In this Issue
- Judge Orders Los Angeles Assisted Living Facility to Stop Abuse and Evictions
- Court of Appeal Vindicates Nursing Home Readmission Rights
- Judge Issues Decisions in Cases Challenging Medicare’s Appeal Process
- Judge Orders Medicare Agency to Provide More Education per Settlement in Jimmo, the “Improvement Standard” Case
- CMS Adds New Quality Measures to Its Nursing Home Compare Website
- CMS Directs States to Prevent Humiliation of Residents Via Social Media
- CCL Issues First Enhanced Fines for Death of Assisted Living Residents
Judge Orders LA Assisted Living Facility to Stop Abuse and Evictions
In a major victory for assisted living consumers, Los Angeles Superior Court Judge James Chalfant issued a temporary restraining order to protect the elderly and disabled residents of Brentwood Manor, a 140-bed residential care facility for the elderly (RCFE) in Los Angeles. Attorneys from Legal Aid Foundation of Los Angeles (LAFLA), and Neighborhood Legal Services of Los Angeles County (NLS), with pro bono legal services from Morgan, Lewis & Bockius LLP and assistance from CANHR, helped residents obtain the order requiring the owners and employees of Brentwood Manor to stop their campaign of harassment and illegal evictions, and comply with state laws regarding facility closures.
Court of Appeal Vindicates Nursing Home Readmission Rights
In a first for California, an appeals court is publishing an opinion explaining why nursing homes are prohibited from abandoning hospitalized residents.
Federal law has long guaranteed nursing home residents an absolute right to be readmitted from temporary hospitalizations. Unfortunately, neither the federal nor state nursing home enforcement agencies have been interested in punishing facilities that violate that right. Consequently, the practice of hospital dumping has been a growing and vexing problem for residents throughout the state.
Read the decision
Judge Issues Decisions in Cases Challenging Medicare’s Appeal Process
A federal judge in Connecticut has issued two decisions that may help to improve the longstanding problem involving administrative review of Medicare coverage denials, in which beneficiaries are routinely denied at the initial stages and then forced to wait long periods of time for a hearing before an Administrative Law Judge (ALJ) where the chance of success jumps to the 60-70% range.
Judge Jeffrey Meyer approved a settlement in a nationwide class action lawsuit, Exley v Burwell, that will ensure that Medicare beneficiaries who appeal denials of coverage to an ALJ will receive hearings and decisions more quickly. In a related case challenging the 98% denial rate at earlier levels of appeal, Sherman v. Burwell, Judge Mayer denied the government’s motion to dismiss and granted the plaintiff’s motion for class certification.
For more information, click here.
Judge Orders Medicare Agency to Provide More Education per Settlement in Jimmo, the Improvement Standard Case
The Center for Medicare Advocacy reports that it and the other plaintiffs in Jimmo v. Burwell – the “Improvement Standard” case –obtained a court order directing the Centers for Medicare & Medicaid Services (CMS) to comply with the January 2013 Settlement Agreement. The August 18, 2016 order requires CMS to provide more education to providers and contractors to re-educate them on Medicare coverage for skilled maintenance nursing and therapy.
Jimmo is a landmark case brought on behalf of a nationwide class of Medicare beneficiaries who were denied coverage and access to care because they did not show sufficient potential for “improvement.”
Click here for the recent court order and other information on the Jimmo case.
CMS Adds New Quality Measures to Its Nursing Home Compare Website
The Centers for Medicare & Medicaid Services (CMS) updated its Nursing Home Compare Five-Star Quality Ratings to include new measures involving successful discharges, emergency visits, and re-hospitalizations. According to CMS Deputy Administrator and Medical Officer, Patrick Conway: “With this update, star ratings will provide an even more accurate reflection of the services that nursing homes provide.”
For more information on the new quality measures, click here.
CMS Directs States to Prevent Humiliation of Residents Via Social Media
Responding to widespread abuses of nursing home residents via postings of humiliating photos and videos on social media, the Centers for Medicare and Medicaid Services (CMS) issued a memo directing state survey agencies to crack down on the abuse.
CCL Issues First Enhanced Fines for Death of Assisted Living Residents
Community Care Licensing (CCL) has issued its first fines under newly revised Health and Safety Code Section 1569.49, which permits enhanced civil penalties for regulatory violations that lead to the death of a resident. Prior to the passage of AB 2236 (Maienschein and Stone) in 2014, the maximum fine an assisted living facility faced was a paltry $150 – even if the resident was physically injured or killed. The new law went into effect on July 1, 2015 and now the first enhanced fines have finally been issued. Kudos to Assemblymembers Maienschein and Stone and all the wonderful organizations and individuals who supported AB 2236 and helped it become law.
Understanding the New Medi-Cal Recovery Laws Webinar
Date: September 6, 2016 – 12:00pm -1:00pm
This webinar will review the new provisions effective January 1, 2017:
- Whose estate can be subject to recovery?
- What is and is not included in “estate” for the purposes of recovery?
- Do spouses need to worry about recovery anymore?
- What is a homestead of modest value in California?
These, as well as other questions will be answered.
- CEUs for SWAP and MCLE for Legal Services and Private Bar – 1 hour credit
- $25 for private bar attorneys, Social Workers, Discharge Planners, etc.
- Free to qualified legal services staff (must be a staff member of an IOLTA agency) Click here to see listing of qualified IOLTA agencies
Our Advocates are here to assist you and answer your questions regarding:
- Counseling on Care Options
- Medi-Cal Eligibility and Recovery
- Resident Rights and Quality of Care Issues