Long-Term Care

News & Analysis as of

CMS Proposes Sweeping Changes for Nursing Home Oversight

On July 16, 2015, the Center for Medicare and Medicaid Services (“CMS”) published a Proposed Rule with new standards that will have a sweeping effect on the long-term care industry. This new Rule is the first comprehensive...more

For-Profit PACE Programs: Harbinger of the Future?

The Program of All-Inclusive Care for the Elderly (PACE) is a benefit program provided by the federal government through the Centers for Medicare & Medicaid Services (CMS), geared toward the care of frail, elderly...more

CMS Call on Proposed Reform of LTC Facility Requirements (Aug.11)

On August 11, 2015, CMS is hosting a provider call to discuss its proposed rule to reform the Medicare and Medicaid participation requirements for long-term care (LTC) facilities. A question and answer session will follow the...more

Health Update - July 2015

Lessons From the Frontlines: Strategies for Supporting Informed Consumer Decision-Making in the Health Insurance Marketplace - Editor's Note: As marketplaces prepare for the third open enrollment period, consumers are...more

CMS Proposes Overhaul of Long-Term Care Facility Participation Requirements

On July 16, 2015, CMS published a proposed rule that would overhaul the Medicare and Medicaid participation requirements for long-term care facilities at 42 C.F.R. Part 483. As CMS points out, an overhaul is necessary...more

Medicaid Managed Care Update: A Middle Ground for Network Adequacy Standards

This article is part of a series that takes an in-depth look at several proposals that would affect managed care organizations, health care providers and other industry stakeholders participating in, and contracting with...more

Medicare/Medicaid Requirements for Long-Term Care Facilities

On July 13, 2015, CMS issued a much-anticipated proposed rule seeking to consolidate the long-term care (LTC) facility participation requirements for the Medicare and Medicaid programs. This major proposal marks the first...more

CMS Issues Proposed Rule Revising Long-Term Care Facility Requirements

On July 16, 2015, the Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to revise the requirements long-term care facilities must meet to participate in the...more

Beware! Long Term Care Class Actions are Coming

Long term care providers beware, class action suits are coming. Due to allegations of chronic understaffing, long term care providers are beginning to face massive class action lawsuits nationwide. The trend began in 2010,...more

New CMS Proposed Rule Revises Long-Term Care Facility Requirements for Medicare and Medicaid Program Participation

On July 13, 2015, the Centers for Medicare & Medicaid (CMS) issued a long-awaited proposed rule (Proposed Rule) that would revise the requirements that long-term care (LTC) facilities must meet to participate in the Medicare...more

Comprehensive Proposed New Rules Announced for Long-Term Care Facilities

"Far reaching," "massive in scope," and "sweeping," are just a few of the terms that have been used to describe a 403-page proposed rule for Medicare and Medicaid nursing homes, which was released Monday (July 12) by the U.S....more

Health Law Wire: OMIG Standards for PRI Audits Held Arbitrary and Capricious (7/15)

The Office of the Medicaid Inspector General (OMIG) was recently given a set-back in its on-going audits of nursing home case mix submissions. These audits focus on “Patient Review Instruments” (PRIs) which form the basis of...more

Medicaid managed care proposed rule expands federal role in rate setting at both the managed care organization and provider level

On June 1, 2015, the US Centers for Medicare & Medicaid Services (CMS) published its proposed rule on Medicaid managed care (CMS-2390-P). According to CMS, the purpose of the proposed rule is to "modernize the Medicaid...more

Getting the Best Medical Care: a Newsletter from Patrick Malone - June 2015

In This Issue: - Demographics = Destiny - It's (Very) Expensive - Make Planning a Priority - How to Shop for Long-Term Care Policies - Buyer Beware - Excerpt from Introduction: Looking Ahead: Preparing for...more

Cutting Costs By Reviewing Ongoing Medical Care For Injured Workers

Long term medical care related to workplace injuries can be a costly and frustrating proposition for employers and/or their Workers’ Compensation insurance carriers. In many cases, the injured workers’ medical care continues...more

CMS Proposes Major Update to Medicaid Managed Care Regulations

The Centers for Medicare and Medicaid Services (“CMS”) released, on May 26, 2015, the a far-ranging proposal for revising the Medicaid managed care regulations (“Proposed Rule”). The number of individuals enrolled in Medicaid...more

NJ Appeals Court Upends Nursing Home Negligence Suit

In a decision with far-reaching ramifications for long-term care litigation, the Superior Court of New Jersey, Appellate Division held that § 30:13-4.2 of the Nursing Home Responsibilities and Residents’ Rights Act (NHA) does...more

Retiring Abroad with a Long-Term Care Insurance Policy

As more people consider retiring abroad, questions are arising about how an overseas retirement will affect long-term care insurance benefits. If you are planning to relocate out of the country and want to purchase or already...more

Health Update - February 2015

Cyber Risk Insurance Policies: What You Need to Know - Editor’s Note: As data breach incidents and related cyber risks continue to increase and gain publicity—and government agencies become more actively involved in...more

Compliance Corner: Long-Term Care and the OIG Work Plan: As HHS Sharpens its Focus, Providers Should Set Their Sights on...

In the fall of 2014, the Department of Health and Human Services Office of Inspector General released its 2015 Work Plan, which highlighted HHS’s compliance focus areas in the upcoming year. As in past years, areas of...more

Illinois Supreme Court Affirms Constitutionality of Nursing Home Bed Tax

In the closing days of its January term, a unanimous Illinois Supreme Court upheld the constitutionality of a “bed tax” on Illinois nursing homes, reversing the Circuit Court’s judgment that the tax violates the state...more

Level of Assets That Spouses of Medicaid Recipients May Keep Rises for 2015

Medicaid law provides special protections for the spouses of Medicaid applicants to make sure the spouses have the minimum support needed to continue to live in the community while their husband or wife is receiving long-term...more

U.K. Court Approves Insurance Business Transfer Scheme

A court in the United Kingdom has approved the transfer of the entire long-term insurance business of Prudential Annuities Limited (PAL) to The Prudential Assurance Company Limited (PAC). The transfer’s purpose was to...more

Health Headlines: Also in the News - December 2014 #2

CMS Publishes Correction to CY 2015 Home Health Prospective Payment System Final Rule – On December 2, 2014, CMS published in the Federal Register a correction to its previously published final rule for Medicare Home Health...more

Parents' Medical History May Make Long-Term Care Insurance More Expensive

Your parents' health could be one of the many factors that long-term care insurance providers take into account when deciding how much to charge you. One large insurer has started rating applicants based, in part, on the...more

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