Beginning October 1, 2013, Ohioans seeking to determine whether they are eligible for Medicaid coverage can visit benefits.ohio.gov instead of scheduling an in-person visit at their local Job and Family Services office.

The state hopes that this new online system will increase the speed and accuracy with which Medicaid eligibility is determined. Through this online system, individuals who are deemed ineligible for Medicaid benefits will then be directed to the federal government’s private health insurance exchange options, which go into effect on January 1, 2014.

At the end of August 2013, the Centers for Medicare and Medicaid Services (CMS) will issue reports to certified skilled nursing facilities via mail as part of its Program for Evaluating Payment Patterns Electronic Reporting (PEPPER) system. These reports will identify areas within a facility’s Medicare Part A payment system that are at risk for improper payment. The PEPPER reports will detail each facility’s Medicare Part A claim statistics for the areas CMS has determined as being at risk for improper payment.

Only facilities that have sufficient data to generate a PEPPER report will receive one. Facilities that do receive one should use the report to audit its own billing practices and work to improve their efficiency and accuracy in billing for Medicare Part A. CMS has noted that the PEPPER reports do not identify improper payments but rather only identify potential areas in the facility for improper payments.

The PEPPER reports will also compare the facility’s Medicare billing risks with the billing data of other facilities in the region. This statistic will provide further guidance in the facility’s assessment of its Medicare billing practices.

If you would like more information on the impact the PEPPER reports will have on your facility, contact one of DLM Legal’s health care attorneys at info@dlmlegal.com.

The United States House of Representatives recently proposed new legislation aimed at curbing Medicare costs. The legislation proposes to decrease skilled nursing facilities’ Medicare rate updates, introduce new post-acute payment systems, and institute readmissions penalties for skilled nursing facilities.

It is estimated that the Medicare Hospital Insurance Trust Fund will be bankrupt by 2026, and that the Supplemental Medical Insurance Trust Fund will increasingly strain the federal budget as Medicare spending is expected to grow from 3.6% in 2012 to 6.5% of GDP in 2087. With this in mind, the House Ways and Means Committee has introduced legislation aimed at reducing Medicare costs. Based upon proposals made by the Medicare Payment Advisory Commission, the proposals include creating bundling payments for a post-acute episode of care and creating site-neutral payments between inpatient rehabilitation facilities and skilled nursing facilities for some procedures.

One proposal is to require public disclosure for all Medicare payments via an online database with the belief that subjecting providers to such public scrutiny may deter some wasteful practices and overbilling.

Another target of the legislation is skilled nursing facility readmission policies. The Medicare Payment Advisory Commission indicates that nearly 14 percent of individuals on Medicare discharged from a hospital to a skilled nursing facility are readmitted to the hospital for conditions that could potentially have been avoided. In an attempt to curb these incidences and lower costs, the proposed legislation would establish a skilled nursing facility readmissions program similar to that already in place for hospitals with the aim of holding nursing homes accountable for hospital readmissions. Reimbursement penalties would be instituted against skilled nursing facilities if they exceed a threshold for admissions to a hospital for certain conditions within a particular timeframe. According to the U.S. Department of Health and Human Services (HHS) 2014 budget proposal, such a policy could save $2.2 billion over ten years.

The Committee is accepting comments on the draft legislation through August 30.

On June 6, 2013, Ohio Attorney General Mike DeWine announced that he would begin installing covert surveillance cameras in residents’ rooms at nursing homes state-wide to investigate allegations of abuse. Since then, DeWine’s office has already used “spy cams” in one investigation that resulted in a Zanesville nursing home being shut down.

DeWine’s position is that if the resident consents to the Attorney General’s installation of a camera, then the camera’s presence is completely legal. By no means should a nursing home ever attempt to impede an Attorney General investigation. There is no clear legal prohibition against the use of surveillance cameras in nursing facilities, but facility administrators should be aware that the Ohio Attorney general is engaging in such practice. Thus, until further notice – whether through judicial or legislative action – DeWine’s office may continue to use spy cams in nursing homes around the state.

The installation of spy cams in a nursing home by a private citizen, however, is a different matter. Both state and federal law confers to nursing home residents various rights of privacy that would be undermined by the presence of a surveillance camera broadcasting images of residents to an off-site, third party location. Until the Ohio legislature or Congress gives private citizens the right to install a spy cam at a nursing home in Ohio, all facilities should have in place a “no surveillance camera” policy of some kind. Such a policy is necessary to uphold the state and federal privacy rights to which nursing home residents are entitled.

For guidance in writing your facility’s policy on surveillance cameras, contact a DLM Legal attorney.