Skilled Nursing Facility

As 2023 begins, the nursing home industry faces unprecedented challenges on multiple fronts. While facilities struggle with a labor crisis, chronic underfunding, high inflation and a combined resurgence of COVID-19 and the flu, the government is ramping up efforts to hold them to even higher operational and regulatory standards. The Biden administration, as well as many state governments, are pushing reforms that will make it much more challenging to operate a compliant and financially viable facility, including minimum staffing levels, increased health and safety surveys, more significant financial penalties, and greater scrutiny of ownership, finances and related party arrangements. In addition, the government is bringing civil False Claims Act cases, and in some cases filing criminal health care fraud charges, against facilities that provide substandard care. Some states are also seeking to impose monitors and enjoin nursing home operations at underperforming facilities.

Continue Reading Nursing Homes Brace for Reforms and Heightened Government Scrutiny

As surges in various respiratory illnesses – including COVID-19 – loom over holiday gatherings, the Centers for Medicare & Medicaid Services (“CMS”) held an Open Door Forum for skilled nursing facility (“SNF”) providers addressing their obligations to offer/provide COVID-19 vaccinations, vaccination education and COVID-19 treatments, and gave providers the opportunity to bring up questions about obstacles they are facing in achieving compliance with the federal requirements.

Continue Reading Long Term Care Update: As Winter Arrives, CMS Renews its Emphasis on COVID-19 Vaccinations, Bivalent Boosters and Timely Therapeutic Treatments

In a recent blog post, we described general registration and application considerations for employers seeking to enroll in California’s new Hospital and Skilled Nursing Facility COVID-19 Retention Payment Program (the “WRP”) on behalf of their employees, including details on eligibility, qualifying periods, and defined legal terms. Readers have asked how to analyze whether physicians and other employees who perform at least some “management” or “supervisory” duties qualify for the WRP, which we address here.

Continue Reading Who is a Manager or Supervisor Excluded from California’s Healthcare Worker Retention Payment Program?

On December 5, 2022, the Department of Health and Human Services (“HHS”), Office of Inspector General (“OIG”), released their Semiannual Report to Congress for the period beginning on April 1, 2022, and ending on September 30, 2022 (the “Semiannual Report”).[1]

Continue Reading OIG Shines a Spotlight on Nursing Homes, Opioid Misuse, and Health Equity in the FY2022 Semiannual Report

Overall, healthcare professionals are 10-15% more likely to develop substance abuse issues than the general population.[1] As addiction to prescription medication has reached nation-wide epidemic proportions, it has become a major driver of drug diversion. Drug diversion occurs when prescription medicines are obtained or used illegally. Healthcare practitioners and facilities are the gatekeepers tasked with safeguarding prescription controlled substances. The failure of a facility to effectively prevent drug diversion leads to substandard care, the denial of essential pain medication or therapy, risk of infection, and even death. 

Continue Reading Don’t Let Drugs Bring You Down: The Importance of an Effective Drug Diversion Program

On October 21, 2022, the Centers for Medicare and Medicaid Services (CMS) announced changes to its Special Focus Facility (SFF) program, including new steps to address nursing home facilities that fail to graduate from the SFF program in a timely manner, or “yo-yo” back into non-compliance after graduating from the SFF program. These changes are consistent with the Federal government’s goal of improving safety and quality of care for the nation’s roughly 1.5 million nursing home residents.

Continue Reading Long Term Care Update: CMS Revises Criteria for its Special Focus Facility Initiative

On September 21, 2022, the Select Subcommittee on the Coronavirus Crisis held public hearings and issued a report assessing the performance of large, for-profit nursing home chains during the early phase of the Coronavirus pandemic. The Subcommittee’s ongoing investigation began in June 2020, and focused on five for-profit nursing home chains that collectively operated over 850 skilled nursing facilities, each of which had significant outbreaks across their facilities. The Subcommittee’s key findings paint an extremely negative picture of for-profit facilities, and include the following allegations:

Continue Reading U.S. Congressional Committee Takes Aim at For-Profit Nursing Homes

On October 4, 2021, the California Senate Bill 650 (“SB 650”), also known as the Corporate Transparency in Elder Care Act of 2021, was signed by Governor Gavin Newsom. As described below, SB 650 is designed to provide the public with greater transparency as to skilled nursing facility (“SNF”) ownership and finances.

Continue Reading What Price Transparency? California SB 650 Shines Light on Skilled Nursing Facility Ownership while Creating New Reporting Burdens for California Skilled Nursing Facilities

Skilled nursing facilities (SNFs) operate in a changing and challenging environment. The upcoming implementation by the Centers for Medicare & Medicaid Services (CMS) of a Patient Driven Payment Model will shift the reimbursement paradigm for SNFs from a focus on the volume of services provided to a focus on specific, clinically-relevant patient characteristics. Combining this significant change in reimbursement criteria with the challenges of low to non-existent profit margins, high employee churn, federal and state regulatory scrutiny and an active plaintiffs’ class action bar, means that in order to survive in today’s marketplace, SNFs must evolve their practices to maximize their operational efficiency and improve their bottom line.
Continue Reading SPOTLIGHT ON INNOVATION: Improving best practices for infection control at skilled nursing facilities