CMD Long-Term Care & Post-Acute Care Management 2 — Questions and Answers
Question 1: As a medical director of a long-term care facility, which of the following is a core regulatory responsibility under federal guidelines?
- Personally conducting all resident admissions assessments
- Implementing resident care policies and coordinating medical care (Correct answer)
- Serving as the primary billing authority for Medicare claims
- Approving all facility construction and renovation projects
Correct answer: Implementing resident care policies and coordinating medical care
Federal regulations require the medical director to implement resident care policies and coordinate medical care in the facility, acting as a key clinical and administrative leader.
Question 2: What does the acronym 'PASRR' stand for, and what is its purpose in long-term care admissions?
- Patient Acuity Severity Risk Ratio — measures clinical complexity
- Preadmission Screening and Resident Review — identifies individuals with serious mental illness or intellectual disabilities (Correct answer)
- Post-Acute Standardized Reimbursement Rate — sets SNF payment levels
- Physician Authorization for Skilled Nursing Referral and Review — authorizes admissions
Correct answer: Preadmission Screening and Resident Review — identifies individuals with serious mental illness or intellectual disabilities
PASRR requires states to screen individuals with serious mental illness or intellectual/developmental disabilities before Medicaid-funded nursing facility admission to ensure appropriate placement.
Question 3: Which document specifies a long-term care resident's wishes regarding life-sustaining treatment and is legally recognized across most U.S. states?
- Minimum Data Set (MDS)
- POLST (Physician Orders for Life-Sustaining Treatment) (Correct answer)
- Care Area Assessment (CAA)
- Resident Assessment Protocol (RAP)
Correct answer: POLST (Physician Orders for Life-Sustaining Treatment)
A POLST form is a medical order document that translates a resident's end-of-life wishes into actionable physician orders for CPR, hospitalization, and other life-sustaining treatments.
Question 4: Under Medicare regulations, what is the minimum required frequency for physician visits to nursing facility residents during long-term care stays?
- Every 30 days for all residents indefinitely
- Every 30 days for the first 90 days, then every 60 days thereafter (Correct answer)
- Weekly for the first month, then monthly thereafter
- Monthly for the first year, then quarterly thereafter
Correct answer: Every 30 days for the first 90 days, then every 60 days thereafter
Medicare regulations require physician visits every 30 days for the first 90 days of a nursing facility stay, then at least every 60 days thereafter, though more frequent visits may be clinically indicated.
Question 5: Which federal program is the primary payer for long-term custodial nursing home care for low-income elderly and disabled individuals in the United States?
- Medicare Part A
- Medicare Part C (Medicare Advantage)
- Medicaid (Correct answer)
- TRICARE
Correct answer: Medicaid
Medicaid is the primary federal-state program funding long-term custodial nursing home care for individuals who meet income and asset eligibility criteria.
Question 6: Which CMS national initiative specifically targets the reduction of unnecessary antipsychotic medication use in nursing home residents?
- Partnership to Improve Dementia Care in Nursing Homes (Correct answer)
- National Nursing Home Quality Care Collaborative (NNHQCC)
- Hospital Readmissions Reduction Program (HRRP)
- Advancing Excellence in America's Nursing Homes Campaign
Correct answer: Partnership to Improve Dementia Care in Nursing Homes
CMS launched the Partnership to Improve Dementia Care in Nursing Homes to reduce unnecessary antipsychotic use through education, person-centered care, and quality improvement strategies.
Question 7: Which long-term care reimbursement model replaced the Resource Utilization Groups (RUGs) system for SNF Medicare payments beginning in October 2019?
- Prospective Payment System (PPS) Original
- Patient-Driven Payment Model (PDPM) (Correct answer)
- Case-Mix Index (CMI) Reimbursement
- Bundled Payments for Care Improvement (BPCI)
Correct answer: Patient-Driven Payment Model (PDPM)
The Patient-Driven Payment Model (PDPM) replaced RUGs in October 2019, shifting SNF reimbursement to be based on patient characteristics and care needs rather than therapy minutes provided.
CMD Long-Term Care & Post-Acute Care Management 2
As a medical director of a long-term care facility, which of the following is a core regulatory responsibility under federal guidelines?