In the wake of the United States Supreme Court’s recent decision to strike a federal provision which denied federal benefits to same-sex couples, the Centers for Medicare and Medicaid Services (CMS) has issued a memorandum dated June 28, 2013 regarding resident visitation policies in Long Term Care (LTC) facilities. All Medicare and Medicaid-certified nursing homes are now required to extend the same spousal visitation rights to its residents regardless of sexual orientation.

Under current regulations, all residents of LTC facilities must be advised of their right to receive visitors consistent with their expressed preferences on a 24-hour basis. LTC facilities must ensure that all residents are given full and equal visitation privileges, including visits from spouses (including same-sex spouses), domestic partners (including same-sex domestic partners), other family members, and friends. Such privileges are subject to “reasonable restrictions,” however, in order to protect the security of the facilities residents, such as denying access to those engaging in disruptive behavior. Surveyors evaluating an LTC facility are instructed to interview residents and family members in order to ascertain whether residents understand their rights as it pertains to visitation and whether the facility has limited or restricted visitors against resident wishes and outside of any reasonable restrictions. Facilities that fail to ensure these rights may be subject to penalties and fines.

You can read the memo at the following address: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-13-42.pdf.

To learn more about these regulations, contact an attorney at DLM Legal today at info@dlmlegal.com or 216.635.0002.

Federal law requires all licensed providers of Medicare (i.e. any organization or facility that receives Medicare funding) to affirm that they do not discriminate on the basis of race, color, national origin, disability, or age at any level of operation.

To ensure that your facility is in compliance with this law, it is recommended that any material you disclose to the public (via brochure, employment application, admission application, or website) contain the following language:

“[Name of Facility] does not discriminate against any person on the basis of race, color, national origin, disability, or age in admission, treatment, or publication in its programs, services and activities, or in employment.”

Additionally, any such facility should include in the above statement the contact information of a representative who can field questions about the anti-discrimination policy.

If you have any questions about your organization’s compliance with this or other Medicare laws, DLM Legal’s attorneys can help. Contact one of them at 216.635.0002 or info@dlmlegal.com.

Section 6401(a) of the Affordable Care Act requires all enrolled Medicare providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. These new screening standards are designed to prevent fraud in the Medicare system.

Only the providers and suppliers who submitted their original Medicare enrollment applications before March 25, 2011 will be required to revalidate their enrollment information.

From now until March 2015, Medicare Administrative Contractors (MACs) will send out revalidation notices intermittently to initiate the revalidation process for each Medicare provider. Providers must submit the revalidation application by the date their MAC has established.

The revalidation forms can be completed via CMS’s website: https://pecos.cms.hhs.gov. Failure to submit the revalidation forms could result in a deactivation of Medicare billing privileges.

For 2012, providers will have to pay a revalidation filing fee of $523 if they are an institutional provider (i.e. all Medicare providers except physicians, non-physician practitioners, physician group practices, and non-physician practitioner group practices).

The Medicare revalidation effort does not change other aspects of the Medicare enrollment process. Providers should continue to submit routine changes as they always have.
For a sample of the revalidation letter that the MACs will be sending Medicare providers, visit: https://www.cms.gov/MedicareProviderSupEnroll/Downloads/SampleRevalidationLetter.pdf

If you or your organization needs assistance with completing the Medicare revalidation process, contact DLM Legal at info@dlmlegal.com or 216.635.0002.

Today, the U.S. Supreme Court announced that it will review a Florida lawsuit challenging the constitutionality of the Obama administration’s Affordable Care Act. The challengers, who include Republican governors and attorney generals from 26 states, contend that Congress has exceeded its authority under the Constitution by passing the Act and requiring individuals to carry health insurance or pay a penalty. The Court is expected to hear oral arguments on the case in March and to issue a ruling in June.

For more details on the case, visit the official blog of the U.S. Supreme Court at http://www.scotusblog.com/2011/11/court-sets-5-12-hour-hearing-on-health-care/

On Tuesday, November 8, the United States Court of Appelas for the District of Columbia Circuit upheld as constitutional the Obama administration’s 2010 health care reform legislation known as the Patient Protection and Affordable Care Act. Notably, Judge Laurence H. Silberman, a conservative jurist appointed by Ronald Reagan, authored the majority’s opinion.

The central challenge to the Act focuses on whether Congress has the authority, under the Constitution, to require individuals to buy health insurance no later than 2014 or pay an annual penalty for failing to do so. Judge Silberman’s opinion reasoned that there is no absolute right to freedom from federal legislation and that Congress has the power to forge national solutions to national problems, even when those solutions affect individuals locally. In a dissenting opinion, Judge Brett M. Kavanaugh argued that the courts lack jurisdiction to review the law until the penalites actually take effect in 2015.

The United States Supreme Court will decide on Thursday whether to hear the same challenge to the Act. As of now, two federal appellate courts have upheld the law while another has struck it down. This split increases the likelihood that the Supreme Court will issue certiorari on the case.

Last week, the Obama administration announced that the Affordable Health Care Act will no longer cover the cost of long-term, in-home services for individuals unable to care for themselves. This part of the Act was known as the Community Living Assistance and Supports (CLASS) program. The U.S. Department of Health and Human Services dropped CLASS from the legislation after it learned the program would exceed the spending limitations set forth in the Act. These limitations hold that any program implemented by the Act must remain fiscally solvent and pay for itself for at least 75 years.

CLASS was to be funded by workers who agreed to sign up for the program and pay premiums on it. If too many people chose to opt-out of paying those premiums at any given time, the program would struggle to stay afloat financially. Experts believe the loss of CLASS will create heavier Medicaid-related burdens on the federal government.

Susan Dentzer, Health Affairs editor-in-chief for PBS’s NewsHour, offered some insightful commentary on the CLASS program and its fate: http://www.pbs.org/newshour/rundown/2011/10/what-the-death-of-the-class-act-means-for-long-term-disability-care.html