regular aid and attendance by another person.

The Aid and Attendance Benefit is generally available for a veteran, a veteran’s spouse, a surviving spouse or a veteran’s parent who is already entitled to veterans pension benefits (each an “Eligible Person”) if that person meets the criteria for “aid and attendance.” The simplest way to qualify for the Aid and Attendance Benefit is for an Eligible Person to be admitted to a nursing home with a physical or mental incapacity. An Eligible Person can also qualify for the Aid and Attendance Benefit criteria if (1) he or she is blind or nearly blind (corrected visual acuity of 5/200 or less) in both eyes or concentric contraction of the visual field to 5 degrees or less, or (2) he or she has documented evidence of regular aid and assistance.

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