Long-Term Care

News & Analysis as of

President Signs Medicare Physician Fee Schedule/SGR Patch with Numerous Health Policy Provisions

In This Issue: - One-Year Medicare Physician Fee Schedule Fix - Valuation of Services Under the Physician Fee Schedule - ICD-10 Delay; LTCH Moratorium to Become Effective Immediately - Skilled Nursing...more

New Approaches – and Increasing Oversight – for Medicaid Managed Long Term Services and Support

Approximately one-third of Medicaid spending, $136 billion, is on long-term services and supports (LTSS). While the majority of Medicaid LTSS takes place in institutional settings, such as nursing facilities and mental...more

Long Term Care Construction Opportunities

Based on the long term care projects with which we have recently been involved, there appears to be great opportunity for growth in the construction of long term care facilities. This is attributed to the ever-growing aging...more

Mitigating Successor Liability in Long Term Care Acquisitions

As in any business acquisition, purchasers in the long term care industry can encounter potential liability due to employment claims, seller violations of representations and warranties under the purchase agreement, tort...more

New Development Regarding Medicaid STAR+PLUS Network Provider Agreements for Texas Nursing Homes

Beginning this fall, Texas nursing home reimbursement will be converted to Medicaid Managed Care. In preparation for the Medicaid Managed Care rollout, Texas Managed Care Organizations ("MCOs") recently sent out network...more

Not Your Grandmother’s Nursing Home -- Boomers and Obamacare spur a transformation of the growing long-term care industry.

The modern nursing home was born from the Social Security Act, which conditioned payments in a way meant to eliminate state-run “almshouses” serving the elderly poor. Over the following decades, the long-term care sector was...more

MedPAC Recommends Reduction To Hospital Outpatient Department, LTCH Payment Rates, Increases To Inpatient Acure Care Hospital...

On January 16, the Medicare Payment Advisory Committee (MedPAC) unanimously voted to recommend that Congress direct the Secretary of Health and Human Services to...more

Key 2014 Dollar Limits for Medicaid Long-Term Care Coverage Released

The Centers for Medicare & Medicaid Services (CMS) has released the 2014 federal guidelines for how much money the spouses of institutionalized Medicaid recipients may keep and the limit on how much a home can be worth for...more

FLSA Care for the Caregivers: New DOL Rule Broadens Minimum Wage and Overtime Protections for Direct Care Workers

A final rule issued by the Department of Labor (“DOL”) is to erode significantly a longstanding exemption under the Fair Labor Standards Act (“FLSA”). For nearly 40 years, under the companionship services exemption, home care...more

Pennsylvania Commonwealth Court Holds Structured Settlement Annuity Is Transfer for Less Than Fair Market Value Under the Deficit...

The Pennsylvania Commonwealth Court’s recent decision in the matter of Sams v. Department of Public Welfare may significantly affect the structured settlement industry, and the settlement of lawsuits on behalf of certain...more

CMS to Begin Implementing 25 Percent Threshold for LTCHs

CMS, in its federal fiscal year (FFY) 2014 final rule, has allowed its five-year moratorium on the 25 percent threshold payment adjustment policy to expire. Following the lifting of this moratorium, LTCHs that admit more than...more

CMS Releases Final FFY 2014 IPPS Rule

CMS has released its final federal fiscal year (FFY) 2014 prospective payment system (PPS) rule for inpatient stays in acute care and long-term care hospitals (LTCHs). The rule projects a net increase in operating payments to...more

Important Terms for Long Term Disability and Other Important Factors to Consider

For people fortunate enough to have a policy of long term disability (“LTD”) benefits, they will typically need to refer to the specific wording of their policy before knowing what steps they have to take and what rights they...more

CMS Issues Final Rule Regarding Required Agreements Between Long Term Care Facilities and Hospices

Beginning August 26, 2013, skilled nursing facilities participating in Medicare and nursing facilities participating in Medicaid (collectively referred to as “long-term care facilities”) that choose to arrange for the...more

New Requirement for LTC Facilities That Arrange Hospice Services through a Medicare-Certified Hospice

Effective August 26, 2013, the Centers for Medicare & Medicaid Services require that a long-term care, or LTC, facility that chooses to arrange for the provision of hospice services through a Medicare-certified hospice must...more

CMS Rule Complicates Long-Term Care Facility and Hospice Relationships

Final rule aims to improve the quality and consistency of care between long-term care facilities and hospice providers but may increase conflict between facility and provider staff. ...more

Health Reform + Related Health Policy News - May 2013

In This Issue: - Top News ..HHS Releases Hospital Pricing Data in Transparency Effort; Results Show Significant Variation ..States Divided on Medicaid Expansion ..CMS Issues FY 2014 Proposed Rules for...more

Planning And Paying For Long-Term Care (Part 6 In A Series: Medicaid/Medical Assistance)

In Part 5, I discussed the issue of “excess” assets and the “spend-down” process in Medical Assistance. Apart from a couple’s exempt assets (house, one car, household furnishings, etc.), the remaining assets are “countable”...more

CMS Proposes Prospective Payment System Update Rules for Inpatient and Long Term Care Hospitals

On Friday, April 26, the Centers for Medicare and Medicaid Services (CMS) issued a crucial payment system rule that proposes updated rates and regulatory policies for inpatient hospitals (including inpatient psychiatric...more

CMS Releases Proposed FFY 2014 IPPS Rule

CMS has released its proposed federal fiscal year (FFY) 2014 prospective payment system (PPS) rule for inpatient stays in acute care and long-term care hospitals (LTCHs). The rule projects a net increase in operating payments...more

CMS Issues Proposed Changes to LTCH Payment Rates and Other Payment Policies for Fiscal Year 2014

On April 26, 2013, the Centers for Medicare & Medicaid Services (“CMS”) released the proposed update to the Medicare long-term acute care hospital prospective payment system (“LTCH PPS”) policies and payment rates for fiscal...more

Insight on Estate Planning - April/May 2013

In This Issue: - How to fund long-term care insurance with a tax-free exchange - Should a CRT be part of your estate plan? - The key to an effective trust is education - Estate Planning Pitfall:...more

Two Recent Directives from the Centers for Medicare and Medicaid Services (CMS) Could Add to the Pain for Medicare and Medicaid...

First, CMS announced on April 5, 2013, that due to the across-the-board federal budget reductions (aka “sequestration”), effective immediately, State Survey Agencies must obtain approval from the CMS Regional Office before...more

Shorts on Long Term Care April 2013

In this issue: - What’s In A Word? N.C. Court of Appeals Invalidates Nursing Home Arbitration Clause Based on Language of the Agreement - “The Climb” — NC Activities Directors Win National Award for Their Work...more

Final Regulations Governing Closure of Long Term Care Facilities

The federal Centers for Medicare and Medicaid Services (CMS) published a final regulation to further implement section 6113 of the federal health reform law, the Patient Protection and Affordable Care Act. The March 19, 2013,...more

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