Welcome to the FMDA's Members Only Pages 

Coding Corner  |  Strategic Plan |  Regulatory, etc.  |  Newsletter  |  Resources   |  Meetings   |  Volunteer

Regulations, Legislation, and Advocacy


GET INVOLVED!

Click Here To
Contact Your Legislators

 

 

Most of these documents are in PDF format. If you can not open them, CLICK HERE to download the FREE Adobe Reader. 

This is the latest Medicare update in the first quarter 2005 page 42 regarding NH / SNF codes. You CAN NOT assign the initial comprehensive assessment to a NP / PA even if they are under physician employment as compared to the April 2003 update. Physicians who are allowing their NP / PA to do their H&P (initial assessment) are providing improper care and if any NP / PA do the "initial assessment" and bill a 99303, they are either committing fraud (if using the physician UPIN number) or will not be paid if using the NP / PA UPIN number. The NP / PA MAY see the resident prior to the physician initial comprehensive (99303) visit and bill 99311 - 99313 codes.

Click here for more information. 

Advance copy of new surveyor guidance for determining nursing facilities’ compliance with requirements at F501, Medical Director

On June 9th, the Centers for Medicare & Medicaid Services (CMS) issued to state survey agency directors the advance copy of new surveyor guidance for determining nursing facilities’ compliance with requirements at F501, Medical Director. The new guidance, which is now available on CMS’ web site, includes Interpretive Guidelines, an Investigative Protocol, and Severity guidance for assigning severity levels for deficiencies cited at F501. The regulation at F501 has not changed.

CMS will issue the final guidance in November 2005. According to CMS’ cover memo, the intervening time period is intended “to allow surveyors to be trained in the new guidance and to permit facilities and medical directors to study the significantly revised and expanded guidance.” Changes in the content are not expected when CMS issues the final document. 

ACHA key staff and subcommittee members are reviewing the guidance. In subsequent communications, we will provide additional information such as the content and significance of the guidance, as well as information and materials to help facilities understand and prepare for implementation.

The guidance also may be accessed on CMS web site at http://www.cms.hhs.gov/medicaid/survey-cert/sc0529.pdf or as a Word Document by clicking here.

The AARP Public Policy Institute is pleased to make available a set of five publications on facts about the Medicaid program and the people it helps, by Lynda Flowers, Mary Jo Gibson, Wendy Fox-Grage, and Ari Houser.

The following link provides access to PDFs for all the titles listed below. For more information about Medicaid long-term care, please contact Mary Jo Gibson at (202) 434-3896. For more information about other Medicaid publications, please contact Lynda Flowers at (202) 434-3889. Original copies of all are available by request at mailto:ppi@aarp.org or calling (202) 434-3890.

http://www.aarp.org/research/health/medicaid/medicaid_facts.html  

Created in 1965, Medicaid is a federal and state-funded program that most people think of as simply a health insurance program for low-income Americans. Today, Medicaid is the largest public or private health insurance program in the United States; this year, 53 million people are expected to be enrolled. Medicaid covers two-thirds of nursing home residents, one in five persons under age 65 with chronic disabilities (including about 70% of poor children), one-third of all births, and half of spending for states' mental health services.

There are many myths about the program, about what it covers, and the people it helps, including the misconception that most Medicaid beneficiaries are on welfare. This set of five documents aims to shed additional light on the Medicaid program - today's safety net for those who are unable to pay for their health and long-term care.

1. "SIX THINGS THAT YOU MIGHT NOT KNOW ABOUT THE MEDICAID PROGRAM," April 2005 (FS#113, 3 pages) - This Fact Sheet provides key facts about the Medicaid program that demonstrate why the program is such an important part of the nation's health care system.

2. "MYTHS ABOUT THE MEDICAID PROGRAM AND THE PEOPLE IT HELPS," April 2005 (FS#115, 4 pages) - This Fact Sheet provides the real facts surrounding nine common myths concerning Medicaid eligibility, services, and beneficiaries. 

3. "MEDICAID OPTIONAL ELIGIBILITY AND SERVICES: OPTIONS THAT AREN'T REALLY OPTIONS," April 2005 (DD#115, 5 pages) - This Data Digest describes the role of "optional" categories in providing acute care services through the Medicaid program, and provides examples of how individuals and families benefit from such optional eligibility and/or optional services.

4. "SLICING THE LONG-TERM CARE SAFETY NET: MEDICAID'S MOST VULNERABLE AT RISK," April 2005 (DD#116, 4 pages) - This Data Digest looks at the role of "optional" Medicaid categories in providing long-term care services for older people and those with disabilities lacking sufficient resources to afford these services themselves.

5. "THE FACES OF MEDICAID LONG-TERM CARE BENEFICIARIES," April 2005 (FS#114, 2 pages) - This Fact Sheet uses vignettes to give examples of common situations faced by Medicaid beneficiaries who receive long-term care services including nursing facilities, personal care, and HCBS waiver services.

To view other publications on topics of importance to midlife and older Americans, please visit our webpage at http://www.aarp.org/ppi Copies of all publications are available by request at mailto:ppi@aarp.org or by calling (202) 434-3840.

You are registered to receive alerts from AARP Public Policy Institute. Go to "E-mail Alerts" at http://www.aarp.org/ppi to edit your profile or unsubscribe.

Date: May 5, 2005
Subject: CMS

CMS has placed an advanced copy of the new surveyor guidance for incontinence and catheters on the CMS website: http://www.cms.hhs.gov/medicaid/survey-cert/sc0523.pdf . (The advance notice to state survey agencies will allow time for training before implementation.) CMS will issue the guidance in Appendix PP and it will become effective June 27, 2005. Although the date on the survey and certification letter says April, it is my understanding from CMS staff that there is a delay between the date of the release to state survey agencies and the appearance on the CMS website.