Statewide Smoking Ban - Are Your Residents Affected?

On March 12, 2010 Governor Mark Parkinson signed into law a statewide ban on smoking. House Bill 2221 is set to go into affect July 1, 2010. While the affect will be felt in many places, nursing homes who currently allow smoking can breathe a sigh of relief.

According to the bill the following would places would be exempted:

Outdoor areas of any building or facility beyond the access points of the building or facility;
Private homes or residences, except when used as a day care home;
Hotel or motel rooms designated for smoking guests if the percent of such rooms does not exceed 20 percent of the total hotel or motel rooms;
The gaming floor of a lottery gaming facility or racetrack gaming facility;
The portion of an adult care home that is designated as a smoking area and that is fully enclosed and ventilated;
The portion of a licensed long-term care unit of a medical care facility that is  designated as a smoking area and that is fully enclosed and ventilated;
Tobacco shops;
Class A and Class B clubs holding a license as of January 1, 2009, and who notify the Secretary of Health and Environment in writing within 90 days after the effective date of the bill that they wish to continue to allow smoking on the premises; and
Private clubs which meet the following criteria:
Are an outdoor recreational facility that is a hunting, fishing, shooting or golf club, business or enterprise operated primarily for the benefit of its owners, members and their guests and is not open to the public;
Have substantial dues or membership fee requirements for use of the facility which are proportional in cost to similarly-situated outdoor recreational facilities that are not considered nominal and have not been implemented to avoid or evade restrictions of a statewide ban on smoking; and
Only permit smoking in designated areas where minors are not allowed.

For a complete look at this piece of legislation including requirements for employers, please click here

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  Advance Planning Has a Special Day

Prepare now for the Third Annual National Healthcare Decisions Day on April 16, 2010. This nationwide event is meant to encourage people to engage in thoughtful advance healthcare planning. In numerous surveys, Americans have voiced their belief in the importance of spirituality as they confront advanced illness and acknowledge the important role that congregations or communities can play. For these reasons, we hope you will join with your colleagues nationwide and participate in National Healthcare Decisions Day (NHDD). Among other things, NHDD encourage providers to educate their faith communities about severe illness, death and lament around this time. For additional information, please click here 

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  CMS Gives Special Focus to "Special Focus"

This month, CMS is making an important change to the provider preview that nursing homes can receive in their folders on five-star nursing home quality rating system.  In response to a suggestion from the Government Accountability Office, we are notifying nursing homes in each state (with the exception of Alaska and the District of Columbia) if they are among the 15 worst-scoring nursing homes (i.e, with a rank of 1-15) in the state.  These nursing homes are candidates for the Special Focus Facility program.  Please note that we are notifying the nursing homes individually.  We are not currently planning to distribute the list publicly. 

Below is the language used in the provider preview report that SFF candidates will receive. Nursing Homes that are not SFF candidates will continue to receive the provider preview report that they have previously received.   

Nursing Home Compare will be updated on Thursday April 22.  Providers will receive provider preview reports beginning April 17.  The toll-free hotline will be open from April 14 to April 29. The number of the hotline is 800-839-9290.

Language included in Provider Preview Reports in the top 15:

IMPORTANT MESSAGE:  Your health inspection score currently makes you a candidate for the Special Focus Facility Program.  Please note that this does not necessarily mean that your nursing home will  be selected for the Special Focus Facility program. 

 For more information about the program, please click here

IMPORTANT HELPLINE NOTE:  Helpline staff are available to answer calls this month.  Helpline hours of operation are 9:00 AM to 5:00 PM Eastern Standard Time, Monday through Friday, April 14th through April 29th.

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  QIS Survey Sites Physical Restraints More Often

F221, and F222, relating to the care area Physical Restraints, are being cited more frequently in QIS Surveys. According to the Code of Federal Regulation (CFR) at 42 CFR 483.13(a):

The resident has the right to be free from any physical or chemical restraints imposed for the purposes of discipline or convenience and not required to treat the resident's medical symptoms.

The Guidelines to Surveyors state that:

"Physical restraints" include, but are not limited to, leg restraints, arm restraints, hand mitts, soft ties or vests, lap cushions, and lap trays the resident cannot remove easily. Also included as restraints are facility practices that meet the definition of a restraint, such as:

Using side rails that keep a resident from voluntarily getting out of bed;
Tucking in or using velcro to hold a sheet, fabric, or clothing tightly so that a resident's movement is restricted;
Using devices in conjunction with a chair, such as trays, tables, bars or belts, that the resident can not remove easily, that prevent the resident from rising;
Placing a resident in a chair that prevents a resident from rising; and
Placing a chair or bed so close to a wall that the wall prevents the resident from rising out of the chair or voluntarily getting out of bed.
If you employ side rails, have beds against the wall, or have winged mattresses in your facility, there is a high likelihood that you could trigger a Stage 2 investigation in this care area.  

Click here to be directed to the Physical Restraints Critical Element Pathway.

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  Congress Makes Progress on Physician Fee Fix and FMAP Extension

Congress is continuing to make progress with legislative efforts to fix the cut to the physician fee schedule that went into effect April 1, and to extend the temporary increase of federal Medicaid funds that were included in last year’s economic stimulus package until June 30, 2011. 

There are two legislative vehicles that seek to address the Medicare physician fee schedule – one a short-term extension until early May, and the other a longer-term extension through the end of 2010. The Medicare Part B physician fee schedule is very important to our post-acute providers as it determines the reimbursement rates for the Part B covered therapy services we provide.  

On Monday, the Senate voted to limit debate on H.R. 4851 – the short term fix – which would provide relief from the cut in Medicare fees and extend a number of federal programs, including unemployment insurance, through early May. A vote on final passage is expected this week.  If the Senate passes the bill as currently drafted with no changes, it will go directly to the President’s desk for his signature.  If the Senate makes changes in the bill, it will have to go back to the House for further consideration before the President can sign it. 

Congress is also working on another bill, H.R. 4213, which would provide longer term extension of many programs including relief from the physician fee cuts, until the end of 2010.  This bill also contains the six month extension – until June 30, 2011 – of the additional FMAP money originally provided in the American Reinvestment and Recovery Act (ARRA).  

H.R. 4213 has passed both the House and the Senate, but in different forms, so the differences need to be resolved before the bill can go to the President to be signed into law.  

Congress is expected to pass H.R. 4851, the shorter term bill, first to provide immediate relief and to give themselves time to complete consideration of H.R. 4213, the longer term bill.

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