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In the News...

01/14/2015

Congressional Senior Advocate re-introduces bill

Congressman Jim Renacci (R-OH) has reintroduced the Creating Access to Rehabilitation for Every Senior (CARES) Act of 2015 (H.R. 290). The legislation eliminates the three-day inpatient stay requirement currently required by the Medicare program.

“The reintroduction of this bill serves as a reminder that this problem is not going away,” said Mark Parkinson, President and CEO of AHCA/NCAL.  “We applaud Congressman Renacci’s commitment to addressing the problems associated with a required three-day stay in a hospital to access skilled nursing care. He is a champion for seniors and those individuals who need our services.”

This bill was originally introduced in 2013, but was tabled until more study could be done. The facility that cared for the resident would have to meet certain criteria in order to have the 3 day stay waived. Those criteria will be guided by the criteria set on CMS' Nursing Home Compare website.

 

OIG REPORTS

SNF fail to meet care planning requirements 2 28 13.pdf

Inappropriate Payments to SNF Cost MC More Than a Billion Dollars in 2009.pdf

Nursing Home Complaince OIG 2000.pdf

Important Announcement of Upcoming Changes to Medicare Case Review

7/7/2014    

Upcoming changes to the Medicare Quality Improvement Organization (QIO) program will directly impact Medicare case review and appeals beginning August 1, 2014.
 

The Centers for Medicare & Medicaid Services (CMS) has restructured the QIO Program from its historical 53 contracts (in which each QIO performs both case review and quality improvement support for each state or territory) to a regional structure for case review and an industry-determined service structure for quality improvement initiatives.

In the new structure, case review and quality improvement functions will be performed by different contractors.  Beneficiary and Family Centered Care QIOs (BFCC-QIOs) will handle case review while Quality Innovation Network QIOs (QIN-QIOs) will provide technical assistance to support providers.

Quality Insights of Pennsylvania has applied to be a QIN-QIO.  Therefore, we will no longer be performing case review and appeals.  Effective August 1, 2014, the new Beneficiary and Family Centered QIO for the region that includes Pennsylvania is Livanta.  This means:

  • Livanta will be responsible for all beneficiary quality review case work and appeals in Pennsylvania. 
  • Healthcare providers and Medicare beneficiaries must contact Livanta toll-free at 1-866-815-5440 for all appeal requests and Quality of Care concerns.
  • All outstanding Higher-Weighted DRG medical record requests after the above date should be mailed to: 

BFCC-QIO
9090 Junction Drive Suite 10
Annapolis Junction, MD 20701

Quality Insights will continue to provide case review and appeals through July 31.  If your case is currently under review or in process, please be assured that every effort has been made to ensure a seamless transition for Medicare beneficiaries with no disruption in case review services.  

These changes are part of CMS’ QIO transformation effort to further enhance the quality of services to Medicare beneficiaries.  You can learn more at qioprogram.org.  If we can be of assistance in advance of the transition date, please do not hesitate to contact QIPA. 

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